National Resource Center on Psychiatric Advance Directives

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"This time, with a PAD, I did not receive any treatments that I did not want. They were very respectful. I really felt like the hospital took better care of me because I had my PAD. In fact, I think it's the best care that I've ever received.” Click for more...

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National Resource Center on Psychiatric Advance Directives - Blog

Welcome to the National Resource Center on Psychiatric Advance Directives Blog. We will be posting blog entries on psychiatric advance directives, crisis planning, patient-centered care, and other related topics. We are very interested in hearing from you about your experiences. Since these laws are fairly new, any stories you might have about using PADs could help a good number of people who may be considering writing them. Thank you for your input.

Who should facilitate PADs?

Should it be a consumer's clinician? Or should it be a peer advocate? Clinicians will know about a consumer's history and background and can navigate the mental health system to make sure the PAD gets read when it needs to. But peers are independent of the treatment relationship and may help consumers write PADs that more authentically document what the consumer, rather than the clinician, wants. But are all peers going to be emphathic and allow a consumer to voice their preferences? Will clinicians never allow a consumer to write down his or her own wishes?

This item includes 13 comments

Loopholes

Since doctors can override PADs, they may not always be respected. If you meet criteria for civil commitment, requests in one's PAD may be overridden. When you ask in a PAD for a certain hospital to be admitted to but don't have insurance, this part of the PAD can never be implemented feasibly anyway. Why have PADs if there are so many loopholes? Do PADs give a false sense of hope?
This item includes 8 comments

Are PADs REALLY recovery tools?

Are PADs verhicles to assist with recovery from mental illness? PADs are meant to help people decide what they want to have happen to them in the event of a psychiatric crisis. But people with mental illness are rarely in such a state; it fact, the belief that people with mental illness are always in crisis is one of the biggest public misperceptions of mental illness. So, if people with mental illness do not often have these crises, then how do PADs really help? Is this just a law that claims to promote 'self-determination' but in effect doesn't really do much at all? Are PADs mere lip-service to enhancing autonomy? Do they encourage recovery? How?

This item includes 2 comments

Revoking PADs

Should PADs be able to be able to be changed or revoked in a crisis? On the one hand, if they can be revoked, that sort of defeats the purpose of having a PAD in the first place since whatever you’d say you wanted in a crisis would be the preference doctors would either respect or not. On the other hand, what if something legitimately changed since the time you wrote the PAD (e.g., new medication) and you never had a chance or got around to write a new one? Is there a good answer to this?

This item includes 12 comments

PAD o' paper?

What kind of form is needed to write a PAD? Some states recommend forms and others don’t. The Bazelon Center includes a sample form, can that be used in states that don’t require certain forms or notarization procedures? Can someone write a PAD on any sheet of paper? How can we find out? What does your state allow?
This item includes 2 comments

Police, Cuffs, and PADs

PADs are meant to help people with mental illness have dignity when they experience a psychiatric crisis. But in many places, it is law enforcement who have first contact with a person having a crisis. Often times, police need to resort to placing people with mental illness in handcuffs, such as when it is required that they provide transport between emergency rooms and psychiatric facilities. Should police know about PADs? If I write in my PAD I don't want to be cuffed and I get hurt, do I have any recourse?

This item includes 3 comments

Health Care Agent Foibles

Health care agents don't always understand their roles. There is a story of a woman diagnosed with schizoaffective disorder who was hospitalized and her health care agent was notified by the hospital but didn't understand why the doctor was calling him, claiming “What do I know?....he's the doctor!” How can family members, friends, etc. grasp what their role is? How can health care agents understand that they are acting as the designated "spokesman" for a person with mental illness?

This item includes 6 comments

Competency to Write PADs

Do consumers need to have competency assessed when they write a PAD? Outside of the one state that requires this (Indiana), this requirement would seem unfair in a way since non-mentally ill people certainly don’t need to have their competency assess when they write advance directives. On the other hand, non-mentally ill people might chose to have their competency assessed, for instance, if someone is writing a will to make sure the will is seen as legitimate later on. What should a consumer do?

This item includes 8 comments

Making Sure PADs are Read

Consumers are concerned that hospitals won't have a copy of their PAD. For example, we’ve heard consumers ask: "How will the hospital know what is in my PAD? If I'm sick, I won't know to take it with me." What can be done about this? Is the situation beyond repair and the logistics too difficult to make sure a PAD is seen when it needs to be seen? Or are there some creative solutions out there?
This item includes 9 comments

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