(Advance Instruction for Mental Health Treatment)
A Psychiatric Advance Directive (PAD) is a legal tool that lets mental health doctors know what kind of treatment you want during a mental health crisis. In North Carolina, it’s called an Advance Instruction for Mental Health Treatment. You can use it along with your Healthcare Power of Attorney.
A PAD allows you to decide in advance if you want to agree to or decline certain psychiatric treatments. You can also choose someone you trust to make decisions for you based on your PAD if you’re unable to decide for yourself.
Any adult who is well enough to think about future mental health treatment choices can create a PAD. It’s a legal document that must be signed in front of two witnesses and a notary because they have to witness those signatures also. A witness is an adult who sees you sign the document; they could be a friend, neighbor, or even a stranger.
Some benefits of having a PAD include:
- Improved relationship with your doctors.
- Fewer unwanted crisis interventions.
- Better match between preferred and prescribed medications over time.
- Greater feeling that your personal needs for mental health services are being met.
(Swanson et al., 2006a; 2008; Wilder et al., 2012)
When Are PADs Used?
A PAD goes into effect when you cannot make decisions, as determined by a doctor. Examples of when you might not be able to make decisions include active states of psychosis, mania, delirium, or unconsciousness. Once you can make choices again, the PAD is no longer used.
Doctors must follow a person’s PAD, but there are a few situations when they cannot. These include if the PAD includes something that is not standard care, if what is requested is not possible, in emergencies, or if there are safety issues.
More Resources
- You can download official NC Psychiatric Advance Directive form.
- You can find Frequently Asked Questions about PAD on the National Resource Center on Advanced Psychiatric Directives website.
- You may find a notary near you in North Carolina on the Secretary of State website. They usually charge a small fee (less than $10).
