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# Psychiatric Advance Directives - Information for Family Members


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


## Family Members


*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


## Why are Psychiatric Advance Directives Important?


*Engages your family member in her or his own treatment


*Empowers your family member to make his or her own choices


*May help avoid commitment procedures which can even divide families


## What are my family members options?


Three options for developing a Psychiatric Advance Directive


*Living Will


*Medical Power of Attorney


*Combination of Living Will and Medical Power of Attorney


## What are your family member’s rights?


State Rule 64-74-5 

Advance Psychiatric Directive Right


*The right to an advance psychiatric directive prepared at a time when the individual has not been adjudged to be incompetent


## What are your family member’s rights?


*The right to refuse to create an advance psychiatric directive


*The right to have it entered into his or her clinical record at the behavioral health service at which he or she is receiving or may receive care or treatment


## Withdrawing a Directive


*Any advance psychiatric directive written and signed by a consumer may be withdrawn at any time verbally or in writing by the consumer


*Often referred as the "Ulysses effect"


## Things to consider


What should your family member consider in writing a psychiatric advance directive?


*Find someone to help that he or she trusts


*Discuss possibilities and choices with this individual


*Get agreement with choices


*Identify a person who will advocate for choices


*Be specific about when the PAD should be used


## Providers


*A consumer has the right to be informed by a behavioral health service of the availability and applicability of an advance psychiatric directive and to receive education and assistance from the behavioral health service in preparing such a document


*Entities must provide education to their staff and their community on advance directives either directly or with other providers


*Education must include education regarding:


    *Rights under state law to participate in decisions regarding their medical care


    *The facility’s policies regarding advance directives


## Complaints


*State Medicaid agencies are responsible for reviewing and responding to complaints regarding advance directives


*Penalties can include fines and / or removal as Medicaid / Medicare approved provider


## What to do if directives are not being followed


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


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


## Engaging your family member


*Discuss the benefits of having a psychiatric advance directive


*If they choose to develop a advance directive, suggest having it included in the treatment plan


*Discuss rights to have a Psychiatric Advance Directive with them, and what can be done if it is not honored


## Remember...


*You can suggest an advance directive - it is up to the person with a mental illness to design and write such a document.


*Your Ideas on the content of an advance directive may be solicited - they should not be forced.


*Any advance directive can be made null and void by the person who wrote it. Rejection does not need to be written.


*Even when commitment proceedings are implemented, the content of an advance directive may be used to determine treatment


## Resources


West Virginia Advocates 


(800) 950-5250


WV Bureau of Senior Services 

(877) 987-3646


Caring Connections 




Advance Self-Advocacy Plan (ASAP) 



National Resource Center on Psychiatric Advance Directives 


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