Mental Health Advance Directive - A Consumer's View
Submitted by: L. McNeill
It seems as though I have battled delusions as frequently as Don Quixote challenged windmills. I was diagnosed with depression with psychotic features in 1992, then after a second episode in 1999, I was diagnosed with bipolar II disorder. Each time my delusions were the “run of the mill” FBI wiretaps whereby I falsely believed that the FBI recorded my conversations, impinging on my free speech, or planted electronic devices that tracked my whereabouts. My doctor filed a petition to have a treatment guardian appointed, and the court ordered a complete stranger to make medication decisions for me because I was incapable of doing so. My first psychosis ended after six months when the doctor, with the consent of the treatment guardian, prescribed an injection of an anti-psychotic drug that can cause tardive dyskinesia, a condition of uncontrollable shakes and jerks. This side-effect can become permanent, usually with regular use of the drug. This old school drug brought me relief and caused no temporary or permanent shakes or jerks.
The second time I became psychotic, it was again for a period of six months and I felt like a guinea pig for new anti-psychotic drugs. The first caused my weight to balloon to 165 lbs, and I slept twenty/seven, but it did not relieve me of the symptoms of my psychosis: imaginary sting operations, wiretaps, and tracking devices. Another second generation anti-psychotic drug that the doctor prescribed caused me to vomit, and I refused to continue taking it. Again, I found myself in front of a hearing officer who ordered that my sister be appointed as my treatment guardian, and she made medication decisions for me. She recommended the medication that caused me to vomit. (The doctor thought the flu caused the vomiting.) I refused to take it. Finally, the doctor with my sister’s consent prescribed the anti-psychotic drug that stopped my delusions in 1992. It cleared up my mind. Why it wasn’t used as the first line of defense in 1999 still baffles me.
Subsequently, I instructed my newest doctor that if I became delusional, he was to administer the first generation medication.
In 2006, like a seven year alarm clock, psychosis hit again. My delusions this time surrounded the Albuquerque Police Department controlling stop lights so I couldn’t cross busy intersections and the belief that Oprah, every girl’s dream, would be asking me to be on her show. I even went on a shopping spree to buy appropriate clothing. Through conversations with my doctor, I opted for a combination of the first generation anti-psychotic medication and electro-shock therapy. To my great relief and my family’s, my psychosis ended in a month.
New Mexico has now enacted a new law, allowing a person to draft an advance directive for mental health treatment (HB459). I spent more time shopping for Oprah’s show than filling out the advance directive form, advising my family and doctors how I wanted to be treated in the event that psychosis befalls me again.
I have bipolar disorder; the disorder does not define me. I have control over how I will manage my bipolar disorder. I have elected to be informed, aggressive and affirmative in letting others known how I am to be medically treated in the event that I no longer have the capacity to make informed decisions concerning my well-being. The new law allows me to do that.
The Mental Health Care Treatment Decisions Act allows individuals with mental illnesses to make their own decisions concerning their mental health care if they become incapacitated. Capacity is defined as “the individual’s ability to understand and appreciate the nature and consequences of proposed mental health treatment, including significant benefits and risks and alternatives to the proposed mental health treatment, and to make and communicate an informed mental health treatment decision.”
Under this act, consumers make decisions concerning selection and discharge of health care or mental health treatment providers and institutions; approve or disapprove of diagnostic tests; and direct mental health treatments. We can also make decisions concerning the designation of an agent to make mental health treatment decisions for us; provided that we have the capacity to make those decisions at the time that we draft our intent on paper.
Although the law has a template form for someone to complete, the form is not necessary. A person, who has a mental illness and has the capacity, can simply declare in writing that he or she wants his or her mental health care provider to take specific action if he or she is mentally incapacitated and unable to refuse or consent to mental health treatment. The consumer should have someone sign that he/she witnessed the consumer sign the advance directive.
The advance directive should address the following:
- State who are the doctors that you want to treat you and those that you do not want treating you.
- Write down your doctor’s contact information so that your family knows who to call. (I recommend that a family member or trusted friend and your physician be provided copies of your advance directive when you are competent.)
- Advise the doctor what persons you want notified if you are ill and incapable of making medical decisions.
- List what medications or treatment that you are willing to have administered and the ones that you don’t want administered. (You can write the reasons why you don’t want to take certain drugs—in my case, a specific drug made me vomit.)
- Indicate whether you have certain allergic reactions to drugs or object to any drug that causes significant weight gain.
- State whether you are willing to try new drugs that your doctor recommends.
- Indicate whether you consent or deny consent to the administration of electroconvulsive therapy.
The following items can also be listed in the advance directive:
Indicate who you want as your agent to make decisions for you or oversee the doctors to ensure compliance with your advance directives.
Consent to or deny consent to hospitalization.
List the hospital where you want be admitted.
State the interventions that should be done before you are admitted into the hospital.
Authorize who can visit you in the hospital and who cannot.
List preferences and instructions about seclusion and restraints if you are admitted to the hospital.
If you deny the permission for hospitalization, your doctor still has the option of seeking hospitalization through the mental health commitment code. The doctor can seek a mental health commitment proceeding to put you in the hospital if you are a danger to yourself or others.
In New Mexico, doctors have to follow your advance directive unless the treatment requested is infeasible or unavailable; the facility or provider is not licensed or authorized to provide the treatment requested; or the treatment requested conflicts with other applicable law.
I encourage everyone to take control of their mental health needs and fill out the mental health directive for their benefit, benefit of the treating doctors, and benefit of family members or friends who want to know what your preferences for treatment would be.
A full discussion of advance directives will be in the Winter issue of the NAMI Albuquerque newsletter - "Challenger".
You can find a copy of the advance directive form at the NAMI office.
A PDF version of HB459 "MENTAL HEALTH CARE TREATMENT DECISIONS ACT" can be downloaded at the bottom of this page under "Related Files". An optional version of the advance directive form can be found on pages 16 through 26 of this document. The document also provides definition of terms and other useful information.
NAMI Albuquerque office hours are Monday through Friday from 10:00 AM to 1:00 PM. Call ahead to make certain that the office is open and that forms are available. Phone: 505-256-0288
6001 Marble Ave. NE, Suite #7
Albuquerque, NM 87110
MENTAL HEALTH CARE TREATMENT DECISIONS ACT (PDF File)