You’ve heard of an advance directive, which puts into writing your wishes should you become incapacitated or unable to communicate your healthcare treatments of choice, but have you heard of a psychiatric advance directive (PAD)? A PAD is similar and is meant for those with a diagnosed mental illness to state their future treatment preferences when suffering an episode, thereby losing capacity or withholding their consent for treatment. If you or someone close to you would benefit from a PAD, let’s look closer at this relatively new and helpful legal document.

What are the Benefits?

The benefits of having a PAD are designed to help an individual through any psychiatric emergency without the chaos of figuring things out in the heat of the moment. PADs open doors of communication with their family, friends, and healthcare providers to have a voice in their mental health care. A PAD protects individuals from unwanted treatments or harmful actions and can reduce unhelpful de-escalation methods, such as seclusion or administering certain medications.

PADs are written beforehand to help those in a mental health emergency outline a clear plan they approve of when an acute episode arises, and they are likely at their most vulnerable. This is empowering in knowing treatment during these times is according to their wishes.

Things to Include

When preparing a PAD, you will determine a proxy who will decide on your behalf if you have become mentally unable or incapable of doing so. Be aware this designation should also include a provision for guardianship, should the court deem it necessary. Guardianship further restricts a person’s decision-making abilities either temporarily or permanently.

Be specific regarding hospitalization, medications, specific and direct treatment choices, such as restraint or experimental trials, and who to contact immediately if the impacted person is referred or admitted for mental health care.

During incapacitation, you cannot terminate or suspend your PAD, depending on the laws of your state. For additional information about PADs from state to state, view the list at When creating or updating your PAD, you must make your wish in writing and ensure your current copy is readily available for your proxy. Consider discussing your decisions with your current mental healthcare team and providing them a copy of your PAD.

Federal Law

The passing of the Patient Self-Determination Act (PSDA) has two primary goals. First, it focused on healthcare facilities receiving Medicare or Medicaid funds to provide a written document describing a person’s legal rights and the facilities’ policies on advance directives. Including the advance directive in the patient’s medical record is also required. This applies to all patients, according to the Patient Self-Determination Act (PSDA). Signed into law in 1990, this act makes it mandatory for hospitals and health agencies of all kinds to inform their patients of their rights to determine their own care, which includes making it known they have an advance directive in their medical records, and not being discriminated against for having one. Second, the law seeks to increase the creation of advance directives by the public. Various consumer surveys report that roughly thirty percent of Americans have created an advance directive.

For anyone with a mental health diagnosis, preparing a PAD is vital for preparing for future episodes. It will allow doctors and providers knowledge of how you desire to be cared for when an episode arises.

At Organized Instincts, we are here to help break down stigmas surrounding mental health and create awareness for mental health tools which helps to keep your financial house in order. Schedule a conversation today and learn how a PAD can protect you or a loved one in crisis.