1. 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.

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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)

11. 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

12. 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 developed by Ted Johnson

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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) , (877) OR
Caring Connections
1731 King St., Suite 100, Alexandria, VA 22314
800/
OR ADVANCE SELF-ADVOCACY PLAN (ASAP)

19. 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

20. Resources West Virginia Advocates http://www.wvadvocates.org
(800)
WV Bureau of Senior Services
(877)
Caring Connections
800/
ADVANCE SELF-ADVOCACY PLAN (ASAP)
NATIONAL RESOURCE CENTER ON
PSYCHIATRIC ADVANCE DIRECTIVES