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Psychiatric Advance Directives (PADs): A Tool for ...
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This document discusses the topic of Psychiatric Advance Directives (PADs) and their role in improving crisis care and addressing legal issues. PADs are legal documents that allow individuals to give consent or refuse future psychiatric treatment when they are of sound mind. They may also appoint someone to make decisions about mental health care in case they become incapacitated. The document includes a case example illustrating the use of PADs in a crisis situation.<br /><br />The origins of PADs trace back to medical, end-of-life directives and a Supreme Court decision in 1990. The Patient Self-Determination Act of 1991 helped implement medical advance directives and living wills, and some states adapted these directives for mental health purposes to strengthen patient self-determination and reduce involuntary commitments.<br /><br />The benefits of PADs include authorizing permission for consultation with family members, providing a history and crisis plan, and avoiding involuntary admissions. Honoring PADs is also a requirement for participation in Medicaid and Medicare for treatment facilities.<br /><br />PADs typically consist of two parts: Advance Instructions and Health Care Power of Attorney. Advance Instructions document treatment preferences and take effect when the individual becomes incapacitated. Health Care Power of Attorney appoints another person to make decisions during crises. The document explains the requirements for clinicians regarding PADs and the powers held by Health Care Power of Attorney.<br /><br />The document also highlights the increasing interest in PADs, with new laws implemented in 27 states since 1991. However, PADs are not yet widely adopted, and barriers to their implementation include lack of awareness, difficulty completing the documents, and limited availability of assistance.<br /><br />In addition, the document provides resources for more information on PADs and references for further reading.
Keywords
Psychiatric Advance Directives
crisis care
legal issues
consent
refuse psychiatric treatment
appoint someone
mental health care
case example
Patient Self-Determination Act
involuntary commitments
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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