Mental Health Legal Centre Inc.

Why Write An Advance Directive?

Please note:  We are seeking feedback on both this section and the draft form we have created as well as seeking consumers for discussion groups on the subject.  Please send all expressions of interest and comments to sara_clarke@clc.net.au 

 

Why write an Advance Directive for Mental Health?

Firstly, it is important to note that an Advance Directive for Mental Health is not a replacement for Enduring Powers of Attorney, we recommend that all prepare those (as discussed at http://www.publicadvocate.vic.gov.au/Powers-of-attorney.html which also has forms available for download) as well as an advance directive.

So why prepare an advance directive at all? The simple fact is that (hopefully) none of us go to hospital when we are well so hospital and crisis staff usually only see us when we are unwell. That tells them little about who we are and our home life, our personal understandings of what works and what doesn’t for our mental health and the people and things we rely on (and who rely on us) in daily life. These things are important.

The cat doesn’t stop needing food because we have been taken away, we don’t cease being allergic to broccoli because we are admitted and we may or may not consider our family to be those written in the file as relatives. Your doctor or psychiatrist may have prescribed something you reacted badly or well to that isn’t recorded in your file. Perhaps you find a hand on the shoulder reassuring when in crisis or perhaps personal touch is unbearable. You may have a friend who always wants to visit you in hospital but you would rather not see them at that time. Work or school may need to be notified of your absence but told something that will not bite you later.

An advance directive gives you the chance to sit down when well, work out what needs to be done and what works best for you should you become unwell and have that information available to the hospital or clinic when you need them to know but may be in a poor position to explain and have your wishes taken seriously. Your advance directive can also name those who hold your Power(s) of Attorney and ensure they are notified to commence their work on your behalf.

Witnessing

Advance directives have no legal weight in Victoria as yet (though we are working on that) but our hope is that as more and more people prepare and file them that they will gain respect and understanding and be seen as a useful tool by consumers, carers and services alike. For this reason we suggest that the witnessing be taken very seriously and that the person witnessing your document has qualifications that will make it hard for others to say that your stated wishes are without validity. The witness has to sign your advance directive and say that:

• he or she saw you sign your advance directive;
• you are, in their opinion, well enough to understand and intend the effects of your advance directive.

Our hope is that those witnessing will take a little time with you so their signatures and qualifications add weight to your advance directive. We suggest that you have it witnessed by a:

• Medical Practitioner
• Psychiatrist
• Clinical Psychologist
• Nurse
• Social worker/Allied Health Worker or
• Solicitor

If someone in the above groups helps you write your advance directive it is preferable to find a less involved witness so there is no appearance of pressure to state preferences that are not really your own.

How to go about it

Take time to think about what you want people to know about the whole you and your life that you may not be able to get across if unwell (our form* has a part for this process) and perhaps even talk with others who have experience of you during those times as to what could be included.

We suggest that you be wary of asking for one specific medication or other treatment as things are constantly changing and you may miss out on something newer and better by being too specific. Today there may be only two choices, by the time your advance directive is read there may be several more. One thing may give you bad reactions you wish to avoid so it is better to write, for example, that you do not want medication X in your advance directive rather than saying that you will only take Y as you may then miss out on Z that is newly out and may suit you better.

Please make sure that you ask anyone you name as having a role to play if they agree to take on the responsibility and explain what you would like them to do in a time of crisis. You may wish to provide them with a copy for their own reference.

We have a form* that you are welcome to download and fill in on a computer or by hand but your advance directive does not need to be in any particular style. Some people may want to present a lot of information, others may just want to list medications they know to be problematic for them or name an advocate. How you do it is totally up to you. We hope many consumers choose to have their say in this way and that one day preparing advance directives becomes routine for consumers and referring to them routine for staff.

Once you have completed your advance directive we recommend sending it to the clinic who hold your file. If you have no existing records you may choose to entrust your advance directive with someone who is likely to be aware of your crisis so they can present it at the earliest opportunity. 

Withdrawing your advance directive

Should your circumstances change and you wish to replace your advance directive with a new one we recommend a formal and witnessed withdrawal of your original be included with your new version. Our form has a section for this.

Crisis Card

It may also be worthwhile for you to consider carrying a “crisis card”. A crisis card is a piece of card or paper that fits in your wallet or purse to be found by police/ambulance/hospital staff should you be unable to communicate well and says something like:

My name is Joe Bloggs and I have schizophrenia. If I appear distressed please contact: Mary Smith (Partner/Agent Power of Attorney (Medical Treatment)) ph: 1234-1234 Fred Bloggs (brother) ph: 8888-8888 Dr Frida Blinks (GP) ph: 4321-4321 My advance directive for mental health care is held at Healthy Clinic, 1234 Main Street, Bigtown

You can include any information that you wish, the idea is purely to try to make sure that even if deemed unable to make decisions for your care that your planning, wishes and self knowledge have the best chance of being heard when you most need them to be.

 

*To use our advance directive form you will need to have a PDF (Portable Document Format) reader installed on your computer. The Adobe Acrobat Reader is available free of charge from Adobe's website.