1. 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.

2. 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

3. 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

4. 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

5. What are your family member’s rights?
State Rule
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

6. 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

7. 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Any advance psychiatric directive written and signed by a consumer may be withdrawn at any time verbally or in writing by the consumer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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

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

16. Resources West Virginia Advocates http://www.wvadvocates.org
(800)
WV Bureau of Senior Services
(877)
Caring Connections
800/
ADVANCE SELF-ADVOCACY PLAN (ASAP)
NATIONAL RESOURCE CENTER ON
PSYCHIATRIC ADVANCE DIRECTIVES