1. ADVANCE PLANNING FOR CRISIS

2. Today’s Topics Background Legal Framework Practical Suggestions Q&A

3. DECISIONS, DECISIONS

4. Stating the Obvious When crisis hits, you are better off with a plan! A good plan requires many features! Access to Information People Preferences Resources Authority

5. Declaration for Mental Health Treatment Who can use it: An adult of “sound mind” who is not being coerced. Who decides person is of sound mind: two witnesses. What does it cover: convulsive treatment, psychiatric medications, 17 days inpatient, outpatient

6. Declaration for Mental Health Treatment How long does it last: 3 years or until revoked by the capable adult. If invoked, when person regains capacity. How is it invoked: when two physicians find a person “incapable.” What is “incapable”: a person’s ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that the person currently lacks the capacity to make mental health treatment decisions

7. Declaration for Mental Health Treatment What can the Declaration do: Give or withhold consent to certain treatment Name a representative (attorney-in-fact) to make decisions during incapacitation Give information about background, symptoms, allergies, desires, etc. Allow another person to see medical records related to mental health treatment

8. Declaration for Mental Health Treatment What are the duties of the attorney-in- fact: Must agree to act if and when person becomes incapable. May receive otherwise confidential information related to treatment. Is not personally liable for the cost of care. In making decisions, must act consistently with the desires of the principal as expressed in the declaration. If not expressed, or otherwise known by the attorney-in- fact, must act in what the in the best interests of the adult. Has “good faith” immunity.

9. Guardianship: Capacity to Meet Needs Impaired Ability To receive and evaluate information effectively, or To communicate decisions Can’t meet the essential requirements for physical health or safety.

10. Guardianship: Capacity to Meet Needs Actions necessary to provide the: health care, food, shelter, clothing, personal hygiene and other care Without which serious physical injury or illness is likely to occur.

11. Guardianship: Limitations Appointed only as necessary to promote and protect the well-being of the protected person. Designed to encourage the development of maximum self-reliance and independence Ordered only to the extent necessitated by the person’s actual mental and physical limitations.

12. Guardianship: Powers Placement Care Comfort Maintenance Training Education Health Decisions Spending for Above

13. Guardianship: Limitations No sterilization Keep rights not given guardian Voting Hire lawyer Right to records Need court approval for restrictive placements and charging room and board.

14. Supported Decision-Making USES: Relationships Practices Arrangements Agreements

15. Supported Decision-Making IN ORDER TO: Maximize independence Promote self-advocacy Avoid intrusive interventions

16. Substituted Judgment Power of Attorney Advance Directive Protective Services Guardian Ad Litem Representative Payees Medicaid Representative Civil Commitment Criminal Penalties Emergency Medical Guardian/Conservator

17. From NAMI Minnesota Identify people willing to help List the phone numbers of the mental health providers and the mental health crisis team Include a list of current medications and their dosages List treatments that have been used in the past (CBT, DBT) Identify key words or calming techniques that have worked in the past Identify your loved one’s preferred treatment facilities Include a copy of their advanced psychiatric directive (if available)

18. Resources Declaration form and instructions: http://www.oregon.gov/OHA/amh/Pages/services/planning.aspx http://www.oregon.gov/OHA/amh/Pages/services/planning.aspx DRO booklets on Oregon mental health laws, guardianship, and more: http://www.droregon.org/need- help/dro-publicationshttp://www.droregon.org/need- help/dro-publications Mental Health Crisis Planning booklet from NAMI Minnesota: http://www.namihelps.org/Crisis-Booklet- Adults.pdfhttp://www.namihelps.org/Crisis-Booklet- Adults.pdf

19. Bob Joondeph, Executive Director bob@droregon.org