Do You Have An Advance Directive For Mental Health Care? Why Would You Want One?

An advance directive for mental health care (ADMHC) is a legal document similar to an advance medical directive which governs end-of-life decision-making. However, an ADMHC is used to express preferences and give instructions in advance to family members and medical providers for future mental health treatment, including medications, voluntary admission to inpatient treatment, electroconvulsive therapy and the like. Frequently, an ADMHC is used to refuse or exclude specific types of treatments or medical interventions, such as medication, physical and chemical restraints, participation in experimental treatments, or hospital selection. An ADMHC can also be used to designate a proxy decision-maker. Through an ADMHC, an individual can assume control over future mental health care treatment decisions.

The instructions included in an ADMHC and the authority to act given to the proxy decision-maker become effective only if the principal becomes incapable of making decisions about his or her care. Treatment providers must seek the principal’s informed consent at all times during which the principal has the capacity to give informed consent.

The person appointed as proxy decision-maker has a duty to act consistently with the principal’s wishes and instructions. If the agent does not know what the principal’s wishes are, he or she has a duty to act in the principal’s best interests. An agent appointed under an ADMHC has the right to withdraw from the appointment at any time.

Importantly, there are some circumstances where medical providers may not be legally required to follow the directives set forth in an ADMHC. For example, if the provider cannot provide the treatment designated, or if the designated treatment would not be legal, ethical, or good medical practice, the medical provider can deny the treatment or intervention designated in the ADMHC and substitute his or her best medical judgment, but only after seeking the approval of the hospital or agency ethics board. If a provider does not follow the directives in the ADMHC, the principal and his or her mental health proxy must be given notice and an opportunity to contest the provider’s decision.

In New Jersey, an ADMHC may be registered with the state by sending a copy of the ADMHC to: DMHS Registry, P.O. Box 727, 50 E. State Street, Trenton, NJ 08625-0727. Once the ADMHC is properly registered, the state Division of Mental Health Services (DMHS) will send a password that will allow the principal to view the directive on the internet. The ADMHC is the also available to designated mental health professionals who have applied to the registry for access.

For more information about ADMHCs, visit the New Jersey DMHS website at A sample ADMHC can be accessed from the home page, and individuals can also draft their own ADMHC.