If someone you loved had a psychiatric emergency, would you know what to do?
Because many people wouldn’t, Kansas mental health advocates are pushing for the state to recognize psychiatric advance directives to guide care for patients in crisis who are unable to communicate.
Patients most often use advance directives to specify the treatments they want at the end of life, but people with mental illnesses could use a similar document to outline psychiatric crisis treatments, said Mike Burgess, a member of the Kansas Mental Health Coalition. The issue is new in Kansas, although some other states have laws on advance directives for mental health care.
A psychiatric advance directive could clarify medications that have worked or caused serious side effects in the past and specify the mental health providers or family members who can make decisions for the patient, Burgess said.
“If your family is a huge trigger (for symptoms), you can say ‘Whatever you do, don’t call my mom,’” he said. “It helps (patients) get the right care a lot more quickly.”
Patients could use the existing legal framework for medical advance directives to cover psychiatric care, Burgess said, but having a template specifically for mental health would raise awareness and ease the process.
In the legislative session that starts Jan. 9, the coalition will push Kansas lawmakers to adopt a framework for psychiatric advance directives similar to one in Virginia, Burgess said. People with mental illnesses wouldn’t be required to complete an advance directive, but he said some might find it helpful to sit down and think through their options when they aren’t in a stressful situation.
Virginia combined psychiatric and medical care in its 2009 law on advance directives so patients could easily lay out their preferences for multiple situations, said Heather Zelle, an assistant professor with the University of Virginia’s Institute of Law, Psychiatry and Public Policy.
That includes a designated guardian who can make decisions about care if a patient is in crisis, she said, although that provision only kicks in if two physicians determine a patient isn’t competent.
“It’s not just sort of a carte blanche to ignore a person’s ‘no,’” she said.
Under Virginia law, health care providers can be held liable if they know a patient has an advance directive and choose not to follow it, though they can make changes if a patient’s condition requires it, Zelle said. Virginia doesn’t require a lawyer or notary to sign a patient’s plan, but two adult witnesses must attest that the patient wasn’t coerced, she said.
The number of Virginians who have filled out advance directives is unclear, and some patients and providers still are confused about the process, Zelle said. Some people reported that completing an advance directive helped them strengthen their supports and avoid a crisis, but the state hasn’t collected data on patients’ experiences, she said.
If Kansas decides to implement psychiatric advance directives, it should put some resources into training case managers and peer support specialists to help their clients navigate the process, Zelle said.
“A lot of health care providers don’t have a lot of time, sometimes hours and hours, to go through a form with someone,” she said.
Meg Wingerter is a reporter for KCUR’s Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics in Kansas. You can reach her on Twitter @MegWingerter. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.