1. Advanced Directives: Sharing YOUR Choices in Case of Crisis

2. Why a Psychiatric Advanced Directive? Trauma Informed Approach Transparency Empowerment Voice and Choice Addresses potential cultural and gender issues Physical Advance Directives http://www.oregon.gov/DCBS/insurance/shiba/Documents/ advance_directive_form.pdf http://www.oregon.gov/DCBS/insurance/shiba/Documents/ advance_directive_form.pdf Many hospitals/PCPs keep these on file Express a person’s wishes regarding life support

3. Psychiatric Advanced Directive It’s a right to share your decisions ahead of time Oregon Revised Statute 127.700 – 127.737 https://www.oregonlaws.org/ors/127.700 https://www.oregonlaws.org/ors/127.700 Declaration for Mental Health Treatment

4. When? For times when a person is experiencing a mental health crisis and For times when a person is unable to share directions or wishes regarding treatment or For times when a person wants a trusted person to make decisions

5. How? A Declaration for Mental Health Treatment goes into effect if A court or 2 doctors have decided A person is unable to understand and make decisions About their mental health treatment

6. Why? People can think ahead and share their choices before a crisis happens Usually, treatment history is shared in a crisis – wishes are not THIS is how people can be sure providers know what their choices are - about their care

7. What? You can share your decisions around medication What to use What not to use You can share your wishes about treatment You can select a trusted person to make decisions for you

8. Where? A Declaration needs to be ACCESSIBLE! If there is a representative, both people should have a copy. The primary mental health provider/team should have a copy. The local crisis response team should have a copy, if possible It could be uploaded on PreManage for ER staff to access

9. How Often? A Declaration is valid, in Oregon, for 3 years. A new one must be done every 3 years, to remain in effect. Changes can be made to a declaration Challenge is to be sure to get all old copies and replace with the new one.

10. Details: State Recommended Form From statute: 127.736 Person must be mentally competent Person must want to do this, it cannot be forced Person decides - Decisions for the individual can be made by A trusted person (representative) or By the mental health provider Use this form to share the person’s directions or wishes

11. Representatives Someone the person trusts to make decisions on for them There can be an alternate Representatives use the Declaration to inform their decision- making If something comes up that is not covered in the Declaration, they must make a decision as close to the decisions the person would make as possible The representative must be asked ahead of time, agree, sign the declaration, and keep a copy of it

12. I consent to… Lists the things the person consents to – the more specific and comprehensive this list is, the better Consider addressing: Medications – type and dosages Short-term inpatient treatment programs Stating preferred provider(s) and facility Electro Convulsive Treatment (ECT) Other specific treatments Eye Movement Desensitization and Reprocessing (EMDR) Light Therapy More

13. I do not consent to… List the things the person expressly refuses to give consent to – the more specific and comprehensive this list is, the better Consider addressing: Medications – type and dosages Short-term inpatient treatment programs Stating provider(s)/facility do not want to use Electro Convulsive Treatment (ECT) Other specific treatments Eye Movement Desensitization and Reprocessing (EMDR) Light Therapy More Consider stating the reason(s) why not

14. Additional Information… …About the person’s Mental Health Treatment Needs Consider including: Health history Mental Soothers Triggers Physical Dietary Requirements Religious/Spiritual Concerns Important contact information/people

15. Signed and Witnessed A Declaration of Mental Health Treatment needs to be signed and witnessed Signed by Person, in presence of 2 witnesses Signed by representative (and alternate representative), both witnessed by 1 person; does not have to be the same person

16. Questions

17. Advanced Directive Resources Information available online: http://www.nrc-pad.org/ https://www.oregonlaws.org/or s/127.700 https://www.oregonlaws.org/or s/127.700 http://www.dshs.wa.gov/dbhr/a dvdirectives.shtml http://www.dshs.wa.gov/dbhr/a dvdirectives.shtml http://mhapa.org/resources/M HAD.htm http://mhapa.org/resources/M HAD.htm http://www.maine.gov/dhhs/sa mhs/mentalhealth/rights- legal/advance-directives.html http://www.maine.gov/dhhs/sa mhs/mentalhealth/rights- legal/advance-directives.html http://www.oregon.gov/DCBS/i nsurance/shiba/Documents/adv ance_directive_form.pdf http://www.oregon.gov/DCBS/i nsurance/shiba/Documents/adv ance_directive_form.pdf http://www.oregon.gov/OHA/a mh/forms/declaration.pdf http://www.oregon.gov/OHA/a mh/forms/declaration.pdf