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March, 2007

New Resource for Psychiatric Advance Directives

ImageIntroduced in the 1990s, psychiatric advance directives, commonly called PADs, offer a way for people with mental illnesses to plan ahead for a mental health crisis, such as those that can occur in schizophrenia or bipolar disorder. PADs are legal documents that typically specify treatment instructions and appoint a designated health care agent, among other actions.

A newly launched online national resource center is now providing comprehensive information on psychiatric advance directives.

The National Resource Center for Psychiatric Advance Directives (NRC-PAD), developed by psychiatric and legal experts at Duke University Medical Center and the Bazelon Center for Mental Health Law, went online in January. Its web address is

According to its developers, the center represents the largest compilation in the United States of information regarding psychiatric advance directives, commonly called PADs.

Most mental health consumers and clinicians favor PADs, but their actual rate of use has remained fairly low, probably due to a lack of easily available information and resources for implementing them, the center developers say.

They hope the website will improve usage rates by serving as an online gathering place for people with mental illness and their families, as well as for clinicians, to learn about PADs and how to complete the documents.

They say the website will also be useful for government policy makers involved in discussions about PADs.

"Advance directives for mental health treatment raise a number of complex questions," said Marvin Swartz, M.D., head of social and community psychiatry at Duke and co-director of NRC-PAD.

"In general, there has been confusion about what the law allows, as statutes vary from state to state. There also has been confusion about how to complete the forms; when the directives go into effect; and who is supposed to read and comply with them. Patients have long needed a place like this new center that can serve as a comprehensive source of information."

The website provides a state-by-state breakdown of PADs-related statutes and listings of local resources for patients and families, discussion forums, answers to frequently asked questions, testimonials from people who have used PADs, and information on the latest research findings concerning mental health issues.

It also includes an audio-visual presentation, organized by topic, to explain the process of creating a PAD.

"As a society, we value the rights of individuals to make their own choices about medical treatment, including mental health care," said Jeffrey Swanson, Ph.D., an associate professor of psychiatry and behavioral sciences at Duke who will serve as lead researcher for the NRC-PAD. "But we also believe in taking care of people who are very ill, especially during times when it may be difficult for them to ask for help or say what type of treatment they would want."

Sometimes the desire to care for the severely ill collides with valuing the patient's right to choose their course of medical treatment, he said.

"Ideally, both values could be met in the use of psychiatric advance directives," Swanson said.

Related Resources from NAMI:

Psychiatric Advance Directives 

NAMI Peer-to-Peer Education Program


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