Advanced Directives: Sharing YOUR Choices in Case of Crisis

Why a Psychiatric Advanced Directive?• Trauma Informed Approach• Transparency• Empowerment• Voice and Choice• Addresses potential cultural and gender issues

• Physical Advance Directives http://www.oregon.gov/DCBS/insurance/shiba/Documents/advance_directive_form.pdf • Many hospitals/PCPs keep these on file• Express a person’s wishes regarding life support

Psychiatric Advanced Directive

• It’s a right to share your decisions ahead of time• Oregon Revised Statute

127.700 – 127.737• https://

www.oregonlaws.org/ors/127.700

Declaration for Mental Health Treatment

When?• For times when a person is experiencing a mental health crisis and• For times when a person is unable to share directions or

wishes regarding treatmentor• For times when a person wants a trusted person to make

decisions

How?

• A Declaration for Mental Health Treatment goes into effect if • A court or 2 doctors have

decided • A person is unable to

understand and make decisions

• About their mental health treatment

Why?• People can think ahead and

share their choices before a crisis happens

• Usually, treatment history is shared in a crisis – wishes are not

• THIS is how people can be sure providers know what their choices are - about their care

What?• You can share your

decisions around medication• What to use• What not to use

• You can share your wishes about treatment

• You can select a trusted person to make decisions for you

Where?• A Declaration needs to be ACCESSIBLE!

• If there is a representative, both people should have a copy.

• The primary mental health provider/team should have a copy.

• The local crisis response team should have a copy, if possible

• It could be uploaded on PreManage for ER staff to access

How Often?• A Declaration is valid, in Oregon, for 3 years.

• A new one must be done every 3 years, to remain in effect.

• Changes can be made to a declaration• Challenge is to be sure to get all old copies and replace with the

new one.

Details: State Recommended Form

• From statute: 127.736• Person must be mentally

competent• Person must want to do this, it

cannot be forced• Person decides - Decisions for

the individual can be made by • A trusted person

(representative) or• By the mental health provider

• Use this form to share the person’s directions or wishes

Representatives• Someone the person trusts to make decisions on for them• There can be an alternate

• Representatives use the Declaration to inform their decision-making

• If something comes up that is not covered in the Declaration, they must make a decision as close to the decisions the person would make as possible

• The representative must be asked ahead of time, agree, sign the declaration, and keep a copy of it

I consent to…• Lists the things the person consents to –

the more specific and comprehensive this list is, the better• Consider addressing:

• Medications – type and dosages• Short-term inpatient treatment programs• Stating preferred provider(s) and facility• Electro Convulsive Treatment (ECT)• Other specific treatments• Eye Movement Desensitization and Reprocessing

(EMDR)• Light Therapy• More

I do not consent to…• List the things the person expressly refuses to give consent to

– the more specific and comprehensive this list is, the better• Consider addressing:

• Medications – type and dosages• Short-term inpatient treatment programs• Stating provider(s)/facility do not want to use• Electro Convulsive Treatment (ECT)• Other specific treatments• Eye Movement Desensitization and Reprocessing (EMDR)• Light Therapy• More

• Consider stating the reason(s) why not

Additional Information…• …About the person’s Mental Health

Treatment Needs• Consider including:• Health history

• Mental• Soothers• Triggers

• Physical• Dietary Requirements• Religious/Spiritual Concerns• Important contact information/people

Signed and Witnessed• A Declaration of Mental

Health Treatment needs to be signed and witnessed• Signed by Person,

• in presence of 2 witnesses• Signed by representative

(and alternate representative), • both witnessed by 1

person; • does not have to be the

same person

Questions

Advanced Directive Resources• Information available online:• http://www.nrc-pad.org/• https://www.oregonlaws.org/

ors/127.700• http://www.dshs.wa.gov/dbhr

/advdirectives.shtml• http://mhapa.org/resources/

MHAD.htm• http://www.maine.gov/dhhs/s

amhs/mentalhealth/rights-legal/advance-directives.html

• http://www.oregon.gov/DCBS/insurance/shiba/Documents/advance_directive_form.pdf

• http://www.oregon.gov/OHA/amh/forms/declaration.pdf