*TS: Psychiatric Advance Directives: Benefits and Strategies for Implementation (PDF)[REF:BHC, RI] The Source, August 2016, Vol 14, #8, Pg 7 JCs1608_B3

The Psychiatric Advanced Directive (PAD) is specifically required for BHC organizations under standard CTS.01.04.01. While that standard is not formally applicable to state psychiatric hospitals, the PAD is certainly relevant. It should also be noted that attention to advanced directives is required of all hospitals under RI.0105.01 and there is no prohibition to support of a PAD. Such a directive “documents the individual’s treatment preferences that should be implemented at a later time if the individual’s ability to make decisions becomes compromised “. As such, an effective document would identify the individuals preferences regarding medications (acceptable, non-acceptable), alternatives to hospitalization, alternatives to highly restrictive or high risk procedures (e.g., restraint, seclusion, ECT), non treatment personal care, visitors, emergency contacts, surrogate determination, assistive devices and diet. Needless to say, PADs are best developed when a patient is well/stable/competent. However, whenever they are developed, it is suggested that a proxy be included so that new treatments arising after the PAD is written and/or activated can be discussed in a timely manner with someone who is competent. Questions about the need for a proxy could be addressed by two assessment tools suggested in the article (i.e., Decisional Competence Assessment Tool for Psychiatric Advance Directives and the MacArthur Competence Assessment Tool for Treatment.) The article also suggest considering the use of online forms and/or software to help structure the process. Search (outpatient) suggests many patients will be able to self-complete a PAD and few will call for refusal of all treatment.
Tip: Take advantage of the Bazelon Center’s publication, PSYCHIATRIC ADVANCE DIRECTIVE: Forms to Prepare an Advance Directive for Mental Health.