Psychiatric Advance Directives Information For Consumers Psychiatric Advance Directives West Virginia Advocates 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 a 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

Three options for developing a Psychiatric Advance Directive 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 Your preferences not someone else's Do not have to use “official forms, however must be notarized and witnessed

Living Will States your wishes about medical care in the event that you can no longer make your own decisions Your preferences not someone else's Details regarding treatments you do or do not want May be similar to instructions you would leave with a health care agent (power of attorney) In WV could include wishes regarding psychiatric care

Medical Power of Attorney Lets you name someone to make decisions about your medical care Should be specific in regards to when it should take effect Designee should be someone you know and trust – and who is aware of your desires and the reasons for them.

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 Your preferences not someone else's

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 When it should be used consider: Events that would trigger use (crisis, etc.) be specific and describe behaviors to look for Describe who should and shouldn’t be involved in your care (family members, providers, etc. Specific treatments you do or do not want (medications, therapy, peer support, etc.) your treating healthcare provider; CONSIDER ADDING A SECOND PERSON AS A REPRESENTATIVE IN CASE THE OTHE RPERSON IS NOT AVAILABLE POWER OF ATTORNEY CANNOT BE • an employee of your treating healthcare provider, unless related to you; • an owner, operator, or administrator of a healthcare facility in which you are a patient or in which you reside; or • an employee, owner, operator, or administrator of a healthcare facility in which you are a patient or in which you reside, unless related to you

Consider… 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” Place(s) you want treatment to be provided or place(s) you do not want to go for treatment; Preferences about electroconvulsive treatment; Your wishes about seclusion and/or restraint; Instructions about care of your children, if you have any; Preferences for aspects of medical care (life sustaining treatments, "do not resuscitate orders," organ donation, etc.); Preferences for length-of-stay EXAMPLE ON PAST EXPEREINCE: I DO NOT WANT TO TAKE DEPAKOTE BECAUSE IT MAKES ME SICK TO MY STOMACH AND I CANNOT EAT

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 If you have a durable power of attorney, give a copy or the original to your agent or proxy Ask your physician to make your advance directive part of your permanent medical record Keep a copy of your advance directive in a safe place where it can be found easily, if it is needed Keep a small card in your purse or wallet stating that you have an advance directive, where it is located and who your agent or proxy is, if you have named one

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 Be reasonable Don’t ask for treatment that isn't available (example: if you request electroconvulsive treatment (ECT) in a state operated hospital in WV you cannot receive it)

Community Education Same written materials do not have to be provided in all settings however all must: Define a advance directive Emphasize that it is designed for consumers to exercise self direction over healthcare Describe applicable state law regarding advance directives

Community Education 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 In WV the Bureau of Senior Services houses most of the information regarding advance directives. BHHF hosts a toolkit on psychiatric advance directives on their website http://www.wvdhhr.org/bhhf/adv_direct1.asp developed by Ted Johnson

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 Providers: At time of admission (better late than ever) Healthcare Plans: at time of enrollment into plan Home health providers: Before receiving care Hospice: 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 Please note also that West Virginia’s involuntary treatment laws still apply: this means that if you were considered a danger to yourself or others, your documents might be overridden

Rights 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 Federal law complaints section applyies to states

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 The witnesses may not be relatives, beneficiaries of your estate or attending physician.  If you also appoint an agent, your agent cannot also act as a witness For SAMPLE forms contact WV Bureau of Senior Services 1900 Kanawha Blvd. East Charleston, WV 25305 Phone: (304) 558-3317, (877) 987-3646 OR Caring Connections 1731 King St., Suite 100, Alexandria, VA 22314 www.caringinfo.org 800/658-8898 OR http://www.upennrrtc.org/resources/view.php?tool_id=200 ADVANCE SELF-ADVOCACY PLAN (ASAP)

Format for Directive Do not have to use the “living will” format for a advance directive to be legal ”Five Wishes” WV Bureau of Senior Services ADVANCE SELF-ADVOCACY PLAN (ASAP) University of Pennsylvania Mental Health Advance Directive Baker Act Handbook and User Reference Guide / 2002 State of Florida Department of Children & Families

Resources West Virginia Advocates http://www.wvadvocates.org (800) 950-5250 WV Bureau of Senior Services (877) 987-3646 Caring Connections 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/