It’s not uncommon for people to address in their estate plan the fact that they could become physically incapacitated and unable to make critical medical decisions themselves. They do this by including health care powers of attorney or advance directives in their estate plans.

But what if your family has history of mental illness? Is there a way to honor your wishes in the event that a mental health episode renders you unable to make decisions about your treatment? A psychiatric advance directive could be the answer.

Health Care Directives

To cover all the health care bases, it’s a good idea to have two documents: an advance health care directive (sometimes referred to as a “living will”) and a health care power of attorney (HCPA). Some states allow you to combine the two in a single document.

An advance directive expresses your preferences for the use of life-sustaining medical procedures — such as artificial feeding and breathing, surgery, invasive diagnostic tests, and pain medication — specifying the situations when these procedures should be used or withheld.

However, a document prepared in advance can’t account for every scenario or contingency, so it’s wise to pair an advance directive with an HCPA. This allows you to authorize your spouse or other trusted representative to make medical decisions or consent to medical treatment on your behalf when you’re unable to do so. An HCPA can include specific instructions to your representative, as well as general guidelines or principles to follow in dealing with complex medical decisions or unanticipated circumstances.

Psychiatric Advance Directive 

Many states allow generic HCPAs and advance directives to address mental as well as physical health issues. But some states limit or prohibit mental health treatment decisions by general health care representatives. Around half of the states have psychiatric advance directive statutes, which authorize special advance directives to outline one’s wishes with respect to mental health care and appoint a representative to make decisions regarding that care.

A psychiatric advance directive may address a variety of mental health care issues, including:

• Preferred hospitals or other providers,
• Treatment therapies and medications that may be administered,
• Treatment therapies and medications that may not be administered, such as electroconvulsive therapy or experimental drugs,
• A statement of general values, principle, or preferences to follow in making mental health care decisions, and
• Appointment of a representative authorized to make decisions and carry out your wishes with respect to mental health care in the event you’re incapacitated.

Although requirements vary from state to state, to be effective, a psychiatric advance directive must be signed by you and your chosen representative, and in some states by two witnesses. Be sure to discuss the terms of the psychiatric advance directive with your family, close friends, physicians, and mental health care providers.

Ease Your Concerns

If you’re concerned about the possibility of mental illness and want to properly address it in your estate plan, a psychiatric advance directive is worth looking into. Consider one if it’s available in your state or look into options for using generic advance directives and HCPAs to address mental health care. Contact us for more information.