What is a Psychiatric Advance Directive?
A psychiatric advance
directive (PAD) is an instruction regarding the treatment and care
an individual wishes to receive when he or she is in a crisis and
is considered to lack the capacity to make informed decisions about
mental health treatment. The PAD is executed at a time when the
individual is not in crisis and is considered to have the capacity
to make informed decisions about treatment preferences. The PAD
can also be a document in which an individual gives legal authorization
to another person to act as a proxy decision maker when the individual
is no longer considered to have the capacity to make those decisions.
Many PADs combine both forms – the instructional and the proxy document.
of the PAD
For years, New Jersey
did not have a law that supported psychiatric advance directives.
Individuals who received mental health treatment in the community
or in hospitals had very little control over the type treatment
they received when they became ill. However, New Jersey had passed
legislation allowing individuals to execute advance directives for
health care to instruct doctors and others regarding the health
care they wanted at a time when they were unable to communicate
their wishes. Disability Rights New Jersey (formerly New Jersey
Protection and Advocacy) realized the inadequacy of the advance
directive for health care, which usually pertained to end-of–life
decisions, to address the needs of individuals wishing to communicate
their mental health treatment preferences to treating mental health
professionals. In an attempt to rectify this problem, DRNJ adapted
the advance directive for medical care by adding to it a mental
health care treatment instruction. The execution of this dual advance
directive was daunting and it was unclear whether the mental health
care treatment instruction would be legally enforceable.
In 2007, the Legislature
passed the New Jersey Advance Directives for Mental Health Care
Act recognizing that “persons with mental illness and their psychiatric
needs warrant enactment of a separate statute governing directives
for these individuals.” The instructions that were developed as
a result of this act were used by some savvy consumers who were
not intimidated by legal language as the available forms followed
the structure of the medical advance directives. However, many mental
health consumers shied away from executing these directives, in
part, because of their often negative experiences with the legal
DRNJ realized early on
that the information that was needed to execute a directive for
mental health care is very similar to the information consumers
needed to complete the Crisis Plan of the Wellness and Recovery
Action Plan (WRAP) ©, developed by Mary Ellen Copeland and Jane
Winterling. A WRAP is a self-management recovery blueprint, designed
to decrease psychiatric symptoms, promote personal responsibility,
and increase the quality of life for individuals. Many individuals
living with mental illness have prepared such a plan to help cope
with their symptoms or are, at least, familiar with the term WRAP.
DRNJ collaborated with
the Mental Health Association of New Jersey (MHA-NJ), an agency
that has been promoting WRAPs in their mental health programs throughout
New Jersey, to develop a psychiatric advance directive that combined
the familiar language of the WRAP Crisis Plan with the legal requirements
of mental health advance directives. The result is a consumer-friendly
document that can be easily understood by consumers and can be completed
with minimal assistance.
Recently, the Governing
Board of Collaborative Support Programs of New Jersey (CSP-NJ) voted
unanimously to make psychiatric advance directives a board initiative.
CSP-NJ-sponsored PAD kick-off events throughout the state to ensure
that individuals with mental illness have the opportunity to become
effective partners in their mental health treatment.
The form can be downloaded
below or from the MHA-NJ website, along with instructions for its
completion and a copy of a registry form. An individual has the
opportunity to register the competed PAD with the Division of Mental
Health and Addiction Services (DMHAS) to help ensure its availability
in a crisis.
Directive Form (pdf)
Directive Instructions (pdf)
Directive Registration (pdf)
Directive Form in Spanish (pdf)
Directive Instructions in Spanish(pdf)
Directive Registration in Spanish
Directive Registration Card (pdf)
Health Association of New Jersey