*Top Ten Tips Sourced from the Minnesota Disability Law Center Advanced Psychiatric Directive and Healthcare Directive

1. Write your directive at a time when your condition is not severe enough to impair your judgment or to raise questions about the validity of the document.

You do not want to fill out an advance directive while you are in the hospital or under commitment, unless the professionals treating you agree that your capacity is presently not impaired.

2. Think of your directive as part of a relapse and crisis prevention plan that kicks in when you aren’t making sound decisions because of your mental health and/or substance use condition.
3. Sit down and discuss the directive with people you trust and who can give you feedback about your concerns and your problems in times of crisis.

Ask them what they would include in the directive if they were you.  You do not have to include their suggestions, but enlisting others may invest them in making it work.

4. Discuss your treatment concerns, and the instructions you are thinking of putting in the directive, with those who will be involved in your treatment and care.

Include your doctors, case manager, therapist, PCA—those who involved in your care.  Do this before you write your directive.

5. Discuss the contents of your advance directive with the person you are thinking of being your agent, before you finalize your directive.

Can that person carry out the instructions and be a good advocate for you? 

6. What goes into the directive must be decided by you.

If you are not comfortable with what is in the directive, if it reflects pressure from others rather than your own choices, then it is more likely that you will reject it when you are in crisis.

7. Include your knowledge of what works for you based on your own experiences.

While this is a legal document, it should not be in legalese.  Use your own words to describe your needs in time of crisis, what works for you, and what hinders progress. 

8. Read over the form first so you understand it, and do a draft.

Do not be afraid to ask for help. 

9. Think about the following things that you may want to address in your directive:
  • What is the best way to describe your mental health problems and what triggers your crises?
  • What are your experiences, wishes and concerns about medications and ECT?
  • What are your wishes and concerns about the use of time out, seclusion, restraints, searches? For example, is restraint  contraindicated by your personal history?
  • Do you have a cognition problem or communication barrier that you want providers to be put on notice about?
  • What works well for you?  Exercise? Time to be alone? Visits from family/friends?  Assurances that the rent is paid or your family is being cared for?
  • If you are a smoker, find out your options —patches, smoking spaces, etc.
10. A directive does not give you more than what you are otherwise entitled to.

Be reasonable in what you put in the directive.  Do not include treatment or services you know you will not be able to get.  Remember too that there are standards of care that your providers will have to take into consideration. A directive is not a wish list, but is your instructions on what does and doesn’t work for you.

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