The Denverchannel.com: Legal Document Gives Voice To Mental Health Patients

Psychiatric Advance Directives Tell Doctors How Patients Want To Be Cared For

POSTED: 11:54 pm MDT September 13, 2008
UPDATED: 12:06 am MDT September 14, 2008
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According to the National Institute of Mental Health, mental disorders are common in the United States and internationally. More than 26 percent of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year. That translates into about 58 million adults, including 13 million adults struggling with severe mental illness.

Many people suffer from more than one mental disorder at a given time. In fact, nearly half of those with any mental disorder meet the criteria for two or more disorders.

The burden of mental illness on health and productivity is vast. Research collected by the Global Burden of Disease study conducted by the World Health Organization, the World Bank and Harvard University shows mental illness, including suicide, accounts for more than 15 percent of the burden of disease in established market economies such as the United States. This is more than the disease burden caused by all cancers.


Some common types of mental illness include the following:

• Anxiety disorders: This category includes generalized anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder, panic disorder, social anxiety disorder and specific phobias.
• Mood disorders: The most common mood disorders are depression and bipolar disorder.
• Psychotic disorders: Schizophrenia is an example of a psychotic disorder.
• Eating disorders: Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common.
• Impulse control and addiction disorders: These may include acts like gambling and kleptomania.
• Personality disorders: Examples include antisocial disorder and paranoid personality disorder.

Many mental health patients worry they will not be able to communicate their wishes in the event of an emergency. Now, a legal document known as a psychiatric advance directive (PAD) may help. The document is designed to instruct health care professionals, family members and friends about how mentally ill patients are to be cared for when they are incapacitated.

Patients can give instructions on what medications or treatments to use and what hospital is preferred. Like a living will, most PADs require two witnesses and notarization. A 2006 survey conducted by researchers at Duke University Medical Center found less than 15 percent of patients have completed PADs. Researchers also found use of the documents reduced the use of coercion during a mental health crisis and improved patient-doctor relationships. While this document can be helpful, doctors can override parts of it if they believe there is a better treatment for the patient.

Completing a PAD is free. The documents are available in about 25 states throughout the country. To find out more about how you or a loved one can create a psychiatric advance directive, log onto NRC-PAD.org