Using Advance Directives

Using Advance Directives

Note: The following details efforts in Michigan to promote the use of advance directives. A number of states including the New York State Office of Mental Health have been encouraging greater use of advance directives for some time now.

Patients to get greater control over treatment

BY LAURA POTTS Detroit Free Press Staff Writer January 18, 2005

They've known each other more than 30 years and have lived together for nearly 10, but when Helen Mann was hospitalized for depression last year, her partner, Jamie Armstrong, was barred from knowing where she was and what kind of treatment she was getting.

"In God's eyes, and between us, we look like we're married," said Armstrong, 44, of Cassopolis, a small town in southwest Michigan. "Since we're not married, I couldn't even find out if she was in the hospital. I called, called, called. I couldn't find out nothing. It made me really concerned, and I just didn't know what to do."

But soon, the couple and others in Michigan who have a history of mental illness can create documentation that outlines their treatment preferences if they are ever deemed incapable of making decisions about their own care. The change goes into effect in March.

Called an advanced psychiatric directive, the document allows people with mental illness to designate a family member or other loved one as a patient advocate. Patients can also legally specify what kind of care they prefer or object to in the event of a crisis.

The legislation allowing the directives was signed into law Dec. 30 by Gov. Jennifer Granholm and applauded by mental health activists and consumers.

"These advanced directives put decision-making into the hands of an advocate," said Tom Masseau, director of media relations for Michigan Protection & Advocacy Service Inc., a Lansing-based watchdog group for people with disabilities. "Now, there's a document in place stating what type of treatment they want, and a judge will consider it. It allows the individual to have a choice in the matter."

Having an advanced psychiatric directive in place -- similar to living wills used to direct medical treatment in life-threatening situations -- is a comfort to Armstrong and Mann, who both are mental-illness patients. The couple have not married because they fear their Social Security disability income would be lowered, putting them at risk of becoming homeless.

But they share everything and want to be a part of keeping each other healthy.

"Now we can talk amongst our caseworker and doctor, and now we can know what's going on with each other," Armstrong said.

He was the one who called police about eight months ago, looking for help for Mann's depression. When she was taken to a local hospital, though, even she couldn't persuade doctors to let Armstrong in on her treatment.

"I felt really, like, lost and a little bit angry because he should know, too. I was upset," said Mann, 47. "I'd like Jamie to know where I'm at and what's going on with me. I think it's his right. It's just a thing that a couple needs to know."

The advanced psychiatric directive is "something that everyone with a disorder of any degree of seriousness should be considering," said Mark Reinstein, president of the Mental Health Association in Michigan.

The directives are widely used throughout the country, and the movement to allow them in Michigan came as legislators pushed for bills that would enable courts to order some people with mental illness into outpatient treatment.

Under the new Kevin's Law, the courts can now order outpatient care for people with a history of mental illness and violent behavior who refuse their prescribed treatment but don't meet the criteria for involuntary hospitalization. If the court-ordered outpatient treatment is not followed, the judge can order hospitalization.

The law was named after Kevin Heisinger, who was beaten to death in August 2000 at a Kalamazoo bus station by Brian Williams. Williams had been diagnosed 20 years earlier with schizophrenia. And for weeks before his attack on Heisinger, he had exhibited the kind of erratic, aggressive behavior, including brandishing a knife, that supporters of the legislation say would be key to ordering someone into treatment

But controversy surrounds Kevin's Law. Some say it could violate civil rights and perpetuate stereotypes that all people with mental illness are dangerous.

The advanced directive legislation seeks to allay those concerns by giving people with mental illness more power in guiding their treatment.

Reinstein said an advanced directive won't necessarily override a court order but can give a judge parameters for what a person prefers. For example, some may have found certain medications unhelpful or may favor one hospital over another.

Though no official advanced directive template exists, state officials are looking into creating one, which could be made available at local mental health agencies and elsewhere, said T.J. Bucholz, spokesman for the Michigan Department of Community Health.

Those who plan to draw up an advanced directive should consult an attorney and also have it notarized. Copies should be kept with the individual and with the advocate and given to local care providers, such as hospitals and Community Mental Health offices.

"It's the first time that advanced directives have been legally recognized in Michigan, and it's very important. It's something that we've always supported," Reinstein said.

For more information and to find sample Advanced Psychiatric Directive forms, see the Web site of the Bazelon Center for Mental Health Law, www.bazelon.org.

Source: Detroit Free Press

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Last Updated on 01/26/05 webmaster@namiscc.org

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