- A psychiatric advance directive (PAD) is a legal document that documents a person’s preferences for future mental health treatment, and allows appointment of a health proxy to interpret those preferences during a crisis.
- PADs may be drafted when a person is well enough to consider preferences for future mental health treatment.
- PADs are used when a person becomes unable to make decisions during a mental health crisis.
Note: These are selected and edited statements from research interviews with participants in a study of PADs at Duke University Medical Center. The participants gave their permission to use quotes anonymously. The quotes have been edited to protect the identities of the speakers, and for brevity and clarity.
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“I told my therapist that I had done a PAD and wanted to bring a copy to her to see what she thought — and she thought it was great. She thought it was wonderful that I had gotten very specific about my treatment preferences. I’ve also talked to my general physician about my PAD. My case worker and basically everybody has given me the thumbs up. They thought it was great for me to do this. That kind of made me feel better.”
“My health care agent is a real close friend and she knows about my illness. She’s been around my illness for so long and basically, she knows what’s going on with me. I trust her judgment.”
“People with mental problems need this, but it’s no good if any doctor or whatever can just crumple it up and throw it aside. It has to be read and they have to take some heed to it. I still think it’s a great thing, a very good thing.”
“My therapist suggested I make copies of my PAD, so I did that, and gave a copy to everyone I wanted to. There is a copy on file at the hospital, just in case, along with my general healthcare directive. I don’t want any mistakes made . . . Those are my wishes and that’s a legal document, and it must be followed.”
“….it was really crowded in the ER so I showed intake my psychiatric advance directive and told them that I needed to go somewhere quiet….so that I could calm down….The intake nurse sat with me in a quiet room until I calmed down.”
“We talked about what was in my PAD. The doctor didn’t treat me like a ‘nut case’ because some hospitals do. He said, ‘You’ve got rights and it’s great that you know you have them — and we’ll try to respect those completely.’ He did a lot for my health, too.”
“I would recommend PADs, because people can have you committed and you don’t have a say about anything, and at least this way you do have some say in your treatment, if it’s read and people see it and it’s legal.”
“What happened was that I started not being able to sleep. I couldn’t blink my eyes. I was very irritable and I was crying all the time and I couldn’t get out the bed — and my health care agent felt like I needed to get to the hospital. So she took me to the hospital and she told them what medications I was on, what was going on with me, what things needed to be done because she had been around me so much and the hospital staff listened to her.”
“I pretty much carry my PAD around everywhere. I told the police about my PAD because they were the first people I spoke to when I got taken to the hospital last time. Then, when the ambulance took me to the hospital, it was really crowded in the ER so I showed intake my PAD and told them that I needed to go somewhere quiet with less people so that I could calm down because I can’t be around a lot of people at once. The intake nurse sat with me in a quiet room until I calmed down.”