In general, most psychiatric advance directives (PADs) and advance directives (ADs) for health care with psychiatric provisions appoint an agent and provide contact information, which includes who should have temporary custody of the patient’s children and pets and spells out the patient’s treatment decisions, among other issues. This may include a patient’s preferences regarding seclusion and restraint, research, medication, facilities, providers, emergency interventions, and treatment modalities, explained Ellen Harris, J.D., of the Bazelon Center for Mental Health Law in Washington, D.C. She added that a PAD may also contain directives about general medical care.

Should patients consult their psychiatrist as they draw up a PAD? "Although it is important for a consumer to have discussions with his or her psychiatrist about the treatment preferences, consumers are advised to actually complete PAD documents on their own or with help from an independent advocate rather than with treatment team members, whose interests may potentially be in conflict with those of the consumer," said Harris.

To ensure that the document is consistent with state law, the patient needs to seek assistance from his or her state protection and advocacy agency, an attorney, or other legal expert. Then, after the document is signed by two witnesses and the patient, a copy should be given to each key person, said Harris.

Once activated, the document can be reviewed by employees at hospitals, group homes, nursing homes, or wherever the patient is being cared for, explained Dennis Feld, J.D., deputy chief attorney for the New York State Mental Hygiene Legal Service, Second Judicial Department. Also, while the person is competent and being considered for court-ordered treatment, it can be reviewed by the courts.