How a Psychiatric Advance Directive Could Help in a Mental Health Crisis

Hospitalizations for mental health can be helpful, but for some people, they can create traumatic memories and distrust of doctors, especially if the facility is less than ideal. My own personal experiences with hospitalization have shown that facilities can vary greatly, and that advocating for yourself in advance is important to the type of experience you may have.

As an adolescent, I entered a local behavioral health inpatient program where the entire floor of teenagers were given an anticonvulsant at night regardless of diagnosis, which almost resulted in liver failure for me by the time I was discharged. I had a strong distrust of medications and mental health professionals for years after. As an adult, I have reestablished a healthy relationship with mental health care, but avoiding the gap in care due to a quality lapse in an inpatient experience would have been most beneficial.

There are many conditions and symptoms that may cause you to become unable to make your own decisions, including substance use disorders, psychosis, post-traumatic stress disorder (PTSD), and more. My experiences with hospitalization combined with years of working in the health care field showed me the importance of advance directives and raised a question for me: As an adult who struggles with mental illnesses, how would I like to be treated in a mental health emergency situation, and how could I make those wishes known?

Mental Health America has a worksheet that can help you plan what your wishes would be should you experience a mental health emergency. The worksheet asks you to consider things what facilities you would or would not like to be taken to, who should be allowed to visit you, and treatment types that you would or would not consent to.

After using the worksheet, you can fill out a legal psychiatric advance directive where you can also name first and second agents who know your wishes and can advocate for your care if you are in an altered state. On the legal form, you can also specify who you would like to take care of your children, and who needs to be contacted upon your hospitalization to ensure nothing is left to chance. You can, within reason, make requests and tailor your care to your needs. On my own psychiatric advance directive, I specified that I not be given medications other than the ones I was already taking prior to hospitalization without permission from my primary care physician and one of my agents if I am unable to make my own decisions.

If you believe in planning ahead, psychiatric advance directives are great tool for the unforeseen. Psychiatric advance directives are giving patients more agency and increasing quality of care during a time the stigma of mental health disorders is waning, and a whole-self perspective on care is becoming more prevalent.

When you fill out a psychiatric advance directive, as with any advance directive, make a copy for your primary doctor, any mental health providers you currently see, keep a copy in your house, and give a copy to each of your agents named in your document.

The legal requirements for enacting an advance directive vary by state and country, so please check your local laws and health care regulations regarding advance directive requirements before creating your plan. State-specific forms can be found at NRC PAD.