What are the implications of the Patient Self-Determination Act (PSDA) for the use of Psychiatric Advance Directives?

The 1990 Patient Self-Determination Act requires that many hospitals, nursing homes and other health care facilities provide information about advance health care directives to adult patients upon their admission to the healthcare facility. Patients are given written notice upon admission to the facility of their decision-making rights, and policies regarding advance health care directives in their state and in the institution to which they have been admitted. Individuals with mental illness may establish an advance directive for health care (generally this is used for end-of-life care), establish a health care agent for health care, and/or establish an advance directive or health care agent for mental health care, to be used in the event the person becomes incapacitated.

The National Resource Center on Psychiatric Advance Directives (NRC-PAD) provides a state by state guide to regulations and also includes appropriate PAD template forms for use in each state where PADs are legally accepted.

SAMHSA has recently released A Practical Guide to Psychiatric Advance Directives in its Evidence-Based Practices Resource Center. The report provides background and practical information to those interested in promoting the use of PADs as a tool for promoting self-directed care in psychiatric treatment, making progress toward parity in mental health treatment. It also supports crisis planning and the rights of persons who live with mental illness.

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