What is a Psychiatric Advance Directive?

positive young doctor in medical uniform talking on cellphone in clinic corridor

Most people know about Living Wills or Health Care Proxies and that they deal with conveying one’s decisions for physical medical treatments. Did you know there is a legal document for a person to express their wishes when it comes to treating mental illness? A Psychiatric Advance Directive – or PAD – allows an individual to detail their choices for mental health care treatment when they cannot make their own decisions.

How Does a Psychiatric Advance Directive Work?

A Psychiatric Advance Directive works in similar fashion as a Living Will and Health Care Proxy. In a Living Will, you spell out what healthcare treatments you would want if you became incapacitated and are at the end of life. A Health Care Proxy allows you to appoint a person to make healthcare decisions in your stead, if you become incapacitated. A Gentreo Health Care Proxy also includes options to express your preferences for life sustaining treatment as you would in a Living Will.

The PAD is designed to plan for future mental health care or a crisis and lets you state whether you want to consent to or decline certain treatments. In this document, you provide detailed instructions and directions for therapies, services, and support. You also name an agent who would act on your behalf to carry out your wishes.  

Should a mental health crisis occur, and healthcare providers determine you are incapable of expressing treatment preferences, the Psychiatric Advance Directive goes into effect. This ensures the patient that they will receive only the treatment and care they want.  

The Psychiatric Advance Directive should be drafted while you can competently make your own decisions. You can revoke the PAD at any time, even during a crisis, as long as you are determined to be competent.

[Read More: Mental Capacity Requirements in Estate Planning]

Why Should I Have a Psychiatric Advance Directive?

A person who has mental illness can be empowered by having a PAD. For example, let’s say a person suffering a mental health crisis is unable to communicate to their healthcare providers and does not have an agent. Without this document in place, physicians would be required to provide appropriate care and treatment. In some cases, the clinicians might seek direction from the healthcare facility’s ethics committee. Decisions made by doctors may be contrary to the patient’s wishes. 

Those with early-stage Alzheimer’s Disease, dementia, schizophrenia, or other psychological disorders should definitely have a PAD. It puts the patient in control when they cannot speak for themselves.

What Should Be Included in a PAD?

  1. Specify Treatments – Detail your preferences for the type of interventions, procedures, and therapies you want and do not want. These could include in-patient care and electroconvulsive treatment.
  2. List Medications – Be sure to note those that have and are working for your condition and ones to avoid, especially if you are allergic.
  3. Appoint an Agent – Choose a person you trust to advocate for you in the event of a crisis. Be sure they know that they’re your agent, and have conversations with them about your wishes so that they know your feelings. 
  4. Choose a Hospital – Identify the facility or hospital where you would want to receive treatment if something happened to you.
  5. Name Doctors/Clinicians – Name the healthcare providers you prefer to work on your case, and include their contact information.
  6. Include Your Support Network – List family and friends who could help pay your bills or care for your children and pets during your treatment. If you have a Will, a Power of Attorney, and/or a Pet Power of Attorney, these documents also include stipulations for who can manage your finances or take guardianship of your minor children. Remember that a Will only goes into effect when you die.
woman in wheelchair on computer

Do All States Have Psychiatric Advance Directives?

Not all states in the country have PADs. In those that do not, you can create one using a particular state’s law pertaining to Living Wills. A PAD is preferable since it relates to mental health treatment choices.

Massachusetts, for example, does not allow for Psychiatric Advance Directives. You must create a “Massachusetts Health Care Proxy”, where a person you appoint would have authority to make decisions on your behalf if you are deemed mentally incompetent. Under the state law, healthcare providers can refuse your proxy’s directives if you are considered a danger to yourself and others. 

Where Should I Store My PAD?

The document should be safely stored and easily accessible by your agent and family members when needed. A digital storage vault, like the Gentreo Digital Family Vault, is best so that you and those of your choice can have 24/7 access, wherever they are.

Provide copies of your PAD to your physicians, hospitals, mental health facilities, and your family. During a sudden mental health crisis, the Psychiatric Advance Directive can protect you from unwanted or even harmful treatments and procedures.


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