Psychiatric Advance Directives: A Tool for Self-Determination and Advocacy for People with Serious Mental Illness

By Julie Balovich, Texas RioGrande Legal Aid

When people think of advance directives, they usually think of medical and financial powers of attorney. These are important planning documents that allow individuals to choose proxies and make decisions for themselves in the event that they are incapable to do so.

Less well known is the psychiatric advance directive – known in Texas as the Declaration for Mental Health Treatment (DMHT). Located in Chapter 137 of the Civil Practice and Remedies Code, the DMHT allows individuals who are not incapacitated to state their preferences and instructions regarding consent to or refusal of mental health treatment in a hospital setting. These documents can be a powerful tool for an individual to provide relevant and important information to mental health providers when they present in perceived crisis. Individuals can explain in the document what medications are effective, ineffective, or even harmful. They can also provide nonmedical information that is helpful such as persons they want to be notified and nonmedical techniques that can help de-escalate a perceived crisis. When individuals are at risk of involuntary commitment, they are at their most disempowered and vulnerable. These documents are a tool for self-determination and self-advocacy.

In the summer of 2017, Texas RioGrande Legal Aid Inc.’s Mental Health Programs managing attorney Laurie Hallmark launched TRLA’s first psychiatric advance directive clinic in partnership with Austin Mental Health Consumers (AMHC). TRLA provided AMHC clients with education about their rights in a hospital setting, as well as the opportunity to execute a DMHT. One client stated: “For people like me who are highly functional but suffer from mental illnesses that periodically make life chaotic, this type of document helps assure continuity of care.”

In March 2018, TRLA partnered with UT Law’s Mithoff Pro Bono INCLUDE Program to sponsor a second successful clinic. Additionally, plans are in the works for a third clinic with Disability Rights Texas this summer.

A clinic setting helps publicize DMHT’s to people who may not know about them. Outreach for clinics is most effective when using peers – people with lived experience with serious mental illness. Both clients and volunteers come away from the experience with a better understanding of the rights of individuals seeking treatment through our mental health system.

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