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Why is an Advance Directive Important to Family Members?
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When a member of your family has a
mental illness, crises can occur.
During these times, you and/or your
family member want treatment which
will help resolve the crisis. On
occasion, overtures for treatment
are rejected, resulting in an
application for commitment.
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Commitment procedures can even divide
families when only the person with a
mental illness is involved in the
commitment process. That is, families
are affected even when a person who
is not a relative files an application
for commitment. It is particularly
difficult when a family member files
the application for commitment. The
application procedure involves
describing behaviors defining a mental
illness and indicating reasons why the
applicant believes the family member
is a danger to self or others. The
applicant must testify, under oath,
regarding the allegations set forth in
the application. The result of an
application for commitment may be
confinement in a setting and with
treatment not accepted by the
individual who is committed.
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Creating and sharing an
advance directive can provide
information about treatment
the family member with a
mental illness wants (and/or
treatment the individual does
not want). Implementing that
advance directive can help make
it unnecessary for an application
for commitment: acceptable and
desired treatment can be provided
in the event of a crisis.
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An advance directive can prevent, or
at least decrease the possibility of,
a legal procedure to commit a person
to involuntary treatment. It can
prevent the need to make allegations
about the mental illness and/or
dangerousness. It may prevent a
situation in which a person with
mental illness is taken into custody
by a law enforcement officer. The
advance directive may enable treatment
to be provided early in a crisis,
resolving the crisis earlier than
if all conditions needed for commitment
are evident in the individual's life.
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Family members may be involved in
creating an advance directive,
increasing participation and
cooperation in treatment and enhancing
family relations.
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Should I Insist that my Family Member have an Advance Directive
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Creating an advance directive
is a very personal activity.
Whether or not you have created
an advance directive concerning
life supports or organ donation,
consider how personal that is.
It is the same with an advance
psychiatric directive. A person
with a mental illness must be
allowed to decide on his or her
own whether an advance
directive is desired.
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Informing a family with a
mental illness of the
possibilities of an advance
directive and how it might be
developed can be helpful.
Information about advance
directives can be obtained
from this toolkit or from your
attorney. It is important to
provide as much information as
possible; no one should enter
into such an agreement without
a full understanding of the
meaning of such a document.
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What can be done to Suggest an Advance
Directive?
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Talk to your family member with
a mental illness when he or she
is not in crisis. Advance
directives should not be written
during a psychiatric crisis.
Explain in your own words what
you know about this kind of
document.
Offer
to participate in creating the
advance directive. It is best
to not insist that you
participate in creating the
advance directive.
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If you are the family member
who would typically file an
application for commitment,
you might describe how it feels
to have that responsibility.
You may want to indicate that
you believe that self-directed
treatment is preferred to forced
treatment. Your local Alliance for
the Mentally Ill can provide
information about the benefits
of self-directed treatment.
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What Role Should I Have in Creating an
Advance Directive?
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As a family member of a person
with a mental illness, you
should only become involved
in creating an advance directive
when your involvement is
requested. That is, if you decide
to inform a family member with a
mental illness that this process
is available to him or her, that
should be the extent of your
involvement--unless he or she
requests information or suggestions
from you.
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It can be helpful to suggest
information that is included
in an advance directive. You
have probably observed the
family member with a mental
illness when he or she is in
crisis. You know, from
experience, what treatment(s)
seem to be acceptable and
helpful. You probably know what
treatment(s) are not acceptable
or do not help quickly resolve
a crisis. Your family member
with a mental illness may
appreciate this information.
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Do not be disappointed if your
knowledge or impressions are
rejected. Do not insist that
what you think is helpful be
included in the advance directive.
An advance directive is personal;
a person creating an advance
directive must be free to make his
or her informed choices about what
is included.
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What if my Family Member Writes an Advance
Directive but does not Inform me?
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A person who writes an advance
directive must only inform those
persons he or she wants to know
about the content. It is possible
to inform others that there is
an advance directive, but not
reveal its content. That is the
option of the person who writes
it.
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If you believe there is an advance
directive, you should ask who has
been informed of the contents. That
will help you when you believe there
is a crisis and the advance directive
should be implemented. Do not expect
that you can
require
implementation of an advance
directive. An advance directive can
be rejected by its author at any
time--and the rejection need not be
in writing.
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What if an Advance Directive is Implemented--
but my Family Member's Crisis Continues?
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Implementing an advance directive
does not assure resolution of a
crisis. Sometimes, the crisis is
such that desired treatment does
not result in a resolution.
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When a crisis reaches a point that
a mental illness is likely to cause
harm to your family member or to
others, the only resolution may be
commitment to involuntary treatment.
The availability of an advance
directive may help determine the
outcome of an order for involuntary
treatment.
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It is likely that a person with an
advance directive will bring it to
the attention of the Court. As an
alternative, the individual's
attorney may introduce the advance
directive as evidence of the kind
of treatment the individual wants
in the event of a crisis. The
advance directive does not
guarantee that this will be the
treatment ordered by the Court; it
is to the discretion of the Court
as to what to order.
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REMEMBER:
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You can
suggest
an advance directive;
it is up to the person
with a mental illness
to design and write such
a document.
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Your Ideas on the content
of an advance directive may
be solicited; they should
not be forced.
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Any advance directive can be
made null and void by the
person who wrote it.
Rejection does not need to be
written.
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When a crisis develops to the
point an individual may be
dangerous to self or others,
commitment proceedings may be
necessary. Even then, the
content of an advance directive
may be used to determine
treatment.
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