Psychiatric Advanced Healthcare Directives.

Most California residents know about the Advanced Healthcare Directive, but very few have heard about the Psychiatric Advanced Healthcare Directive (“PAD”). The PAD is a standalone health care instrument that, “… allows a person with mental illness to protect their autonomy and ability to direct their own care by documenting their preferences for treatment in advance of a mental health crisis [Probate Code Section 4679(a)(2)).

A PAD supplements, but does not replace, the Advanced Health Care Directive, which is broader in scope. Psychiatric care instructions can also be incorporated directly into an Advanced Health Care Directive. Each document can only be executed by a person who has capacity to make medical decisions.

Each healthcare document is used to appoint an agent to make decisions for you, and to say how you want to be treated, where you want to be treated and whom you want to be involved in your health care in the event of a future crisis. For example, if a person experienced a bad side effect from certain medication then a preference to avoid such medications and the reason can be stated. Also, a person may wish to say that they do not want to be cared for in a particular hospital.

Section 4679 (c) of the Probate Code, California’s PAD implementation statute, declares that PADs improve collaboration, outcomes, empowerment, and medication adherence; that PAD’s are most helpful when they include reasons for preferences; and that while mental health care preferences are not themselves instructions or decisions they provide valuable information that can improve a person’s care.

Creating a PAD itself is a very useful exercise. It engages self-understanding and prior experience with one’s psychiatric conditions and situations to say how such should be addressed in the future. The National Association of Mental Illness (“NAMI”) California has online family education, psychiatric directive tools, and support groups (https://namica.org/find-your-nami/).

The National Resource Center on Psychiatric Advance Directives (NRC PAD) has an online Advanced Health Care Directive that includes specific psychiatric care instructions (https://nrc-pad.org/states/california-forms/).

Presently, 8 California counties and city/groups are participating in online PAD pilot program. The program provides residents in these communities an online tool to create, store and share a PAD with health care providers, first responders, and others. Importantly, this program also involves training first responders in the participating counties and cities to understand how to access and use the information in the online PAD. The desired outcome of the PAD program is that psychiatric crisis are better managed through better and more readily available information to reduce the severity of the psychiatric crisis.

Whether a PAD is the right approach and tool for any individual is a personal choice. That the PAD is a recognized health care instrument in California indicates that there is a place for a specialized psychiatric health care directive. It gives people the opportunity to designate an agent, to communicate instructions and preferences for future use in a crisis.

The foregoing discussion is not legal or health care advice. Consult a qualified professional for guidance. Dennis A. Fordham, attorney, is a State Bar-Certified Specialist in estate planning, probate and trust law. His office is at 870 S. Main St., Lakeport, Calif. He can be reached at Dennis@DennisFordhamLaw.com and 707-263-3235.