Insight Matters
Fall, 2001

Psychiatric Advance Directives Introduced

Dale Svendsen, MD
ODMH Medical Director

Consumers of mental health services in Ohio are beginning to use the Advance Directive Durable Power of Attorney for psychiatric health care. The Advance Directive is a document that empowers the individual to name an agent, a trusted friend or family member, to make health care decisions when an attending physician determines that the individual has lost the capacity to make informed health care decisions for him/herself.

Although durable powers of attorney have been available for medical care since 1991, applying this document to psychiatric care is a recent development. In 1999, Washington and Stark counties successfully piloted a project to implement and provide training on Psychiatric Advance Directives. The Ohio Department of Mental Health (ODMH), through the Office of Consumer Services and the Office of the Medical Director, supported this effort that is consistent with recovery from mental illness and assists a person in coming to terms with his or her illness.

To assist in bringing psychiatric advance directives to all parts of Ohio, ODMH is supporting a Coordinating Center of Excellence (CCOE) through Washington County to offer information and technical advice to all areas of the State. Project manager, Carol Youtz, and project coordinator, Marybeth Bolerjack, are facilitating training sessions in eight areas of the State. These sessions have attracted consumers as well as board and agency staff. The trainings share psychiatric advance directive toolkits, videos, written materials and a train-the-trainer model for a consumer-driven speaker's bureau.

Recently, Psychiatric Advance Directives were shared at the OPA Meeting in Cleveland at the ODMH booth. Brochures and information sheets were available along with the new Web site address: http://wcmhar.com/AdvanceDirective/ . Information on Psychiatric Advance Directives is available on the Web site, including an Advance Directive form. Although a legal document, an Advance Directive may be changed or revoked at any time. The Ohio Legal Rights Service's Durable Power of Attorney for Health Care and Declaration of Treatment Instructions is especially adapted for use by individuals wishing to complete an advance directive for psychiatric health care.

Developing a Psychiatric Advance Directive, when healthy and in collaboration with the psychiatrist, other clinicians and the designated agent, is advised. This allows the individual the opportunity to discuss signs and symptoms of the illness, plan early interventions, and define effective treatment preferences should a major relapse occur. In the psychiatric advance directive the individual is likely to include instructions to the agent regarding treatment preferences such as medications, which hospital or physician is preferred, or choices about the temporary care of children. When properly planned and implemented, a Psychiatric Advance Directive promotes effective collaboration between the psychiatrist and the patient, helps the individual accept and deal with the psychiatric illness, and promotes recovery.

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