- 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.
Connecticut Q and A
Ten commonly asked questions about PAD’s for Connecticut
Please note: the following 10 FAQs are designed to provide a quick and accessible guide to what your state’s statutes say – or do not say – about PADs. The FAQs do not attempt to provide a complete picture of the law in your state, nor can they take the place of legal advice. The answers were accurate when written in October 2006.
1. Can I write a legally-binding psychiatric advance directive (PAD)?
Yes. You may appoint an agent, known in Connecticut as a “Health Care Representative”, to make decisions about your treatment if you become incompetent to make decisions. You may also write instructions about your health care, including your mental health care. A helpful guide, produced by the Office of the Attorney General of Connecticut, is available here. This guide contains model forms, although the statute does not require a particular form of words. To specify mental health instructions, it is recommended that you use the model forms, attaching extra sheets where necessary.
2. Can I write advance instructions regarding psychiatric medications and/or hospitalization?
Yes. The statute allows you to set out your instructions on any aspect of your health care treatment, which could include advance decisions about psychiatric medications and/or hospitalization. This is called a “Living Will”. If you wish, you may use a Living Will to make advance decisions to refuse medications or hospitalization, although state law may operate to require your hospitalization in an emergency, even if you have declined it in your instructions.
3. Does anyone have to approve my advance instructions at the time I make them?
No. However, you must sign your instructions/appointment of Health Care Representative in the presence of two witnesses, who must also sign the document. Your witnesses must not be employees of your health care provider. There is also an optional form called a “witnesses’ affidavit” which requires the use of an attorney or notary. For more detail, please see the Attorney General’s guide.
4. Can I appoint an agent to make mental health decisions for me if I become incompetent?
Yes, as explained above. Your Health Care Representative must be someone other than an employee of your health care provider or employee of your nursing home, if applicable.
5. If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?
Yes. Your Health Care Representative is able to make any decision that you could have made if you were competent, except for certain procedures including psychosurgery and shock therapy (ECT).
6. Does my agent have to make decisions as he/she thinks I would make them (known as “substituted judgment”), or does he/she have to make them in my “best interests”?
Your Health Care Representative must use substituted judgment wherever he/she knows of your wishes. If your wishes are not known, your Health Care Representative must act in your best interests.
7. Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both?
No. You may do one, the other, or both.
8. Before following my PAD, would my mental health care providers need a court to determine I am not competent to make a certain decision?
No. Your instructions, and/or the authority of your Health Care Representative, go into effect when your health care provider determines that you are “unable to understand and appreciate the nature and consequences of health care decisions… and to reach and communicate an informed decision regarding the treatment”. Your Health Care Representative may request that he/she be given written notice if this occurs.
9. Does the statute say anything about when my mental health providers may decline to follow my PAD?
No. However, if you are thought to present a danger to yourself or others, it is likely that you could be treated contrary to your instructions, or those of your Health Care Representative.
10. How long does my PAD remain valid?
Your document remains valid unless and until it is revoked. You can revoke your instructions at any time, either orally or in writing. In contrast, however, revocation of a Health Care Representative’s appointment must be in writing and signed by two witnesses. Making new instructions, or appointing a new Health Care Representative, usually invalidates previous documents. Finally, if you appoint your spouse as your Health Care Representative, you would need to amend or clarify your documents in the event of divorce or legal separation.