Medical and Psychiatric Advance Directives and the Mentally Ill

The topic of Advanced Care Directives.is a topic I've been thinking a lot about as I am facing - most likely - some more major surgery. That is .. I think by now, most of us have a clue what those are and what it can mean if a person faces a health crisis without one...But there is a situation - a particular circumstance - where it is especially critical to have them in place. And, as a study I just read about pointed out, (see the following link: http://www.sparkpeople.com/resource/health_news_detail.asp?health_day=648556 ) those of us who suffer from mental illness are the population who is the least likely to have one of these in place.

Because someone who suffers from a serious degenerative disease of the brain, such as schizophrenia may not be competent to make decisions regarding their health care in the event of a health crisis or simply at the end of life when they may be institutionalized or in a nursing care facility; it is critical that the families of the mentally ill pick up the ball that society has dropped and encourage the mentally ill person to get this need met and to educate them about their options before such a need becomes obvious or felt.

It is important that the consumer (wow, do I hate that word!) be in a period of sound mind when they make these important decisions which have such serious implications at a later time. It is especially important, I feel, not only that they are not psychotic at the time of the deciding but also that they are not undergoing any severe depression, as this can color their choices for a later time when they may NOT be feeling this way. This is all speaking of medical advance directives (which for clarity sake I should define here: These are legal documents assigning the responsibility for decisions regarding the patient's care to another responsible trusted adult in the event that they are unable to communicate or are not of sound mind or sufficient health to make them for themselves. These generally involve end of life care determinations such as whether or not to use tube feeding, ventilators or other life support, whether to have resuscitation efforts suspended, etc.)

And I would here like to make the point that it is really important for a mentally ill adult to assign to someone they trust the right and the responsibility to permanently or temporarily have the power of attorney so that they may take care of the consumer's best interests financially during periods of severe illness. For example, this can extend from merely paying a few bills out of the patient's own funds to arranging for their long term care and the manner of funding it....Obviously this is a big responsibility and should only be assigned to someone who is willing to take it on and who is well trusted. Typically it would be a spouse, parent or close relative.

However, the mentally ill also have other issues that may necessitate their attention during periods of stability that they should really attend to. There is such a thing as a Psychiatric Advance Directive which is just beginning to be legally recognized here in the USA. Only certain states have adopted them and recognize them as legally binding. And even fewer of them allow the patient to exert some control over their care methods such as whether or not to refuse or take medication, to consent to or to refuse ECT etc.. I think, as a person with schizophrenia myself, that this is a critical issue and it is really important for parents, consumers and any mental health professionals who would do so to speak up and get involved in pushing for legislation to introduce the legality of these documents in a widespread manner of acceptance across our country. The following link is a great article put out by NAMI which describes and explains what a PAD is and how it works....http://www.nami.org/Content/ContentGroups/Legal/Advance_Directives.htm .

I know myself that there are certain facilities which I would rather die than be admitted to again. I also know that in times of psychosis, I will deny my illness and refuse medication...and that I also frequently need to be restrained. NOW, in a period where I am well, I have opinions about the specifics of these issues: facilities, which types of medication, what type of restraints, and whether or not to "encourage" me to have ECT...all of these I would love to have some control over NOW while I am coherent and reasonable...and I think it is great that some states have approved such things and I applaud them. We need to encourage this in all states! Because face it, a person, when they are lost in a psychotic episode and hospitalized in a facility, is at the mercies (or lack of them) of that institution and it's employees and you as the family member really do not have any idea of, or control over, what is happening to them from the point of their hospitalization onward. And they, because they are not rational or in control of themselves, have even less control over what happens to them than you do. They (we) are often victims of inhumane treatment or forced to undergo treatment which will leave lifelong scars on them (us), not only emotionally but often, cognitively.

The following is an excellent form in PDF format which gives a sample PAD (Psychiatric Advance Directive) which I believe you may print out, fill out and then have notarized -EVEN if you live in a state where they are not recognized yet legally, it cannot hurt to have this on file with your family or caregivers so that, in the event of a mental health emergency they have your wishes on file and they may (or may not) be regarded and honored. http://www.nami.org/Content/Microsites59/NAMI_of_Southwest_Louisiana/Home56/Resources12/Advance_Directive_for_Mental_Health.pdf

So think it over and NOW while there is opportunity, take charge of your future! You never know when life can throw you a curve ball, and if you wait til the pitch is thrown, it is too late!