Psychiatric Directives May Be A Game Changer For Mental Health Patients

By Kelly Burch 12/06/18

Psychiatric advance directives give mental health patients a way to express ahead of time, when they are in a sound state of mind, how they would like to be treated during hospitalization or treatment.

mental health patient speaking to his psychiatrist about a psychiatric directive

Steve Singer, who has bipolar and borderline personality disorders, knows that he sometimes needs to go to the hospital. However, he also knows that certain treatments from staff — like getting the police involved or keeping Singer in a locked room — can make his condition much worse, not better. 

Because of this, Singer drafted a psychiatric advance directive, a document that is entered in his medical chart and dictates his wishes, even when he is unable to express them. 

“That psychiatric advance directive, I think is so important,” he told The New York Times. “It allows me to turn things around.”

For mentally ill patients and their families, hospitalization and treatment can be terrifying. While people are experiencing psychosis or other symptoms of mental illness they are often desperate for support, but certain treatments or medications can exacerbate the situation rather than calm it. 

Psychiatric advance directives allow people with mental illness agency over how they are treated by giving them a means to express ahead of time, when they are in a sound state of mind, how they would like to be treated. The documents can cover issues such as which medications should be avoided, what words can help cut through psychosis or which family member can make decisions during crisis. The directives are added to a patient’s chart and should be followed as long as the conditions within meet the patient’s best interests. 

This type of advance directive is authorized in 27 states and can be incorporated into different types of medical directives in other states. Now, the Substance Abuse and Mental Health Services Administration is considering ways to encourage directives, and Medicare and Medicaid are requiring hospitals to ask if patients have a directive. As awareness grows, clinics are being held around the country to help patients draft psychiatric advance directives.

Effective directives “would enhance people receiving appropriate treatment,” said Dr. Mark Rapaport, chairman of psychiatry and behavioral sciences at Emory University. “But this is going to be really hard to do.”

The directives need to be notarized and given to medical professionals or be logged in the state’s system. They also need to be realistic, requesting treatment that medical professionals can provide in a crisis. 

Dr. Marvin Swartz, a Duke psychiatry professor, said that just the act of drafting a directive can be empowering for patients and improve their interactions with their health care team. He offered 239 patients the opportunity to write a directive and found that those who did had fewer crises and involuntary hospitalizations. 

Please read our comment policy. - The Fix
Kelly Burch Contrib.jpg

Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.