Psychiatric Advance Directives Information For Family Members Psychiatric Advance Directives West Virginia Advocates Protection and Advocacy for Individuals with Mental Illness Advisory Council This information was developed to raise awareness of Psychiatric Advance Directives. It is not intended to provide legal or medical advice.

FAMILY MEMBERS Psychiatric Advance Directives: Used to document a individual’s specific instructions or preferences regarding mental health treatment, in preparation for the possibility that the person may lose capacity to give or withhold informed consent to treatment during a crisis

Why are Psychiatric Advance Directives Important? Engages your family member in her or his own treatment Empowers your family member to make his or her own choices May help avoid commitment procedures which can even divide families More likely to participate in a treatment regimen if I can choose my own supports and services

What are my family members options? Three options for developing a Psychiatric Advance Directive Living Will Medical Power of Attorney Combination of Living Will and Medical Power of Attorney Family member’s preferences, not someone else's. “Living Will” primarily consists of decisions concerning taking “extraordinary” measures to save or continue life, but can include decisions or preferences concerning any medical care. A “Medical Power of Attorney” provides an opportunity to name an individual who can act on a person’s behalf when the person is incapacitated. A person holding a Medical Power of Attorney for someone else should be familiar with the individual’s preferences. Do not have to use “official forms, however must be notarized and witnessed

What are your family member’s rights? State Rule 64-74-5 Advance Psychiatric Directive Right The right to an advance psychiatric directive prepared at a time when the individual has not been adjudged to be incompetent Under the Behavioral Health Consumer Rights

What are your family member’s rights? The right to refuse to create an advance psychiatric directive The right to have it entered into his or her clinical record at the behavioral health service at which he or she is receiving or may receive care or treatment Right to refuse to create one Right to have the advance directive included in your clinical record

Withdrawing a Directive Any advance psychiatric directive written and signed by a consumer may be withdrawn at any time verbally or in writing by the consumer Often referred as the “Ulysses effect” State and federal law recognize this right

Things to consider What should your family member consider in writing a psychiatric advance directive? Find someone to help that he or she trusts Discuss possibilities and choices with this individual Get agreement with choices Identify a person who will advocate for choices Be specific about when the PAD should be used When it should be used consider: Events that would trigger use (crisis, etc.) be specific and describe behaviors to look for Describe who should and shouldn’t be involved in your care (family members, providers, etc. Specific treatments you do or do not want (medications, therapy, peer support, etc.) your treating healthcare provider; CONSIDER ADDING A SECOND PERSON AS A REPRESENTATIVE IN CASE THE OTHE RPERSON IS NOT AVAILABLE POWER OF ATTORNEY CANNOT BE • an employee of your treating healthcare provider, unless related to you; • an owner, operator, or administrator of a healthcare facility in which you are a patient or in which you reside; or • an employee, owner, operator, or administrator of a healthcare facility in which you are a patient or in which you reside, unless related to you Sometimes not desirable for a family member to hold Meciical Power of Attorney

Providers A consumer has the right to be informed by a behavioral health service of the availability and applicability of an advance psychiatric directive and to receive education and assistance from the behavioral health service in preparing such a document

Providers Entities must provide education to their staff and their community on advance directives either directly or with other providers Education must include education regarding: Rights under state law to participate in decisions regarding their medical care The facility’s policies regarding advance directives This responsibility is under the federal law, and states must comply Providers that receive Medicaid and Medicare as payment for services must comply Responsibility to educate-Federal law-Patient Self Determination Act (1994) Notification of right to create-State Law-West Virginia Healthcare Decisions Act AND Behavioral Health Consumer rights Under federal law the State Medicaid agency has a responsibility to provide to you upon request information describing the advance directive law in WV

Complaints State Medicaid agencies are responsible for reviewing and responding to complaints regarding advance directives Penalties can include fines and / or removal as Medicaid / Medicare approved provider Complaints may include: Failure to comply with notice of right to create a advance directive Failure to comply with a advance directive when it was reasonable to do so Providers failure to provide reasons of refusal to comply with a AD to the consumer

What to do if directives are not being followed Complaints can be filed with the agency that surveys and certifies Medicare and Medicaid providers Providers and healthcare plans must inform consumers they have this right, and how to file a complaint Federal law complaints section applyies to states

Engaging your family member Discuss the benefits of having a psychiatric advance directive If they choose to develop a advance directive, suggest having it included in the treatment plan Discuss rights to have a Psychiatric Advance Directive with them, and what can be done if it is not honored

Remember…….. You can suggest an advance directive – it is up to the person with a mental illness to design and write such a document. Your Ideas on the content of an advance directive may be solicited – they should not be forced. Any advance directive can be made null and void by the person who wrote it. Rejection does not need to be written.

Remember…….. Even when commitment proceedings are implemented, the content of an advance directive may be used to determine treatment

Resources West Virginia Advocates http://www.wvadvocates.org (800) 950-5250 WV Bureau of Senior Services (877) 987-3646 Caring Connections www.caringinfo.org 800/658-8898 ADVANCE SELF-ADVOCACY PLAN (ASAP) http://www.upennrrtc.org/resources/view.php?tool_id=200 NATIONAL RESOURCE CENTER ON PSYCHIATRIC ADVANCE DIRECTIVES http://www.nrc-pad.org/component/option,com_frontpage/Itemid,1/