May 14, 2026 ~ Triage Health is proud to collaborate with dedicated professionals who share our commitment to ensuring that individuals diagnosed with cancer and their caregivers have access to clear, accurate information about their rights and options. This blog post is written by Sarah Kelman (SarahKelmanLaw.com), a member of Triage Cancer’s Legal Advisory Council:
A mental health crisis can make it hard for you to express your needs. Planning ahead while in a period of stability can help you, your caregivers, and your health care providers know what to do if a crisis arises.
You may be familiar with an advance directive, a legal document that expresses your health care wishes and names someone to make health care decisions when you can’t, commonly connected to end-of-life care.
What Is a Mental Health Advance Directive?
A mental health advance directive is very similar: it is a legal document to express your mental health care wishes and name someone to make decisions about mental health care when you are unable to make decisions. A mental health advance directive (MHAD), also called a psychiatric advance directive (PAD), acts as your voice in the shared decision-making process of mental health care. Importantly, MHADs do not replace day-to-day consent when you have decision-making capacity.
What Can an MHAD Include?
MHADs can contain a wide range of information. You can include mental health care treatment preferences, such as medications, therapies, and crisis stabilization techniques that have helped you, or hospitalization preferences. An MHAD can also identify your health care agent, also known as a psychiatric proxy. Relatedly, an MHAD can include privacy releases that allow providers to speak with people you’ve chosen in advance. Additionally, MHADs can contain practical crisis information, such as early warning signs, de-escalation strategies, and emergency contacts.
What Are the Limitations of an MHAD?
MHADs do have limitations. MHADs cannot require a provider to offer a treatment that is unavailable or medically inappropriate. In some states, patients may not be able to use an MHAD to refuse certain interventions in every circumstance.
Who Should Consider an MHAD?
While MHADs have historically been made by people with substance use disorder or severe mental illness, like schizophrenia, bipolar, or major depression, MHADs could benefit anyone with a condition that can involve periods of impaired decision-making capacity. Impaired decision-making capacity can result from developmental or disease processes, cognitive impairment, neurocognitive disorders, or brain injury.
You should consider an MHAD if you receive a diagnosis of:
- Alzheimer’s disease
- Vascular dementia
- Lewy body disease
- Parkinson’s disease
- Traumatic brain injury (TBI)
- Frontotemporal degeneration
- HIV infection
- Huntington’s disease
- Prion disease
- Amyotrophic lateral sclerosis
- Multiple sclerosis
- Multiple system atrophy
How Can an MHAD Help?
MHADs can help. They improve communication with health care providers during emergencies, reduce conflict and guesswork for caregivers, and reduce the risk of retraumatizing experiences by documenting triggers and preferences. Studies have shown that people with MHADs are less likely to be hospitalized involuntarily and less likely to be violent. Some researchers suspect that these positive outcomes may be due to patients’ increased sense of control or may be due to care providers’ greater knowledge of what has worked for the patient in the past.
How to Create an MHAD
Creating an MHAD is easier than you think.
- Find your state’s rules and forms at the National Resource Center on Psychiatric Advance Directives.
- Describe your preferences in clear, specific language. Include what helps you and what makes your condition worse.
- Choose a trusted decision-maker. It’s best to include them in making your MHAD so they can understand the values behind your preferences. Understanding your values can help when a clinician offers your trusted decision-maker a choice among options that were not documented in your MHAD.
- Review the MHAD with your mental health care team to refine it.
- Comply with your state rules for finalizing it.
- Distribute it. Give a copy of your current MHAD to your trusted decision-maker and care team. Keep a copy on your phone. Upload it to your patient portal.
Tips for Caregivers
What if you are the caregiver of a person with a condition that can involve periods of impaired decision-making capacity? Bring up an MHAD gently. Focus on supporting autonomy, not taking over. If your loved one has an MHAD, as with any other advance directive, present the document early in a crisis and ask the staff to add it to the chart.
Additional Resources
There are resources available to learn more. The National Resource Center on Psychiatric Advance Directives collected several resources on its Getting Started page. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a great document, A Practical Guide to Psychiatric Advance Directives. The National Alliance on Mental Illness (NAMI) has a NAMI Guide to Psychiatric Advance Directives directed at military-connected people, but with information that is generally applicable.
Consider making an MHAD as part of your whole-person care planning today. It’s important to make this document before health conditions progress and cognitive impairments increase.
