Psychiatric Advance Directives

Maryland law allows anyone 16 years of age and older to be involved in decisions about their mental health treatment. A psychiatric or mental health advance directive (PAD) is a legal document that allows a person with mental illness to state their preferences for treatment in advance of a crisis. This may help protect a person’s autonomy and ability to ensure the right care and procedures are followed during a mental health crisis. PADs are similar to living wills and other medical advance planning documents used in palliative care, but specifically address psychiatric concerns.

Both advance medical directives and psychiatric advance directives (PADs) consist of two parts: a “living will” and a “health care proxy” or “medical power of attorney.” A living will is a document in which a patient provides direction regarding medical treatments that the patient wishes to accept or refuse under various circumstances. A health care proxy is a document designating an agent to act on the patient’s behalf with respect to medical decisions. 

The first part of a PAD gives patient instructions regarding future mental health care treatment, while the second part of a PAD designates a proxy decision-maker for mental health care. A person who wishes to develop a PAD can use one or both parts.

The advance instruction can detail preferences for treatment, give consent for admission and provide consent for who may be contacted in advance. It can designate preferred medications and treatments.

A PAD goes into effect when a person is deemed unable to make sound decisions in his or her best interest. A treating physician or psychologist makes the decision about capacity based on how the person presents at the time of examination. Some examples of periods when a person may lack capacity include acute psychosis, mania, catatonia, delirium, or unconsciousness. At this point the PAD goes into effect and treating medical professionals can use the PAD to get a  better understanding of the person’s treatment preferences and family/friends to contact. If there is a health care power of attorney in place, the designated health care agent can make decisions on the patient’s behalf.

PADs are only used temporarily. Once the person regains capacity to make sound decisions, they can resume participating directly in decisions about care. Any adult of sound mind can create a PAD. For more information on creating Advance Medical Directives or Psychiatric Advance Directives, please contact Stouffer Legal at 443-470-3599 in the Greater Baltimore area.