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Mental health advance directives
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Are you ready to complete a mental health advance directive?
What is a mental health advance directive?
A Mental Health Advanced Directive (MHAD) is a legal document that helps people to plan, consent to, and refuse certain types of mental health care in advance of a crisis. An MHAD helps doctors and support teams know what care the person wants and what treatment is the most helpful.
An MHAD usually has at least two main parts, advance instructions and the power of attorney for mental health care:
- Advance instructions for an MHAD include the kinds of medications and treatments they consent to and what to do about their life needs. A person may include information about what might help de-escalate a crisis here as well.
- Mental health power of attorney section is where a role called the “agent” is appointed. The agent is legally appointed to assist with a person’s care under particular circumstances. A person does not have to appoint an agent, but many people find it helpful.
Where can I get a form?
- View a model "fill-in-the-blanks" form (developed by Northwest Justice Project).
- Your mental health provider may also have copies of the form.
Where can I learn more about how to create an MHAD?
The MHAD Training Toolkit is a resource for individuals, families, providers, peers, first responders, and other system partners to learn more about how to create and promote use of MHADs.
The Toolkit includes six core models, depending upon your area of interest, and one high-level overview ("flash" training).
All trainings videos are available to view anytime. Additionally, the slides and scripts may be downloaded and used to facilitate trainings in-person and other learning formats.
- Mental Health Advance Directives 101: Understanding, Supporting, Thriving
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This training provides an introduction to MHADs, highlighting what an MHAD is and why it matters. The training outlines the main parts of an MHAD and the basic legal rules, how to create an MHAD and what to include, what an MHAD can and cannot do, and how people can offer support in MHAD creation and use. The intended audience includes persons interested in having an MHAD, persons helping facilitate completion of an MHAD, agents, care providers, first responders, crisis providers, Tribal partners, certified peer specialists/peer supporters, persons with lived experience, and family members of persons with mental and behavioral health concerns.
- Compassionate Conversations: Facilitating the Completion of Mental Health Advance Directives
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This training highlights key considerations for individuals to facilitate others to create an MHAD. The training addresses steps to complete an MHAD as well as ways to navigate difficult emotions and ensure the MHAD feels supportive and empowering. The intended audience includes persons interested in having an MHAD, persons helping facilitate completion of an MHAD, agents, care providers, Tribal partners, certified peer specialist/peer supporters, persons with lived experience, and family members of persons with mental and behavioral health concerns.
- Agents for Mental Health Decisions: Best Practices in Supporting Mental Health Advance Directives
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This training discusses how to choose the right person to be a mental health agent, and the role of the agent and how to support someone during a crisis, working with providers and systems, and self-care for agents. The intended audience includes persons interested in having an MHAD, agents, Tribal partners, certified peer specialist/peer supporters, persons with lived experience, and family members of persons with mental and behavioral health concerns.
- Crisis Prevention and Intervention: Using a Mental Health Advance Directive
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This training provides an overview of the role of MHADs in crisis prevention and intervention, ensuring the MHAD is used, communicating in crisis situations, and post-crisis review and MHAD revisions. The intended audience includes persons interested in having an MHAD, persons helping facilitate completion of an MHAD, agents, care providers, Tribal partners, first responders, crisis providers, certified peer specialists/peer supporters, persons with lived experience, and family members of persons with mental and behavioral health concerns.
- Crisis Care Providers and Mental Health Advance Directives
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This training provides an overview of MHADs for crisis care providers. The training addresses the role of agents and highlights how crisis responders and hospital staff can use MHADs to provide safe care that supports recovery and build trust. The intended audience includes care providers, first responders, crisis providers, Tribal partners, and certified peer specialist/peer supporters.
- Mental Health Advance Directives and Outpatient Providers
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This training provides an overview of MHADs for outpatient providers. The training highlights how outpatient providers can talk about and support MHADs, and how this can help people get better care and avoid crises. The intended audience includes persons interested in having an MHAD, care providers, Tribal partners, and certified peer specialist/peer supporters.
- Flash Training: Mental Health Advance Directives
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This flash training provides a brief introduction to MHADs, highlighting the main parts of an MHAD, what should be included in an MHAD, when an MHAD goes into effect, and steps to creating an MHAD. The intended audience includes persons interested in having an MHAD, persons helping facilitate completion of an MHAD, agents, care providers, first responders, crisis providers, Tribal partners, certified peer specialists/peer supporters, persons with lived experience, and family members of persons with mental and behavioral health concerns.
MHADs information for providers
An MHAD helps to guide the care team and makes sure support is provided in a manner that is legally compliant and most likely to help the person.
The MHAD tells the team what medications, support people, treatment or calming techniques the person consents to and what are likely to help the person feel more stable.
Research shows that people who complete an MHAD often have reduced instances of unwanted or forced care, better medication response because preferred medications are known to providers, and fewer crises. Research also shows that people with MHADs have higher satisfaction with their care, stronger relationships with their care team, and greater confidence in their recovery.
Additionally, providers can be a wonderful resource for helping to facilitate the completion of the MHAD.
Read the MHAD and providers one pager.
Where can I go for more information about MHADs?
- The Department of Social and Health Services Legal Services page.
- Read the law, Revised Code of Washington (RCW) 71.32.
- Call your local mental health provider or ombuds service.
- Call the Division of Behavioral Health and Recovery’s (DBHR) office of Recovery Partnerships at 1-800-446-0259.