Many of us know someone or will possibly be responsible for someone that is affected by mental illness. Yet, many patients have not executed patient advocate designations for psychiatric care. Psychiatric illness may come on quite suddenly and can be traced to metabolic imbalances, drug interactions, and other situations that, initially, may not appear to pose a threat to someone's mental health. There are numerous stories of patients being erroneously diagnosed and treated for an extended time for a condition that did not exist. This can result in severe depression and anxiety disorders. When treatments fail, the patient can sometimes be persuaded to undergo therapies that may provide relief but have severe side affects. For example, I recently read about a woman who agreed to undertake electric shock therapy after her course of treatment failed to successfully combat a supposed infection. Electric shock therapy is known for wiping out years of memories which can force the patient into losing their career and being unemployable. If the patient is depressed, maybe to the point of suicidal tendencies, can they be competent to consent to treatment and therapy? On the other hand, individuals with severe psychiatric illnesses such as bipolar disorder, post-traumatic stress disorder, and schizophrenia can have time periods where they are stable, lucid, and handle a high-level career. Everyone should have input, at some point, into the treatment of their medical and psychiatric issues in the event of an emergency.
Individuals can make these decisions while they are still competent, and generally, these decisions are addressed in a Patient Advocate document (a power of attorney designation for health care and mental health). We encourage our clients to appoint a trusted surrogate (a "patient advocate") with a power of attorney to authorize psychiatric care on behalf of the client in the event of mental illness. An individual may prefer to combine the appointment of a patient advocate with an expressed declaration of his or her preferences when the patient advocate encounters certain situations and choices that affect the patient. There will continue to be legal, moral, and ethical issues related to decisions for the treatment of mental illness. The person you choose to stand in your place to make mental health care and treatment decisions on your behalf should be willing to take the time to understand mental illness, advocate for care that is in your best interest, and persuade mental health providers to undertake the best course of action for you. We have assisted many clients with the designation of a patient advocate in a written and signed document, that can be placed on file with relevant health care providers. We can help you do the same to better protect yourself, or a family member, in the event of an unexpected (or expected) onset of mental illness. Dan A. Penning