Johns Hopkins Health Alert
Do You Need a PAD?
In many health emergencies, such as heart attacks and strokes, doctors make all the decisions. The same is often true of mental health crises as well. But if you have a psychiatric condition that could lead to hospitalization -- such as bipolar disorder, schizophrenia, or severe depression -- you may have strong feelings about various treatment options. This is when a psychiatric advance directive (PAD) can be just what the patient ordered.
A psychiatric advance directive is a legal document that clearly states your wishes for treatment of a mental health disorder. It acts in the same way a general healthcare directive declares your preferences or a living will spells out your choices about end-of-life care.
Not everyone with a mental health issue needs to draw up an psychiatric advance directive. For example, people with mild anxiety or depression or seasonal affective disorder probably do not need to worry about being hospitalized for these conditions. But if you’ve been admitted to a hospital for a psychiatric illness in the past or if your doctor feels that you may at some point lose the ability to make rational decisions -- even temporarily -- a psychiatric advance directive may be worthwhile.
A psychiatric advance directive must be filled out while you are competent and healthy. Usually you must have it signed by two witnesses and notarized. Currently, 25 states have statutes supporting the use of psychiatric advance directives specifically, and all 50 states have laws supporting the use of living wills or other health-care directives.
If you live in a state that hasn't yet addressed psychiatric advance directives, you can usually attach an additional form to the standard healthcare directive. To get the correct information (and a form to fill out), visit the National Resource Center on Psychiatric Advance Directives and click on "State by State Info": www.nrc-pad.org.
Posted in Depression and Anxiety on February 3, 2010
Reviewed January 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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A PAD (Psyciatric Advance Directive) and a crisis plan helps my son who has schizophrenia "feel safe." His last hospitalization was 13 years ago, but memorably humiliating, as have been some of his prior hospitalizations. He knows that we (his mother and father) will do everything possible to avoid hospitalization, but he has been fearful when we have gone away. He is fearful that mental health personnel will hospitalize him or that his brother will commit him. The crisis plan lists several steps to take before there is even a hint of hospitalization. The crisis plan is more explicit than the PAD. However, the PAD lists the medications that definitely have not worked in the past, and lists restraints as too terrifying to be useful. As we all know, inpatient psychiatrists have their own favorite medications and too often do not listen to the patient, even if he/she can make himself understood. We hope that the PAD will eliminate using medications that have been shown not to work.
Posted by: gpaulgar | November 27, 2010 8:11 PM