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Psychiatric advance directives: Is there a Colorado equivalent?

Mental illness spans a continuum and reaching the right diagnosis and mix of medications can take years. Some who struggle with bipolar disorder, schizophrenia or severe depression, to name a few, recognize the symptoms of an oncoming mental health crisis and check themselves into a hospital. Others may live in denial, refusing to seek treatment or going off prescribed medications as soon as they stabilize.

Recently, the New York Times covered how a person with bipolar and borderline personality disorders used a psychiatric advance directive (PAD) to find peace of mind. This document allows a patient to describe which treatment they do and do not want. While Colorado does not recognize a specified PAD form, a Medical Power of Attorney can offer some of the same relief.


What details to include?

Preferences about medications and certain treatments, such as a request to avoid electroconvulsive shock therapy if at all possible. Individual guidance can help during a hospitalization as well.

For example, a military combat veteran with post-traumatic stress disorder (PTSD) and delusions in Texas wrote an 18-page document. It includes ways for health care professionals to establish that they are real, because he sometimes has a hard time believing people are who they say. Statements such as “We drove here” and “We are still on planet Earth” are helpful. It also listed steps to defuse crisis situations, including Yogi tea and reassurances such as “It’s going to be OK” before medication or seclusion.

How can you get these desires across to medical providers?

Colorado does not yet recognize PADs as standalone documents; however, you can convey this information in a Medical Power of Attorney (MDPOA). This form is used to appoint an agent to make medical decisions. It can also include preferences about treatment and medications like a PAD does.

Since the option is to appoint an agent rather than communicate directly to physicians, it is a good idea to speak frankly with whoever is considered prior to appointment. Writing down specifics of what has and has not worked can then become a guiding document for this person and provide insight to nurses and physicians in a crisis.

An MDPOA may also be an option to look at before starting a guardianship proceeding. For parents of teens about to turn 18, it might provide a middle road, offering freedom for an adult child with a safety net. Before completing an MDPOA, speak with an experienced guardianship attorney to determine the best approach for your unique family circumstances.

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