During a severe psychiatric crisis, people may temporarily lose the ability to communicate their medical preferences clearly to hospital doctors or emergency room staff. A Psychiatric Advance Directive (PAD) is a legal document created while you are well that outlines your treatment choices, specifies medications you consent to or refuse, and designates a proxy to speak for you.
1. Why a PAD Is Essential
Without a legal directive, emergency room staff and inpatient psychiatrists make decisions based on standard hospital routines, which may include medications that previously caused you severe side effects or placement in facilities you prefer to avoid.
- Maintains Personal Autonomy: Ensures your voice, values, and choices guide your care, even during incapacitation.
- Prevents Adverse Reactions: Lists psychotropic medications, dosages, or physical interventions that have failed or caused bad reactions in the past.
- Shortens Hospitalizations: Gives clinical teams an immediate roadmap of what works for you, accelerating your stabilization and discharge.
2. What to Include in Your Directive
| PAD Component | What You Specify |
| Preferred Facilities | The local hospitals or crisis stabilization centers you prefer (and any you explicitly wish to avoid). |
| Medication Preferences | Medications and dosages that have helped you, alongside drugs you refuse due to severe side effects or allergies. |
| Healthcare Agent (Proxy) | The name and phone number of a trusted partner, family member, or friend authorized to make medical decisions if you cannot. |
| De-Escalation Instructions | What helps you calm down (e.g., quiet, dimly lit room, specific music) and explicit preferences regarding physical restraints or seclusion. |
| Practical Responsibilities | Clear instructions on who should feed your pets, look after your children, pay your rent, or notify your employer during a stay. |
3. How to Execute and File a PAD
- Use Your State’s Template: Most states have standardized forms for Mental Health Advance Directives. Download your state’s template from the National Resource Center on Psychiatric Advance Directives.
- Witnesses & Notarization: Sign the document in front of two adult witnesses (who cannot be your treating doctor or clinic staff) and have it notarized.
- Distribution: Provide physical copies to your primary care doctor, psychiatrist, local hospital medical records department, therapist, and your appointed healthcare proxy. Keep a digital copy saved on your phone.
