Courtesy of Hyson Green Calvary Private Hospital
An advanced directive is an expression of the patient's preferences of future mental health care and treatment. The directive is usually written when the patient is well and referred to when the patient is experiencing a relapse in their mental health. Thus the patient is pre-emptively able to communicate their preferences for care.
This advanced directive should be filled out in collaboration with a clinician and is a summary of an agreement between the patient, psychiatrist, hospital and any other concerned mental health professional.
It should ideally be adhered to as much as possible with the understanding that clinical needs will at all times override any preferences expressed in this document.
The Advanced Directive contains information on the following:
- Signatories to the document
- The preferred treating team
- Significant others to be contacted
- Those not to be contacted
- Early warning signs and symptoms and action plans (relapse prevention plan)
- Preferred transport to the facility
- Preferred treatment facility
- Preferred inpatient interventions
- Preferred other interventions
- Preferred medication at each stage of relapse
- Medications not to be administered
- Preferred treating psychiatrist/mental health professional/CATT etc
- Preference to not be treated by mental health professional/psychiatrist
- Signature
Signatories to this document
Provide name and contact number for the following positions:- Patient
- Community psychiatrist
- Admitting Psychiatrist
- GP
- Community mental health team
- Partner
- Parent
- Friend
Preferred treating team
Provide name and contact number for the following positions:- Patient
- Community psychiatrist
- Admitting Psychiatrist
- GP
- Community mental health team
Significant others to be contacted
Provide the following details for each significant other:- Name
- Phone
- Relationship
- Special tasks
- When notified Top of page
Those not to be contacted (or visited)
Provide name and relationship for each person.Relapse prevention plan
Provide details of early warning signs (mild, moderate and severe) and action plan for each warning sign.Preferred transport to the facility
Provide a list of four types of transport and reason for each.Preferred treatment facility
Provide details of facility (mild, moderate and severe) and reason for each.Preferred inpatient interventions
Provide list of interventions and reason for each.Preferred other interventions
Provide list of interventions and reason for each.Preferred medication
Provide list of medication and reason for each. Top of pageMedications not to be administered
Provide list of medication and reason for each.Preference to not be treated by mental health professional
Provide list of professionals and reason for each.Signature
Name:Date:
Signature: