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Legal doc gives voice to mental patients

September 23, 2008 12:00:00 AM PDT
You've probably heard of a living will -- a legal document that expresses the wishes of a patient who can't speak for himself. But who will speak for you if you're in the midst of mental breakdown? The solution: writing your preferences down on something called a PAD. Marcia Anders has battled manic depression for most of her life.

"I have had several instances of traumatic experiences," said Anders.

Robert Chokan has dealt with bipolar disorder for more than 30-years. He tried to kill himself three times.

"My life was not worth living. I couldn't see any end to it," said Chokan.

Two patients with two real problems. And one of their biggest fears -- not being in control when an episode strikes.

"I wanted to have something available, living as a single person that would speak for me in the event of an emergency," said Anders.

Now, there is. It's a document called a psychiatric advance directive, or PAD. Patients instruct on who should be the decision maker, what hospital they prefer and which meds work best.

Duke researchers studied pads extensively and found they reduce the use of forced treatments during a mental health crisis and improve patient-doctor relationships.

"Its actually part of a number of important trends towards a more collaborative mode of decision-making," said Dr. Jeffrey Swanson, Professor of Psychiatry and Behavioral Sciences Duke University Medical Center.

About 25 states including California have PADS available. Less than 15 percent of mentally ill patients have completed them. One warning -- a doctor can always override parts of the document if he believes there's a better treatment.

PAD worked for Marcia Anders. During her last hospital crisis, doctors pulled her charts and were given instant info.

"The PAD speaks for me when I can't speak for myself," said Anders.

Robert and his wife know how tough living with a mental illness can be.

"It's something I have to resign myself to having the rest of my life," said Chokan.

But with a psychiatric advance directive, he feels a little more in control.

It's not necessary for a lawyer to be involved in the creation of a pad. Like a living will, most advance directive documents require two witnesses and notarization. Completing a document is free.

Web Extra Information: A voice for mental health patients

BACKGROUND: According to the National Institute of Mental Health, mental disorders are common in the United States and internationally. More than 26 percent of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year. That translates into about 58 million adults, including 13 million adults struggling with severe mental illness. Many people suffer from more than one mental disorder at a given time. In fact, nearly half of those with any mental disorder meet the criteria for two or more disorders.

THE IMPACT: The burden of mental illness on health and productivity is vast. Research collected by the Global Burden of Disease study conducted by the World Health Organization, the World Bank and Harvard University shows mental illness, including suicide, accounts for more than 15 percent of the burden of disease in established market economies such as the United States. This is more than the disease burden caused by all cancers.

TYPES OF MENTAL ILLNESS: Some common types of mental illness include the following:

  • Anxiety disorders: This category includes generalized anxiety disorder, post-traumatic stress disorder, obsessive compulsive disorder, panic disorder, social anxiety disorder and specific phobias.
  • Mood disorders: The most common mood disorders are depression and bipolar disorder.
  • Psychotic disorders: Schizophrenia is an example of a psychotic disorder.
  • Eating disorders: Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common.
  • Impulse control and addiction disorders: These may include acts like gambling and kleptomania.? Personality disorders: Examples include antisocial disorder and paranoid personality disorder.

A NEW VOICE: Many mental health patients worry they will not be able to communicate their wishes in the event of an emergency. Now, a legal document known as a psychiatric advance directive (PAD) may help. The document is designed to instruct health care professionals, family members and friends about how mentally ill patients are to be cared for when they are incapacitated. Patients can give instructions on what medications or treatments to use and what hospital is preferred. Like a living will, most PADs require two witnesses and notarization. A 2006 survey conducted by researchers at Duke University Medical Center found less than 15 percent of patients have completed PADs. Researchers also found use of the documents reduced the use of coercion during a mental health crisis and improved patient-doctor relationships. While this document can be helpful, doctors can override parts of it if they believe there is a better treatment for the patient.

HOW TO GET ONE: Completing a PAD is free. The documents are available in about 25 states throughout the country. To find out more about how you or a loved one can create a psychiatric advance directive, click here.

 

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