The term “Psychiatric Advance Directive”, or “PAD”, is used to describe a document in which you can set out instructions in advance on the mental health treatment to which you consent, and the mental health treatment which you refuse, in the event that you become incapable of making informed decisions about your own mental health care in the future. Your treating physician (and your health care agent) must honor those instructions, unless they have independent legal authority to provide or consent to treatment that is contrary to your instructions. PAD’s also include sections in which you can set out treatment preferences that you have (for example: the hospital(s) where you would prefer to be treated in the event that you have a psychiatric crisis; the intervention methods that are most helpful for you in crisis situations), which can help health care providers in making more effective treatment decisions in regard to your care when you are incapacitated and unable to effectively direct your care.
States that Authorize the Use of Psychiatric Advance Directives (PAD’s)
Since 1990, 26 states have passed laws authorizing and recognizing the use of Psychiatric Advance Directives. In 25 of those states, the PAD is a stand-alone document. You must use a separate “Health Care Power of Attorney” or “Health Care Proxy” document if you want to authorize someone to make decisions for you about your health care - including your mental health care - in the event that you become incapacitated.
Comprehensive Information on Psychiatric Advance Directives (PAD’s)
The National Resource Center on Psychiatric Advance Directives has a
website that contains comprehensive information on PAD’s, including
detailed information on each state’s approach to PAD’s. The site also
has educational materials, videos and tutorials that explain PAD’s, how
they work, and how you can fill one out, and it provides links to PAD
forms that you can use.
You can go to the NRC-PAD website by clicking here.
Virginia’s Approach to PAD’s
MAKING THE PAD A PART OF THE ADVANCE DIRECTIVE: Based upon the input of mental health consumers, advocates, and other stakeholders, the Virginia Supreme Court’s Mental Health Law Reform Commission recommended against Virginia adopting a stand-alone PAD. The reasoning was two-fold: (1) mental health is an inseparable part of overall health, so information and instructions about a person’s mental health care should be seamlessly included within the information and instructions about that person’s overall health care; (2) having a stand-alone PAD creates the risk of perpetuating the stigma associated with mental illness, by treating it as a separate condition that is somehow separated from a person’s overall condition.
ADDRESSING DEMENTIA: Another key argument against the stand-alone PAD is that many people may choose not to fill out a PAD because they do not have a mental health diagnosis. However, every adult faces the prospect of developing dementia in later life, which may require psychiatric care, including psychiatric hospitalization. By including mental health care as part of overall health care, the Virginia advance directive makes it easier to raise and address the issue of what plans should be made for treatment of possible future dementia.
MAKING THE HEALTH CARE POWER OF ATTORNEY A PART OF THE ADVANCE DIRECTIVE: The Virginia Advance Directive includes, in one form, both your appointment of a health care agent and your instructions about future health care in case you become incapacitated.
Your Freedom to Choose the Form and Format You Want
The Virginia Health Care Decisions Act (HCDA) does not require that your Advance Directive be in a particular form (as long as you sign it and date it and have two adult witnesses sign and date it). It also does not require that you include the appointment of your health care agent and your health care instructions on the same form, or that you include instructions about mental health care on the same form as your instructions about other health care.
Putting Instructions About Mental Health Care on A Separate Form
The Concern: A number of people with mental illness have experienced, or are concerned about, being stigmatized and treated differently in regard to their general health care when their health care providers discover that they have a mental health diagnosis. For that reason, they want to put their instructions about their future mental health care in a document that is separate from the document in which they address general health care. Virginia law allows you to do this, at your option.
Forms Available: Staff at the Virginia Office for Protection and Advocacy (VOPA) have developed forms aimed at enabling people to place their instructions and preferences about mental health care, and to appoint an agent to make decisions about mental health care, on a form that is separate from the form on which they appoint an agent and give instructions about general (including end-of-life) health care. (Note: You can certainly appoint the same agent on both forms. However, some individuals may find that, for example, they want a particular family member to make general health care decisions for them - particularly in the case of end-of-life matters, but that they want a different person to make mental health care decisions for them.) You can get the VOPA form for appointing an agent and giving instructions about general health care by clicking here. You can get the VOPA form for appointing an agent and giving mental health care instructions and preferences by clicking here.