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Mental health professionals weigh pros and cons of psychiatric advance directives for determining patient treatment during crisis

Patients' medical records.
Patients' medical records.
Ariel Skelley/Getty Images

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Determining the kind of care that someone suffering from mental illness wants and needs during a mental health crisis can be challenging, especially when the patient suffers from a condition that leaves him or her disconnected from reality or otherwise unable to make sound decisions for him or herself.

It’s why more and more patients are discovering and creating psychiatric advance directives, or PADs for short. In a similar vein to a living will or a do-not resuscitate order, a PAD allows a patient to lay out the kinds of treatment and medication that he or she does or doesn’t want in the event of a situation that leaves the patient unable to make choices in his or her best interests. PADs can also designate family members as surrogate decision makers in the event of a crisis.

While many doctors and patients see a PAD as a useful tool, some have concerns about how a legally-binding document like a PAD, which is legal in 27 states, might hinder a doctor’s ability to provide treatment they think is necessary or would be more effective than what a patient has outlined in a PAD. Others worry about what happens if a patient doesn’t regularly update the PAD and it neglects certain medical advances or new treatment options that weren’t available when the PAD was originally completed. And still others worry about the ability of someone who suffers from a serious psychiatric condition to even complete a PAD.

We’ll discuss the utility of psychiatric advance directives and the potential concerns they raise with some mental health professionals.


Marvin Swartz, M.D., professor in psychiatry and behavioral sciences at Duke University and director of the National Resource Center on Psychiatric Advance Directives

Judy Ho, associate professor of psychology at Pepperdine University; she is also a licensed clinical and forensic psychologist in Manhattan Beach, CA.; she tweets @DrJudyHo

Katayoun Tabrizi, M.D., clinical associate in psychiatry and behavioral sciences at Duke University