New Law provides more personalized options in mental health care.
If you’ve ever experienced a mental health crisis, you should know there’s a powerful new tool to give you more autonomy and power if it happens again. In 2020, Nebraska passed a new law that created Advanced Directives for Mental Health Care.
An Advanced Directive allows you to set out your preferences for your mental health care and treatment. It’s planning to do now to help you in a future mental health crisis. Even when a crisis means we have temporarily lost the capacity to make our own mental health care decisions, the Advanced Directive allows us to let our loved ones and providers to know what we do and do not want during our mental health care. In crisis, we may not be able to clearly communicate what we need, so writing an Advanced Directive ahead of time tells everyone our wants and needs.
For example, you might want to designate a specific person to have authority for you while you are in crisis. One Nebraskan told us “I knew my brother, more than anyone else in my life, was someone I trusted. I just didn’t want my parents making decisions for me, so I made sure my paperwork named my brother.” Sometimes privacy laws such as HIPAA can make it hard for your family or friends to find out exactly what is going on with you during a hospitalization. An Advanced Directive lets you name one or more people who can communicate with your providers with full authority.
As another example, you may have tried a certain prescription in the past and found it wasn’t effective—in fact, it had made your mental health worse. When writing up your Advanced Directive, you can set out medications or certain treatments that have helped or have harmed you so the people providing care during a future crisis can avoid ineffective or harmful options. One man explained why he needed clear instructions to help his agent do what he wanted: “My decisionmaker is my mom. She hates the idea of electro-shock therapy because she says it reminds her of the movie ‘One Flew Over the Cuckoo’s Nest,’ but I tell her that was then, and the ultra-brief pulse is better for me than all the side effects from pharmaceuticals. It’s not for everyone, but this is my preference, and I feel a lot more secure to have it in writing.”
Some people have specific facilities where care was effective—and sadly some facilities where they felt they were not treated right. Your Advance Directive can recommend certain places that would be good for your recovery and places you can warn would be problematic for you. One therapist explained, “When a patient of mine is hospitalized, I know their history…but the people there in the moment might not realize that driving the person just one extra mile to a different hospital could make all the difference in their care. Once a patient is admitted, it’s harder to move them. I have been recommending Advanced Directives for everyone I work with.”
Another common topic that is covered in Advanced Directives is who has permission to visit you while you are hospitalized. If there is one individual who you know will be unhelpful to your recovery, you can specify that they cannot come to see you while you are in recovery.
The requirements to create an Advanced Directive for Mental Health Care are very simple: it must be in writing and signed and dated by you. You can either have two witnesses or a notary public witness your signature. (If you decide to use two witnesses, make sure that neither of them is named in the document as having any decision making power—the witness should be disinterested.) Nebraska has created a form that you can use.
And of course, if you change your mind about the Advanced Directive and want someone else to be your decision maker or want to include a new instruction, it’s simple to change. Just write up your new Directive—that will automatically revoke the old one. Or you can revoke the old one by simply informing your caregiver, doctor, etc., that you intend to revoke the original Advanced Directive.
If you want even more reading material on Advanced Directives, the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration has created this thorough guide.
You know yourself better than anyone else, and you deserve to have power in your hands, even during a psychiatric crisis. It is empowering to speak up for yourself and have your wishes considered during emergency care.
Want a presentation to your class, civic group, peer support group, or others about creating an Advanced Mental Health Directive? Contact us for a free presentation by calling us at 1-800-422-6691, or emailing info@disabilityrightsnebraska.org or fill out an online request form.
Amy Miller is a monitoring attorney with Disability Rights Nebraska where she works on a number of issues including monitoring conditions at facilities where people with disabilities reside and voting rights.
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