©2003 International Association of Forensic Mental Health Services

Psychiatric advance directives (PADs) are relatively new legal instruments that may be used to document a competent person’s specific instructions or preferences regarding future mental health treatment, in preparation for the possibility that the person may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness (Appelbaum, 1991; Winick, 1996). All states permit some form of legal advance directive (AD) for healthcare, which can be used in conjunction with at least some forms of psychiatric treatment. Typically, these instruments authorize a surrogate decisionmaker with Durable Power of Attorney for Healthcare to act in accordance with an incapacitated patient’s previously-expresse