Advance directives are written instructions that you prepare to help guide your medical care and psychiatric care. They apply in certain situations, such as if you are terminally ill or severely injured in which you are no longer capable of making decisions regarding your own medical or mental health care. Your physician or psychiatrist holds the right to determine when you are no longer able to make your own choices. Although advanced medical directives are well-known among terminally ill patients and elderly patients; psychiatric advanced directives are just as important for individuals of any age who are battling with bipolar disorder, depression, anxiety, schizophrenia or any other mental health disorder that has the potential to worsen at any time. Psychiatric advance directives allow individuals with a mental illness to shape their care before they are too sick to do so. For example, if an individual is in an acute state of mania, they may be admitted to an inpatient psychiatric facility against their will, if there is not an advanced directive in place. It is not uncommon to hear stories of individuals who are experiencing a mental breakdown or active psychosis to be placed in a psychiatric locked facility with an armed guard for 2-3 days against their will and without their phone until they speak with a case manager or social worker. A psychiatric advance directive can potentially prevent this. There are two common types of advanced directives known as a living will and a medical power of attorney.

A psychiatric advance directive can:

  • Promote your autonomy and empowerment.
  • Enhance communications between you, your doctor, treatment team and family.
  • Protect you from ineffective, unwanted or possibly harmful treatment or actions.
  • Help prevent crises and reduce the use of involuntary treatment or safety interventions, such as restraint or seclusion.

Living will: You define what medical treatments you want and do not want for yourself. These treatments can include things like cardiopulmonary resuscitation (CPR), inpatient psychiatric hospitalization, mechanical ventilation (a “breathing machine”), medications, feeding tubes, artificial nutrition, dialysis, and intravenous (IV) fluids. You can include the medications and dosages that you know are most helpful to you and those that you do not wish to receive. Also, other items to includes can be names of facilities or healthcare professionals you want to be involved in your care and people who can help you with essential activities (such as paying your bills and taking care of your children, pets or plants). You also have the choice to dictate which level of care you want to receive regarding inpatient care, residential care or outpatient care. However, if your therapist or psychiatrist feels that you are at risk of harming yourself or another individual, then that professional retains the authority to make decisions that are deemed necessary to ensure your safety and that of other patients and hospital staff.

Power of attorney: (sometimes called a health care proxy or agent). This process involves choosing someone you trust to make decisions about your medical and psychiatric care if you cannot make those decisions.

How do you create an advanced directive?
An advanced directive is a legal document that can be modified at your will. However, you must create this document and make changes only when you are capable of making competent decisions regarding your medical and psychiatric care. Some states require the aid of an attorney when creating this legal document, so it is wise to check with an attorney in your state. Once you create this legal document, it is essential to carry a copy with you and place a copy in a secured location that can be accessible by an individual you trust. In an emergency, you or a loved one may need to access with the document and therefore keeping it available is just as important as creating it.