Psychiatric Advance Directives: Empowering Self-Determination In Behavioral Health

For those unfamiliar with these, a Psychiatric Advance Directive (PAD) is a type of legal document designed to articulate an individual’s preferences for mental health treatment in the event of a future behavioral health crisis where they may be unable to make decisions independently. These directives serve to promote self-determination and ensure that an individual’s wishes regarding their care are honored to the greatest extent possible even during periods of incapacitation.

What Is The Benefit Of A Psychiatric Advance Directive?

PADs are valuable for individuals with a history of behavioral health challenges, enabling them to proactively outline their treatment choices in the event of a crisis. This can facilitate faster recovery post-crisis and support ongoing wellness by ensuring that care providers are informed of the individual’s specific needs and preferences. A comprehensive PAD typically includes:

1. Treatment Preferences: Specific instructions regarding medications (types, dosages, or those to avoid), therapies, and other interventions.
2. Hospitalization Preferences: Desired or undesired inpatient facilities, length of stay, and conditions for discharge.
3. Designation of Agent: Appointment of a trusted individual (an agent or proxy) to make treatment decisions on the principal’s behalf if they become incapacitated, along with the scope of their authority.
4. Crisis Triggers and De-escalation Strategies: Information about factors that may precipitate a crisis and preferred methods for de-escalation.
5. Support System: Identification of individuals to be contacted during a crisis, such as family, friends, or peer support specialists.
6. Personal Values and Beliefs: Statements about personal values that should guide treatment decisions.

Statutory Authorization In California

PADs are authorized in California under Welfare and Institutions Code Section 5278. This statute authorizes individuals to execute a written advance directive for mental health treatment, allowing them to specify their wishes concerning mental health care, including consent to or refusal of medication, electroconvulsive treatment, and admission to a mental health facility. The directive must be signed by the principal and witnessed or notarized, and it becomes effective upon a determination of incapacity by a treating physician or psychologist.

The Pads CA Project And Forth Coming Resources

The PADs CA project, as detailed on its website (www.padsca.org),represents an initiative by a consortium of California counties. The project’s core objective is to develop and test digital Psychiatric Advance Directives, focusing on specific populations within specialty behavioral health services. A significant component of this endeavor is the creation of a secure online platform.

This digital tool is intended to educate users about PADs, facilitate their completion, and enable secure storage for future access. A release date for the tool is not yet available, but if you (or a loved one) could benefit, it is worth keeping an eye on!