Advanced Directive for Psychiatric Issues

In the article, “When Treatment is Traumatic” by Melody Moezzi in the Fall 2016 edition of Bp Magazine, I read something I had never considered, that of needing Advance Directives for one’s Mental Health and a detailed crisis plan. She discussed having had good hospitalizations and bad ones. And, that we can specify which mental health facilities we want to go to and vice versa.

Included with that was we have the right to specify what drugs we do not want to take and treatments we do not want . . . ones we may have had adverse reactions to in the past when physicians and psychiatrists may not have access to that information. She also speaks to vetting your own psychiatrist . . . research the person, interview others who have had that person, interview that psychiatrist before committing to sharing your deepest secrets with him or her. She reports this cuts down on the trauma hospitalization may cause.

Accordingly, I did a little research about PAD’s (Psychiatric Advance Directives) and some of the present problems within the system now. One good instruction manual for the development of your PAD is at:

It answers the questions you may have about how to go through the process of specifying your needs and writing them down. It explains the legal process and what your rights are.

As Duff Wilson says in the December 11, 2009 issue of the NY Times, this can help protect poor children who are presently likelier to receive powerful Antipsychotics than treatment and therapy because the latter are more expensive. In fact, poor children are 4 times more likely to receive powerful anti-psychotics than middle-class children who have private insurance. Medicaid may push for this but just remember – you have the right to push right back. An educated consumer has the right to Appeal and make informed choices even when on Medicaid. These drugs have long-standing to permanent metabolic changes and drastic weight gain. It stands to reason the same factors may apply to adult psychiatric patients.

The David L. Bazelon Center also speaks to this issue. Patients may be restrained, seclusion, forced hospitalization or receive forced treatment and medications if they do not have a standing PAD. We need to have copies of our PADs at our Pediatrician or Primary Physician and/or Psychiatrist as well as with our Mental Illness Medical Advocate. Many times earlier intervention can eliminate the need for such serious and draconian measures. Many times our Primary Care Physician administers Psychiatric drugs because there is too long a wait for a Psychiatrist and treatment is necessary. However, they rarely have the training to make such decisions and so may administer the wrong drugs because the family or physician feels it is necessary or that they don’t have other options.

David L. Bazelon Center
Another factor for consideration is because family counseling or psychiatrist counseling sessions are more expensive, Medicaid may resist paying for them with poor patients. In other words, we are discriminated against, something that should come as no surprise to most of us.

A couple of final things:

UPENN Collaborative on Community Involvement
A Guidebook for Creating a Mental Health Advance Plan or Psychiatric Advance Directive

This organization provides a 32 page document covering all aspects of preparing for your mental illness needs in the future but in easy to understand terms. Not all of which may be directly relavent to you personally. Neverthless, it is a useful reference to draw from as you create the document that suits your exact needs. Just remember to periodically review your PAD because your needs may change over time.

There is also the DBSA Wellness Toolbox – “[A] Collection of self-help and wellness tools to help you communicate better with your doctor, keep track of your symptoms and moods, record the progress you’re making and help you reach recovery.

I have a Living Will but you can bet I’ll be drawing up a PAD ASAP.


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