Position Statement 23: Psychiatric Advance Directives
Policy Position
Psychiatric advance directives are an extension of advance medical directives that address symptoms of a mental illness. Mental Health America supports and promotes the use of psychiatric advance directives as a tool for the expression of an individual’s free will and self-determination in coping with mental health and substance use conditions.
Background
A psychiatric advance directive offers a clear written statement of an individual’s treatment preferences and other wishes and instructions. It can also be used to assign decision-making authority to another person who can act on that person’s behalf during times of incapacitation.
Psychiatric advance directives offer several key benefits. Correctly implemented and executed, they can:
- Promote individual autonomy, empowerment and recovery
from mental illness;
- Enhance communication between individuals and their families, friends,
healthcare providers, and other professionals;
- Protect individuals from being subjected to ineffective, unwanted, and
possibly harmful treatments or actions; and
- Help in preventing crises and the resulting use of involuntary treatment
or safety interventions such as restraint or seclusion.
Individuals considering the creation of a psychiatric advance directive must be fully informed about the benefits and limitations of these legal instruments. Barriers to the implementation of psychiatric advance directives, such as state laws that add unnecessary procedural or legal burdens, should be eliminated. Most importantly, anyone creating an advance directive must be able to do so without coercion, with choices regarding implementation and revocability, and with full knowledge and understanding of the implications of his or her decisions.
Mental Health America believes that psychiatric advance directives are an underutilized tool for empowering individuals and offer significant potential for preventing or mitigating crisis situations. While every state has enacted legislation authorizing some form of advance directive for health care, many of these general advance directive laws do not provide adequately for the unique problems relating to the treatment of mental illnesses.
Call to Action
- Mental Health America recommends that states enact legislation creating specialized psychiatric advance directives. Such legislation should be designed to enable individuals to freely choose the most important elements of the directive for them including: what types of treatment will be covered, what events or determinations will trigger implementation, whether or not and under what circumstances the directive will be revocable.
- Such legislation should also be based upon the recognition that, while the treatments authorized can be highly beneficial, even life-saving, for the individual, many treatments have serious side effects. Therefore, the decision to agree or not to agree in advance to such treatments or to authorize someone else to do so on one’s behalf is a serious one which should be accompanied by appropriate safeguards to insure that the decision is fully informed and free from coercion. It is particularly important that an individual who is considering designating someone to act on her/his behalf chose someone who understands that individual’s values and preferences and can be relied upon to faithfully carry out her/his wishes.
- Mental Health America recommends that individuals, family members,
friends, advocates, healthcare providers and other professionals meet in community
dialogues and work together to promote education, training and research towards
the successful creation and implementation of psychiatric advance directive
programs[1].
- Mental Health America also recommends that states require that mental
health providers must comply with a valid psychiatric advance directive unless
to do so would result in serious and imminent physical harm to the individual
or others.
Effective Period
The Mental Health America Board of Directors approved this policy on September 8, 2006. It will remain in effect for five (5) years and is reviewed as required by the Mental Health America Public Policy Committee.
Expiration: September 8, 2011
Effective Period
The Mental Health America Board of Directors approved this policy on September 8, 2006. It will remain in effect for five (5) years and is reviewed as required by the Mental Health America Public Policy Committee.
Expiration: September 8, 2011
[1] Additional resources on Psychiatric Advance Directives are available at www.MHA.org/position/advancedirectives/index.cfm#toolkit
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