Who makes mental health decisions for me if I can’t?

There may be times where you are unable to make your own health care decisions, due to physical or mental health problems. In these cases, it’s not always clear who will be able to make these decisions for you. Each state has its own laws, and they’re not always consistent. It’s possible that these decisions could be made by family members who don’t know or respect your preferences. You can avoid this by designating a trusted person to make decisions on your behalf when you are unable to make them yourself.

Health care power of attorney (POA) and health care agent

You can specify who you want to make these decisions for you in a legal document, called a health care power of attorney (POA). The person you specify is called a health care agent. (Sometimes people use the word “power of attorney” to describe the person as well as the document.) In addition to making health care decisions on your behalf, your health care agent can also access your mental health records.

Your health care agent can only make decisions for you when you are unable to make them yourself. Once you recover, you are back in charge of your own treatment.

Choosing a health care agent

Pick someone you trust, who you know will have your best interest in mind. It can be any legal adult—a friend or family member is a good choice. You can make a temporary assignment, or you can change who your health care agent is down the line—it’s not a lifetime commitment.

When you ask them to be your health care agent, talk to them about your opinions about your treatment. What kinds of treatment are you opposed to? Which ones do you prefer? You can’t cover every situation, but the point is to help your health care agent understand you and your preferences as much as possible. That way, when a situation arises, they can have a better idea of what you’d want them to do.

How to create a health care power of attorney

You can create a health care POA on its own, or you can designate your health care agent as part of a psychiatric advance directive (PAD). In a PAD, you can also include specific information about your preferences. For example, you can specify which treatments you do or do not want to receive, which hospital you prefer to be treated at, etc.

There’s no national standard for how to create a health care POA. You’ll need to look up the laws in your state to see what the specific requirements are.

You don’t need a lawyer to create one—but if you have access to a lawyer, it can’t hurt to have them look it over. There’s also lots of free legal advice online, including templates you can use to write the document. Or, you may be able to find a free legal clinic nearby. Hospitals often have staff who can help you with questions about these kinds of documents.

The National Resource Center on Psychiatric Advance Directives (NCR-PAD) offers state-by-state guides to laws, rules, forms, and other resources. You can also follow Mental Health America’s 4-step guide to creating a psychiatric advance directive.


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