Psychiatric Advance Directives (PAD)

A Psychiatric Advance Directive (PAD) is a legal document written by a currently competent person who lives with a mental illness. A PAD allows a person to be prepared if a mental health crisis prevents them from being able to make decisions. A PAD describes treatment preferences, or names a person to make treatment decisions, should the person with a mental health condition be unable to make decisions.

There are two kinds of psychiatric advance directives:

  • An Instructive PAD gives instructions about the specific mental health treatment a person wants should he or she experience a psychiatric crisis.
  • A Proxy PAD names a health care proxy or agent to make treatment decisions when a person is unable to do so.

Most states allow a combination of both instructions and a proxy. At times, a PAD is combined with a general medical advance directive.

Currently, 25 states have laws that permit psychiatric advance directives. For states that do not, an individual can still draft a PAD under the more general statutes connected to health care directives, or Living Wills. However, a PAD is preferred because of the unique issues of mental health care and treatment. These issues can include medication preferences, inpatient treatment considerations and the reality that a person can experience changes in their wellness over time.

For more information on psychiatric advances directives visit the National Resource Center on Psychiatric Advance Directives.

Where We Stand

NAMI supports the development of public policies and laws that encourage psychiatric advance directives. In particular, NAMI supports psychiatric advance directives that include processes for caregivers and health care providers to work together with individuals who live with mental health conditions to not only develop plans for treatment, but also services and supports that may be necessary in the future.

Read NAMI’s Public Policy Platform for more information on our position on psychiatric advance directives (Section 9.3).

What NAMI is Doing

NAMI encourages states to create and/or promote laws that encourage the implementation of psychiatric advance directives. NAMI works with advocates at the state level to encourage the promotion of psychiatric advance directives.

NAMI also serves as a resource on psychiatric advance directives for public policy makers at all levels.