Psychiatric Advance Directives (PAD)

The Issue:  Psychiatric Advance Directives (PAD)

Where We Stand:

NAMI supports public policies and laws that encourage the development and use of psychiatric advance directives (PAD).

Why We Care:

A psychiatric advance directive (PAD) is a legal document that details a person’s preferences for future mental health treatment, services, and supports, or names an individual to make treatment decisions, if the person is in a crisis and unable to make decisions.

While PADs have been around for years, they aren’t often used in clinical settings. Many people with mental illness, their families, and health professionals are not familiar with PADs. Currently, only 25 states have laws that permit psychiatric advance directives. For states that do not have laws, an individual can still draft a PAD under the more general statutes connected to health care directives or Living Wills. However, a PAD is preferred because of the unique issues of mental health care and treatment. These issues can include medication preferences, inpatient treatment considerations and the reality that a person can experience changes in their wellness over time.

There are numerous benefits to completing a PAD. When a person has a PAD, proper care can be given, and involuntary treatment may be prevented. Individuals can also share their PADs with their local hospitals, providers and police departments so their preference of care is clear and can be easily prioritized. And when family members are kept up to date on an individual’s PAD, they can be better advocates for their loved one.

How We Talk About It:

  • Psychiatric advance directives are legal documents that allows a person with mental illness to state their preferences for treatment in advance of a mental health crisis.
  • PADs help an individual with mental illness preserve their autonomy while ensuring the right care at the right time.
  • People who complete PADs are more likely to work collaboratively with their clinicians, experience fewer coercive crisis interventions, and feel that their personal needs for mental health services are being met.
  • When PADs are used correctly, medical providers, local hospitals, police departments and caregivers can provide care that is aligned with an individual’s preference.
  • All states should have laws that permit psychiatric advance directives in order to empower people with mental illness and support a path to recovery. 
  • Policies that encourage the use of PADs and prioritize including PADs in routine care can help people with mental illnesses protect their autonomy in a crisis situation.

What We’ve Done: