# Psychiatric Advance Directives - Information for Consumers

 

Disability Rights of West Virginia 

Protection and Advocacy for Individuals with Mental Illness Advisory Council

 

This information was developed to raise awareness of Psychiatric Advance Directives.  It is not intended to provide legal or medical advice.

 

## What is it?

 

*Psychiatric Advance Directives:

   

Used to document an individual’s specific instructions or preferences regarding mental health treatment, in preparation for the possibility that the person may lose capacity to give or withhold informed consent to treatment during a crisis

 

## What can I do?

 

Three options for developing a Psychiatric Advance Directive

 

*Living Will

*Medical Power of Attorney

*Combination of Living Will and Medical Power of Attorney

 

## Living Will

 

*States your wishes about medical care in the event that you can no longer make your own decisions

 

## Medical Power of Attorney

 

*Lets you name someone to make decisions about your medical care

 

## Benefits

 

*Self direction over care

 

*Decreases chance of involuntary treatment

 

*Enables you to choose your own continuum of care, listing what you need and don’t need - what you know from experience helps you and what does not

 

## Consider...

 

What should you consider in writing your psychiatric advance directive?

 

*Find someone to help that you trust

 

*Discuss your choices with this individual

 

*Make sure they agree with your choices

 

*Make sure they will advocate for your choices

 

*Be specific about when the PAD should be used

 

*Opportunity to be specific regarding care

 

*Review your psychiatric advance directive with someone on a regular basis ... sometimes your preferences may change!

 

*Describe what has happened in the past and why you chose your preferences

 

*Use clear language ... instead of, "I prefer not to," state, "I do not want" or instead of, "I prefer," use, "I want"

 

## Be Clear

 

*Your advance directive can include a power of attorney and written instructions, however, be clear about when power of attorney takes over and when to follow written instructions

 

## Rights

 

*To be informed of your right to create a psychiatric advance directive

 

*Remember you have the right to revoke your advance directive at any time and choose not to follow it - and you may do that verbally

 

*The treatment you prefer in crisis maybe different than your usual treatment that keeps you well

 

## Community Education

 

Same written materials do not have to be provided in all settings however all

must:

 

*Define an advance directive

 

*Emphasize that it is designed for consumers to exercise self-direction over healthcare

 

*Describe applicable state law regarding advance directives

 

*All information distributed must be current

 

    *Must include state law revisions within 90 days of effective date of the revision

 

    *Providers may contract with other entities to provide the information.  However, the provider is legally responsible for ensuring education occurs

 

## When Information on AD Policies Must Be Provided

 

*At time of admission

 

*Upon enrollment in a healthcare plan

 

*Before receiving care

 

*When initially receiving care

 

## Family receipt of Advance Directive Information

 

Providers may give information regarding a advance directive when:

 

*The consumer is incapacitated and unable to receive information due to a mental disorder or a incapacitating condition, or if the consumer is unable to articulate whether or not they have a advance directive

 

*The information must be given to the consumer once they are no longer incapacitated

 

## Rights

 

Providers must honor your psychiatric advance directive unless:

 

*It is withdrawn verbally or in writing by you

 

*The provider does not have the resources to provide the treatment

 

*A provider believes that the directive would endanger your life or be dangerous to others

 

If a provider does not honor your psychiatric advance directive they must:

 

*Tell you the reason for not honoring your advance psychiatric directive

 

    *It must be due to lack of resources, or because the provider feels your preferences would endanger your life or others’ lives

 

## What to do if directives are not being followed

 

*Complaints can be filed with the agency that surveys and certifies Medicare and Medicaid providers

 

*Providers and healthcare plans must inform consumers they have this right, and how to file a complaint

 

## Legal Document

 

Making it a legal document

 

*The West Virginia Living Will form and / or Power of Attorney form can be used, but don’t have to

 

*Signed with two witness in front of a notary public Format for Directive Do not have to use the "living will" format for an advance directive to be legal

 

## Resources

 

West Virginia Advocates 

<http://www.wvadvocates.org> 

(800) 950-5250

 

WV Bureau of Senior Services 

(877) 987-3646

 

Caring Connections 

<http://www.caringinfo.org> 

(800) 658-8898

 

Advance Self-Advocacy Plan (asap) 

<http://www.upennrrtc.org/resources/view.php?tool_id=200>

 

National Resource Center on Psychiatric Advance Directives

<http://www.nrc-pad.org/component/option,com_frontpage/Itemid,1/>