National Resource Center Now Available for Psychiatric Advance Directives
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
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
"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
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
"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.