What Is a Mental Health Advance Care Directive?

What Is a Mental Health Advance Care Directive?

Under Washington state law, a mental health advance directive, sometimes called a mental health advance care directive or psychiatric advance care directive, is a specific type of advance care directive that allows individuals to outline their preferences for treatment in the event that they are unable to make decisions due to a mental health crisis.

A mental health advance directive should not be confused with the more general advance care directive, also known as an advance directive or living will. This latter directive is a legal document outlining a person’s preferences for medical care should they become unable to make decisions for themselves due to incapacity without a specific cause. It can include instructions on specific treatments they do or do not want, such as resuscitation, mechanical ventilation, installation of a feeding tube, and the introduction of other life-sustaining measures. 

A mental health advance directive, on the other hand, is specific to incapacity due to mental health issues. Like a general advance care directive, a mental health advance care directive often includes a health care proxy, empowering a trusted individual to make medical decisions on a person’s behalf. 

However, given that the purpose of an advance care directive is to communicate a person’s health care wishes so they are known and respected, furnishing guidance to family members and providers during critical times, you might wonder why and when you need a mental health advance care directive specifically. What follows is a more detailed discussion about mental health advance care directives so you can decide whether one is right for you.

Who might need a psychiatric advance care directive?

A psychiatric advance care directive can be particularly helpful to individuals with a history of mental illness, including those with diagnoses of schizophrenia, bipolar disorder, or major depression, as it expresses their treatment preferences so they may be respected during a mental health crisis. Those whose mental health conditions cause periods of impaired decision-making ability can also use the directive to outline their wishes for treatment when they are in a clear state of mind. Additionally, individuals undergoing long-term psychiatric care may want to specify their preferences for medications, treatments, and hospitalization in case they are unable to communicate their wishes later. 

People with a strong family history of mental illness might utilize a mental health advance directive as a precautionary measure. The same holds for those experiencing simultaneous disorders, such as substance use occurring alongside a mental health disorder, to set the stage for comprehensive care should a crisis arise. 

Even those without a diagnosed mental illness may choose to create a mental health advance care directive to plan for unforeseen mental health emergencies and feel confident their care will align with their values and preferences. Regardless of the reason behind it, by having a psychiatric advance care directive, individuals can maintain a degree of control over their treatment, reduce uncertainty and conflict between caregivers, and enhance the likelihood of receiving care that corresponds to their wishes.

What information does a mental health advance care directive include?

Issues often addressed in a psychiatric advance care directive include those concerning approval for, refusal of, or restrictions on psychiatric medications and treatments. It can also detail your preferences for hospitalization should your symptoms worsen, as well as specify who may or may not visit you while you are hospitalized. 

Moreover, a psychiatric advance care directive allows you to detail the type of care you prefer medical staff to attempt before considering more intensive interventions such as restraints or electroconvulsive therapy (ECT), which is still utilized today. Overall, a mental health advance care directive establishes protocols so that your treatment aligns closely with your wishes and supports communication with caregivers during critical moments in caring for your mental health.

If I have a psychiatric advance care directive, can I still make decisions for myself?

Whether you can make decisions for yourself given the execution of a mental health advance care directive will depend on whether you have a guardian and if you haven’t been found by a judge to be incapacitated. In those situations, someone else will be in charge of making decisions on your behalf. 

As long as you have capacity, however, you can change or revoke a mental health advance care directive at any time. Should your mental health advance care directive conflict with another one you have, the one executed last in time will prevail. 

How do I keep my mental health advance care directive from becoming the subject of a challenge?

The best way to protect your mental health advance care directive from a challenge is to make certain it is drafted and executed according to Washington state law. The best person to do this is an estate planning lawyer with experience drafting such directives. 

After being drafted, it is important you sign your mental health advance directive in front of a notary. If that is not possible, you can sign it in front of two witnesses. That said, it is important to note that not all witnesses will suffice. 

You cannot have as a witness someone whose interests could conflict with yours, such as a romantic partner, a relative, or anyone who could benefit based on your receiving treatment for your mental health. Other people who cannot act as a witness include your health care proxy (the person you designated to have power of attorney over your health care), your medical provider, or a proprietor or staff member of any establishment where you are receiving treatment or where you live. Your witnesses must be 18 years of age or older.  

Find a Seattle estate planning lawyer to assist you with a mental health advance care directive. 

Though a delicate topic, mental health needs to be discussed, addressed, and protected. This is particularly true if you have had mental health issues in the past or, alternatively, it is an aspect of your well-being you are especially concerned about.

At Elise Buie Family Law, our team of estate planning lawyers is here to listen to your concerns and field your questions, advising you so that you are comfortable with and confident in your estate plan. Everyone deserves to live with peace of mind that they will be cared for should they be unable to care for themselves. An estate plan can offer you these protections. Contact us at our Seattle location or use our link to set up a consultation.  


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