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Psychiatric Advance Directive

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.

Legislative History 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 system.


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.

Suggested Links

Advance Directive Form (pdf)

Advance Directive Instructions (pdf)

Advance Directive Registration (pdf)

Advance Directive Form in Spanish (pdf)

Advance Directive Instructions in Spanish(pdf)

Advance Directive Registration in Spanish (pdf)

Advance Directive Registration Card (pdf)

Mental Health Association of New Jersey

Traumatic Brain Injury Resources

Grievance and Appeal Policy





New Jersey's designated protection and advocacy system for people with disabilities

Disability Rights New Jersey
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