Psychiatric advance directives provide focus on mental health care, P.1

Our Georgia readers may have heard of advance health care directives and of their importance in helping to avoid confusion and disagreement over medical decision-making. Think of Terri Schiavo and similar incidents. Among those who know about advance directives, there is a tendency to think of these important documents as useful tools for competent adults who want to identify their wishes for end-of-life care in the event they undergo an acute injury or degenerative illness that ultimately leaves them incapacitated. And, indeed, this is a fairly accurate concept of what advance directives can do.

Advance directives as traditionally conceived are more geared to providing guidance to family members and caregivers regarding end-of-life medical decisions. To this end, they give individuals the ability to identify specific wishes regarding medical care and to appoint a medical decision-maker known as a health care agent. A growing trend, however, is to see advance directives as potentially usefully to those with mental health conditions that periodically leave them incapacitated. 

Psychiatric advance directives, as these documents are called, allow mental health patients to list their preferred medications; which medications they would reuse and why; the best way to handle a crisis; desired treatment during a crisis; and other relevant matters. The purpose of this is to give individuals with mental health conditions more control over their health care and to ease decision-making during times of psychiatric crisis.

Only a limited number of states allow for the use of psychiatric advance directives at the present time. Among states that do recognize these documents, each has unique laws, so it is important for those looking into setting one up to do their research and preferably work with an attorney and/or medical professional who understands both the medical and legal issues at stake.

Although Georgia does not currently have a specific statute governing the use of advance directives geared to psychiatric care, general advance directives are certainly recognized and encouraged. These documents may be tailored to individual needs, but there are limitations. In Georgia, for instance, a health care agent appointed by the patient is not able to consent to psychosurgery, involuntary hospitalization or treatment under the Mental Health Code, Title 37. Restraints exist in other states, where laws authorizing the use of advance directives may not address psychiatric concerns or specifically exclude health care agents from making psychiatric decisions

In our next post, we’ll continue exploring the issue of psychiatric advance directives, specifically looking at potential limitations of these documents, and their relevance to estate planning. 

Source: Med City News, “Psychiatric advance directives: More patients engagement, better outcomes,” Salasky, Prue, June 10, 2013. 

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