Family and Caregiver Schizophrenia Discussion Forum

Now Mental Health Patients Can Specify Their Care Before Hallucinations and Voices Overwhelm Them

Increasingly, patients, advocates and doctors believe such directives (called PADs) could help transform the mental health system by allowing patients to shape their care even when they lose touch with reality. Hospitals must put them in patients’ medical records and doctors are expected to follow them unless they document that specific preferences aren’t in the patients’ best medical interest.

As the pendulum has swung from institutionalization to outpatient care, psychiatric directives also offer a middle path by allowing patients to designate family members to speak for them when they’re too sick to do so themselves.

But some doctors and hospitals are wary that the documents could tie their hands and discourage treatment they consider warranted. Some worry the directives won’t be updated to reflect medical advances. Others question whether people with serious psychiatric conditions are ever capable of lucidly completing such directives.

Still, early research and experience suggest that PADs, authorized by law in 27 states and possible in others as part of conventional medical advance directives, could help some of the millions of people with serious mental illness cope better and guide doctors treating them.


Oh thank you so much for posting this!! I looked up my state, Florida, and was surprised that this is already in place and no one has ever told me about it, including NAMI.

It will be great to get this in place for my daughter, and for my sons who are worried about “what if?..” (since their sister became ill).

I need to get my own directives in place, well, just because older folks sometimes develop dementia (hopefully not me, but “what if?..” and I haven’t even gotten a will written, etc.

I really appreciate this wonderful post and article.


Details on these, and sample Advance Directives available at the following links:


The comments were even more interesting than the article itself, which is often the case with NYT articles.

No mention in the article how anosognosia might affect the implementing of an advanced directive. My understanding is that ADs go into effect when a patient is not able to make his/her own medical decisions.

What happens if the patient tells the treating doctors, “I’m not sick. Ignore that document. I can make my own decisions.”? Or, “I’ve changed my mind. Rip that thing up.”?