Why You Need a Psychiatric Advance Directive

By Lois Maharg
March 2018

No one likes to contemplate losing the ability to make rational decisions about healthcare. Yet this situation may arise during a mental health crisis.

When it does, other people end up making treatment decisions for you—unless you have a Psychiatric Advance Directive (PAD). An “instructive” PAD gives instructions about specific treatments you do and do not want during mental health crises. A “proxy” PAD names a patient advocate (a trusted family member or friend) to make decisions on your behalf.

Michigan’s PAD is called an Advance Directive for Mental Health Care. It requires naming a patient advocate and then asks you to specify which treatments you will and won’t allow your advocate to consent to.

Choices include treatments involving:

  • outpatient therapy
  • inpatient mental health services and hospital of preference
  • psychotropic medications and which ones are acceptable
  • electro-convulsive therapy
  • placement in a group residence
  • seclusion and restraints

Your advocate must make decisions according to your wishes. Healthcare providers must honor them, too, unless they are inconsistent with “generally accepted community practice standards of treatment”; a requested treatment is not available; complying would be inconsistent with court-ordered treatment; or there is an emergency situation endangering your life.

Your advance directive remains valid until revoked, which you may do at any time, orally or in writing.

Visit the Michigan Department of Health and Human Services online and download the Advance Directive Form. After filling it out, you must sign it in the presence of two witnesses. Witnesses cannot be relatives, heirs, the person you’re appointing to be your patient advocate, or an employee of any health or residential care provider.

Your advocate must also sign and date the form to show that he or she agrees to be your advocate when you are unable to make decisions for yourself.

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