An advance directive is a written document that expresses your wishes in advance about what types of treatments, services and other assistance you want during a personal mental health crisis.
A directive provides a clear statement of your medical treatment preferences and other wishes or instructions. You can also use it to grant legal decision-making authority to another person to be your advocate and agent until the crisis is over.
Please be warned that there are many instances of doctors not respecting people’s advance directives. This is by no means a perfect solution, but it is a useful tool that we recommend.

When will I need an advance directive?

An advance directive goes into effect if you are hospitalized and it has been determined that you “lack the capacity to make decisions for yourself.” By writing your advance directive when your capacity is not in question, you have the opportunity to better influence what happens during a hospital stay. In an emergency situation, therefore it’s critical that an advanced directive is made in advance.

What should a psychiatric advance directive include?

You can include the psychiatric drugs and dosages that you prefer to take and those that you do not wish to receive or you can express that you do not want to take psychiatric drugs at all. You could also list names of facilities or healthcare professionals you want involved in your care, and people who can help you with important activities (such as paying your bills, and taking care of your children, pets or plants). You can also even identify the people you do or do not want as visitors if you’re hospitalized.

One of the more powerful features of an advance directive is your ability to designate someone else to make decisions for you if you are admitted to a hospital. You can name that person by stating that only he or she should make decisions for you in the event that you have been determined to lack the capacity to do so. This person is considered to have “power of attorney”.

For state by state information in the United States and for other countries:

Do I need a lawyer to prepare an advance directive?

Laws vary in each area. To maximize the ability of your advance directive to be enforced, you should consult with an attorney. The best approach is to have both a lawyer and a doctor sign your advanced directive, thereby verifying your competence at the time it was signed.

Who should have a copy of my advance directive?

It’s important that people know you have an advance directive and know where to find it. Put a copy in your home where it can be easily found; and, put another one in a safe place with your other important papers. Be sure to give copies to people you trust – your agent or a trusted friend or relative; you should also have one on file at any hospital where you have been a patient before.

Can I change my mind?

You can change the contents of your advance directive by making corrections or writing out a new one. However, it is your responsibility to ensure that everyone has a copy of your most current advance directive.

Depending on where you live, you can also choose to make your advance directive revocable. This means you can reserve the right to cancel your advance directive even during a crisis. This must be stated in writing. However, if you choose to revoke your advance directive, your agent will no longer be able to advocate for you. Before you decide whether to make your advance directive revocable, you should thoroughly discuss this with your friends, family and healthcare providers.