Advance directives Health Article

Definition

An advance directive is a written document in which people clearly specify how medical decisions affecting them are to be made if they are unable to make them, or to authorize a specific person to make such decisions for them. These documents are sometimes called "living wills." Psychiatric advance directives serve the same purpose as general medical advance directives, but are written by mental health consumers as a set of directions for others to follow, made in advance of an injury, psychiatric illness, or crisis.

Description

Many consumers of mental health services know which treatments work best for them and, over the past several years, their opinions have become increasingly valued by those providing services. However, when a mental health consumer becomes unable to make decisions or to give informed consent for treatments offered, others (including family, friends, judges, or care providers) make the decisions for the individual in crisis. In these kinds of crisis situations, advance directives may be beneficial for the person receiving care, because the advance directive is a legal document that may protect him or her from unwanted treatment.

Psychiatric advance directives usually fall into two categories: instruction directives and agent-driven directives.

Instruction directives

An instruction directive is a written document that specifies which treatments an individual does and does not want, in the case that that individual becomes unable to make decisions about his or her care. These documents may indicate the affected individual's preferences about many aspects of treatment, including:

• people who should be contacted at a time of psychiatric crisis
• activities that reduce (and heighten) anxiety for the individual
• effective alternatives to restraint or seclusion for the individual
• acceptable and unacceptable medications and dosages
• other interventions that might be considered during a time of crisis (such as electroconvulsive therapy)