6/27/11: do you need a mental health advance directive?

After thinking more about the woman who died of starvation and hypothermia after being discharged from a mental hospital (see my prior blog), I did a little research on mental health advance directives (MHADs). In her case, I don’t see where the MHAD would have been helpful, since in most cases, the state can override a person’s request to forgo treatment, refuse medications or hospitalization, or (as in her case) simply be left alone. I’m not entirely convinced, but in some cases this might be a useful tool.

Washington State is among a few states that recognize and honor MHADs. Fashioned after directives that are written to guide family and providers about a person’s wishes for end-of-life care, the MHAD offers the opportunity to:

  1. Name an agent who is authorized to make treatment decisions for a person who is deemed temporarily unable to make competent decisions due to mental illness;
  2. List preferences regarding medications, treatments (such as electroshock therapy), institutions, and providers; and
  3. Control who should and should not be told that there is a mental health crisis.
Two things we’ve learned from encouraging people to fill out advance directives are (1) they are rarely used; and (2) they often help to start conversations about end-of-life issues among family members and between patients and providers. So they have a utility before an end-of-life crisis that is hard to ignore. Likewise, the MHAD could prove to be a starting place for more honest conversations about mental illness within families and between patients and their providers . 

I’ve had my own mental health crises, so I have personal reasons to consider this. It might be important to you or someone you know. More to the point, I’ve witnessed so much suffering due to mental illness and feel haunted by it. I’m not even sure what mental illness is from a medical standpoint, but I know it causes extreme suffering and can lead to death. I know that we don’t talk enough about it; don’t know how to support people during crises; and don’t have a mental health care system that knows how to relieve suffering and prevent deaths.
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One Response to 6/27/11: do you need a mental health advance directive?

  1. Linda Spalding says:

    I was very pleased with your post today for the exact reasons you gave regarding the importance of MHAD. The public do not have an inkling of the depth of suffering people endure who live with a mental illness. It is tradegy upon tradegy due to ignorance of such illness. Your post is very timely given that many states have drastically cut mental health services and people in our area are at crisis point filling up the emergency rooms so much so that hospitals cannot cope with the added influx. There are people I have had Mental Health issuses that brought me to deaths door and known many who through no fault of their own could not survive. I have been blessed with excellent care to the extent I am healthier and happier than the public at large. I work with our local affiliate of National Alliance on Mental Illness (NAMI) with fundraising, plus facilitate a weekly consumer support group and teaching 10 week in depth education courses on recovery and wellness. Part of the curriculum is doing a MHAD over two sessions. We do a practice form and hand out a real form to take home. NAMI developed and provided the course materials which have had a high success rate. Go to NAMI website for resources and materials.

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