What is the role of a health care agent in a psychiatric advance directive?

A health care agent is an individual identified in a psychiatric advance directive who is empowered to make decisions about mental health care if a person becomes incapable. The health care agent must follow the instructions in the psychiatric advance directive and act in accordance with the individual’s wishes. The health care agent can make a range of decisions including discussing treatments, communicating with or changing a health care provider, admission to a treatment facility, and using medications and other treatments, including electroconvulsive therapy. In a case where a patient is not capable of making mental health decisions and has designated a health care agent, providers should work closely with that agent to ensure that treatment conforms to the patient’s stated preferences. Providers can also help patients to identify health care agents before a crisis occurs. 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. You can find more information here.

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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