Published: Sept. 18, 2006
Updated: Sept. 19, 2006
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By Duke Medicine News and Communications
DURHAM, N.C. -- A newly launched online national resource center is now providing comprehensive information on "psychiatric advance directives," legal documents that people with mental illnesses can create to specify, in advance, their preferred course of treatment if they should experience a mental health crisis.
The National Resource Center for Psychiatric Advance Directives (NRC-PAD), developed by psychiatric and legal experts at Duke University Medical Center and the Bazelon Center for Mental Health Law, went online today. Its web address is http://www.nrc-pad.org.
The center is funded by the John D. and Catherine T. MacArthur Foundation.
According to its developers, the center represents the largest compilation in the United States of information regarding psychiatric advance directives, commonly called PADs. Introduced in the 1990s, PADs offer a way for people with mental illnesses to plan ahead for a mental health crisis, such as those that can occur in schizophrenia or bipolar disorder. PADs typically specify treatment instructions and appoint a designated health care agent, among other actions.
Most mental health consumers and clinicians favor PADs, but their actual rate of use has remained fairly low, probably due to a lack of easily available information and resources for implementing them, the center developers say. They hope the website will improve usage rates by serving as an online gathering place for people with mental illness and their families, as well as for clinicians, to learn about PADs and how to complete the documents. They say the website will also be useful for government policy makers involved in discussions about PADs.
"Advance directives for mental health treatment raise a number of complex questions," said Marvin Swartz, M.D., head of social and community psychiatry at Duke and co-director of NRC-PAD. "In general, there has been confusion about what the law allows, as statutes vary from state to state. There also has been confusion about how to complete the forms; when the directives go into effect; and who is supposed to read and comply with them. Patients have long needed a place like this new center that can serve as a comprehensive source of information."
The website provides a state-by-state breakdown of PADs-related statutes and listings of local resources for patients and families, discussion forums, answers to frequently asked questions, testimonials from people who have used PADs, and information on the latest research findings concerning mental health issues. It also includes an audio-visual presentation, organized by topic, to explain the process of creating a PAD.
The Duke and Bazelon experts believe that improving the use of PADs is an important part of a larger mission to promote greater autonomy for people with serious psychiatric conditions.
"Our goal is to support greater self-determination and recovery for people with mental illnesses through improved treatment decision making and access to high-quality mental health care when it's most needed," said Robert Bernstein, Ph.D., director of the Bazelon Center for Mental Health Law and co-director of the NRC-PAD.
"As a society, we value the rights of individuals to make their own choices about medical treatment, including mental health care," said Jeffrey Swanson, Ph.D., an associate professor of psychiatry and behavioral sciences at Duke who will serve as lead researcher for the NRC-PAD. "But we also believe in taking care of people who are very ill, especially during times when it may be difficult for them to ask for help or say what type of treatment they would want."
Sometimes the desire to care for the severely ill collides with valuing the patient's right to choose their course of medical treatment, he said.
"Ideally, both values could be met in the use of psychiatric advance directives," Swanson said.