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Imagine being admitted to a hospital – then told you're not competent to make decisions about your care.

If you are living with depression, bipolar disorder or another mental illness, you may someday require hospitalization. And, you may find that you have little say about your treatment. Medical staff will make most of the decisions about your care if your symptoms become severe.

But, there’s a way to stay in charge. You and your family members should be prepared for the possibility that you could become incapacitated as a result of your depression or mania, or attempted suicide.

The time to plan for such an emergency is when you're well and able to think clearly. Gather information and think about your preferences.

Find out, for example, what your doctor's procedure is for reaching him/her in an emergency. Will you be seen by your own doctor or someone on call? What hospital(s) are your doctors associated with?
Don't forget to check with your insurance plan. Are there hospitals your plan will approve and others it won't? Are there limits on your length of stay? Will it cover a partial hospitalization or day treatment program?
Electroconvulsive therapy (ECT) may be recommended. Do you know enough about it to specify, in advance, whether or not you want to have it? Do you know what medications have been effective for you and which have not, or have had problem side effects?

Putting your preferences in writing can allow you to have more control over what happens to you if become so ill you cannot to make decisions for yourself.

A legal document called a psychiatric advance directive (PAD) can provide you with this type of protection. It's a new tool for documenting your instructions and preferences regarding future mental health treatment. It can ensure better communication between you and your doctor and may prevent hospitals from giving you unwanted types of treatment or treatment you know is not right for you.

What's included in a PAD?
A PAD may include any of these and other instructions:

• Designation of agent(s)
• Emergency contacts
• Preference for a court appointed guardian
• Choice of treatment facility
• Preference for alternatives to hospitalization
• Preferences about doctors who will treat you if you are hospitalized
• Preferences regarding medications
• Preferences regarding treatments such as electroconvulsive therapy (ECT)
• Who should be notified of your admission to a psychiatric facility
• Who should be prohibited from visiting you
• Preferences regarding who should care for your children

Is my PAD legally binding?
Most states permit some form of legal advance directive (AD) for healthcare, but twenty-five states have specific PAD statutes, each with somewhat different requirements.  Learn about the laws in your state.

Regardless of state laws, if you have an advance directive, medical staff are more likely to honor your preferences.

Find out how to prepare a psychiatric advance directive

This article does not constitute legal advice. Before you assume that the advance directive you create using this form will be legally valid in your state, you should consult a lawyer.

Related articles
Going into the hospital
ECT pros and cons
Teaming up with your doctor
HMOs and managed care

More articles

Sources
Depresson Bipolar Support Alliance
DBSA
North Carolina National Empowerment Center - Articles/Making Advance Directives work for you/By Daniel Fisher, M.D., Ph.D.
Bazelon Center for Mental Health Law