advanced directives: sharing your choices in case of crisis
DESCRIPTION
Psychiatric Advanced Directive It’s a right to share your decisions ahead of time Oregon Revised Statute – https://www.oregonlaws.org/ors/ https://www.oregonlaws.org/ors/ Declaration for Mental Health TreatmentTRANSCRIPT
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Advanced Directives: Sharing YOUR Choices in Case of Crisis
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Why a Psychiatric Advanced Directive?• Trauma Informed Approach• Transparency• Empowerment• Voice and Choice• Addresses potential cultural and gender issues
• Physical Advance Directives http://www.oregon.gov/DCBS/insurance/shiba/Documents/advance_directive_form.pdf • Many hospitals/PCPs keep these on file• Express a person’s wishes regarding life support
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Psychiatric Advanced Directive
• It’s a right to share your decisions ahead of time• Oregon Revised Statute
127.700 – 127.737• https://
www.oregonlaws.org/ors/127.700
Declaration for Mental Health Treatment
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When?• For times when a person is experiencing a mental health crisis and• For times when a person is unable to share directions or
wishes regarding treatmentor• For times when a person wants a trusted person to make
decisions
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How?
• A Declaration for Mental Health Treatment goes into effect if • A court or 2 doctors have
decided • A person is unable to
understand and make decisions
• About their mental health treatment
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Why?• People can think ahead and
share their choices before a crisis happens
• Usually, treatment history is shared in a crisis – wishes are not
• THIS is how people can be sure providers know what their choices are - about their care
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What?• You can share your
decisions around medication• What to use• What not to use
• You can share your wishes about treatment
• You can select a trusted person to make decisions for you
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Where?• A Declaration needs to be ACCESSIBLE!
• If there is a representative, both people should have a copy.
• The primary mental health provider/team should have a copy.
• The local crisis response team should have a copy, if possible
• It could be uploaded on PreManage for ER staff to access
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How Often?• A Declaration is valid, in Oregon, for 3 years.
• A new one must be done every 3 years, to remain in effect.
• Changes can be made to a declaration• Challenge is to be sure to get all old copies and replace with the
new one.
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Details: State Recommended Form
• From statute: 127.736• Person must be mentally
competent• Person must want to do this, it
cannot be forced• Person decides - Decisions for
the individual can be made by • A trusted person
(representative) or• By the mental health provider
• Use this form to share the person’s directions or wishes
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Representatives• Someone the person trusts to make decisions on for them• There can be an alternate
• Representatives use the Declaration to inform their decision-making
• If something comes up that is not covered in the Declaration, they must make a decision as close to the decisions the person would make as possible
• The representative must be asked ahead of time, agree, sign the declaration, and keep a copy of it
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I consent to…• Lists the things the person consents to –
the more specific and comprehensive this list is, the better• Consider addressing:
• Medications – type and dosages• Short-term inpatient treatment programs• Stating preferred provider(s) and facility• Electro Convulsive Treatment (ECT)• Other specific treatments• Eye Movement Desensitization and Reprocessing
(EMDR)• Light Therapy• More
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I do not consent to…• List the things the person expressly refuses to give consent to
– the more specific and comprehensive this list is, the better• Consider addressing:
• Medications – type and dosages• Short-term inpatient treatment programs• Stating provider(s)/facility do not want to use• Electro Convulsive Treatment (ECT)• Other specific treatments• Eye Movement Desensitization and Reprocessing (EMDR)• Light Therapy• More
• Consider stating the reason(s) why not
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Additional Information…• …About the person’s Mental Health
Treatment Needs• Consider including:• Health history
• Mental• Soothers• Triggers
• Physical• Dietary Requirements• Religious/Spiritual Concerns• Important contact information/people
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Signed and Witnessed• A Declaration of Mental
Health Treatment needs to be signed and witnessed• Signed by Person,
• in presence of 2 witnesses• Signed by representative
(and alternate representative), • both witnessed by 1
person; • does not have to be the
same person
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Questions
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Advanced Directive Resources• Information available online:• http://www.nrc-pad.org/• https://www.oregonlaws.org/
ors/127.700• http://www.dshs.wa.gov/dbhr
/advdirectives.shtml• http://mhapa.org/resources/
MHAD.htm• http://www.maine.gov/dhhs/s
amhs/mentalhealth/rights-legal/advance-directives.html
• http://www.oregon.gov/DCBS/insurance/shiba/Documents/advance_directive_form.pdf
• http://www.oregon.gov/OHA/amh/forms/declaration.pdf