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Mental health advance directive and Dementia Provision

Living wills apply to physical illnesses. But various forms of mental illness may have effects that some regard as equally catastrophic. Other documents will be needed to guide decisions about treating these illnesses.


A Psychiatric Advance Directive (PAD) is a legal document created by a currently competent person who lives with a mental illness. There are two types of PADs. One describes the person’s mental health treatment preferences, including psychiatric medications, hospitalization, alternatives to hospitalization, seclusion and restraint, and electroconvulsive therapy. The other names a healthcare representative who can make decisions for the person should he or she become unable to make decisions for due to a psychiatric illness. Most states permit either or both of these documents and permits their combination medical advance directives. (Adapted from the work of the NATIONAL ALLIANCE ON MENTAL HEALTH.)


COMPASSION AND CHOICES has a related “Dementia Provision” that can be appended to Living Wills. It stipulates patients’ treatment preferences if they develop Alzheimer’s Disease or other forms of dementia and cannot speak for themselves. States vary in their willingness to honor these documents.

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