Psychiatric Advance Directive (PAD)

Every person wants to be in control of the treatment they receive. It’s your body and mind, and you should get to decide. But there may come a time in a mental health crisis when you are not able to decide what happens to you.

A psychiatric advance directive (PAD) can help. It's also called a behavioral health advance directive. A PAD helps you express your wishes about the type of mental health care you want. It lets you pick who you want to speak for you if there is a time you can't talk about your wishes.

Benefits of a psychiatric advance directive

You fill out a psychiatric advance directive when you are mentally healthy and not in a crisis. You plan ahead for a time when you will need help. A PAD is for times when you have a mental health condition and your symptoms may be getting worse.

A PAD lets you:

  • Keep your autonomy
  • Protect yourself from treatments you don't want
  • Help prevent the use of things such as restraints
  • Note your preferred treatment facilities
  • Guide your family and the treatment team during a difficult time
  • Get the right level of care during a mental health crisis

By using a PAD, you can ensure that your voice is heard. Your wishes will be known when you are having a mental health crisis.

How a psychiatric advance directive is used

A PAD has 2 jobs. Both are vital to protect your wishes and safety. They are:

1. To give clear instructions to emergency medical services, law enforcement, and healthcare workers.

2. To tell people who your healthcare agent is. This is the person you pick to speak for you.

But this doesn’t mean your PAD will be used in every situation. There are times when a PAD can't be followed. These include:

  • When it conflicts with accepted practice standards
  • When the requests are not possible or available
  • When it conflicts with emergency treatment
  • When it conflicts with the law

A treatment team may decide to commit you to a facility if they feel it is needed. This decision would override any request in your PAD. But that doesn’t mean other requests will also be ignored. Your treatment team will keep to your preferences when possible.

Picking your healthcare agent

Choose someone you trust to carry out your wishes. Examples of people you may want to consider include:

  • A spouse or partner
  • A close friend
  • A sibling
  • A family member
  • An adult child

This person will act for you with your wishes in mind. They will:

  • Do what you instruct in your PAD
  • Discuss and review treatment information
  • Change your healthcare provider if needed
  • Decide on your admission to a treatment facility
  • Decide on medicines or treatments

You can be as specific as you like in your PAD for what your agent does for you. For example, you can limit your agent to only mental health treatment decisions. You can tell your agent what exact medicines or treatments you do or don’t want.

How to make a psychiatric advance directive

Work with your provider and healthcare team to fill out a psychiatric advance directive. PADs can vary by state. You can check your state’s requirements by going to the website NRC- PAD.org

If your state uses psychiatric advance directives, you can expect them to include:

  • A section in which you state your intent to fill out an advance directive
  • Sections where you can write your specific wishes
  • A section where you can name your healthcare agent
  • A page to sign your name and write the date

In many states, you will need at least 1 witness present when you sign the form. If you need any help with the form, talk to your mental healthcare provider. They may be able to help you. Or they can direct you to someone who can.

Some states don't use psychiatric advance directives. But there are still options for you. Many of these states allow you to pick a healthcare agent or proxy even if they don’t have an official PAD. If this is the case, make sure your agent is aware of your wishes. They will carry out wishes you tell them, instead of using a PAD.

To learn more

Contact these groups to find out more: