Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable.

Journal Article (Journal Article)

Psychiatric advance directives (PADs) can help adults with serious mental illnesses preserve their autonomy and avoid involuntary interventions during an incapacitating mental health crisis. A PAD is a legal document prepared while mentally competent and states the person's treatment preferences to be implemented during a future crisis, ideally with the advocacy of an authorized proxy decision maker. PADs have been available in the United States for more than three decades but have yet to be robustly implemented in practice. This Open Forum describes PADs metaphorically as a device for remote communication among the person with mental illness, a proxy decision maker, and health care providers. Barriers to PAD usage occur on both "transmitter" and "receiver" sides and must be addressed to advance PAD implementation.

Full Text

Duke Authors

Cited Authors

  • Swartz, MS; Swanson, JW; Easter, MM; Robertson, AG

Published Date

  • February 1, 2021

Published In

Volume / Issue

  • 72 / 2

Start / End Page

  • 219 - 221

PubMed ID

  • 33334149

Electronic International Standard Serial Number (EISSN)

  • 1557-9700

Digital Object Identifier (DOI)

  • 10.1176/


  • eng

Conference Location

  • United States