What is a Psychiatric Advance Directive and How Can It Help You?

Planning ahead for serious illness can feel overwhelming, especially when it involves your mental health. A psychiatric advance directive (PAD) is a legal document that lets you record your treatment preferences and name trusted individuals to make decisions on your behalf if you are unable to do so. Similar to a medical advance directive for physical healthcare, a PAD helps you maintain control over your mental health treatment and ensures your voice is heard — even during times when you may have trouble communicating or making decisions.

Whether you live with schizophrenia or another mental health condition, understanding how a PAD works can bring peace of mind and give you more say in your care. This article will guide you through what a PAD is, why it matters, and how it can be a vital safeguard for your schizophrenia treatment choices.

How Does a Psychiatric Advance Directive Work?

A psychiatric advance directive — sometimes also called a mental health advance directive — is a plan you create while you’re feeling well, in case your symptoms become severe in the future. Your PAD goes into effect only if your doctor determines you’re unable to make decisions at that time. This could be because you are:

• Unable to communicate
• Very confused
• Unconscious

When that happens, the doctor would then refer to your PAD to get a clear description of your treatment preferences and contact the person you have chosen to make decisions for you (if you’ve named someone). The PAD is temporary. Once you’re able to make decisions again, you regain that ability. If your preferences change, you can update your PAD at any time.

What’s Included in a Psychiatric Advance Directive?

The exact requirements for a PAD can vary depending on your state, but most PADs have two main parts:

• Advance instruction — A written description of the mental health care you want
• Healthcare power of attorney — A person you trust to make decisions for you if you’re unable to

You can choose to include one or both parts in your PAD.

Advance Instruction

Advance instruction lets you highlight your preferences for mental health care if you’re ever unable to speak for yourself. This can include decisions such as:

• Which medications or treatments you do or don’t want
• Where you prefer to be treated and by which healthcare providers — for example, whether or not you want to go to the hospital, or what alternative options you’d prefer
• Who should be contacted if you experience a serious episode

Healthcare Power of Attorney

Your PAD can name a friend, family member, or other trusted person to make mental health care decisions for you if you’re unable to. You can also use your PAD to name people you do not want making decisions on your behalf.

You should choose someone who:

• Understands your mental health condition
• Has your trust and puts your well-being first
• Can be reached during an episode
• Knows what this role involves and feels prepared to take it on

What Are the Benefits of a PAD?

The ability to make choices about your life is important to everyone, including people living with schizophrenia. Research shows that people with schizophrenia or other serious mental illnesses feel better and do better when they are able to make choices about their care.

Researchers have found that when people living with schizophrenia have choice and control over important life decisions, such as housing and treatment preferences, they feel physically and emotionally better. On the other hand, feeling afraid or being forced to give up decision-making and independence can lead to disengagement from care.

Creating a psychiatric advance directive ahead of time can be empowering. It can help you feel invested in your care, give you a greater sense of control, and boost your confidence in the treatment you receive — even during times when symptoms become harder to manage. A PAD can also strengthen trust and communication between you and your mental health care providers.

In one survey of people with serious mental illness, as well as their families, caregivers, doctors, and advocates, more than 90 percent of respondents agreed that PADs “give people with serious mental health problems more control over their lives.” Many also agreed that PADs help providers understand what people they support want from their treatment, which can lead to a better quality of life for them.

How To Create a Psychiatric Advance Directive

To create a PAD, start by learning the rules and requirements in your state. The National Resource Center on Psychiatric Advance Directives is a helpful resource for information for each state in the U.S.

As of July 2025, only 25 states have formal legal guidelines for PADs. If you live in a state without those guidelines, you can still write down your preferences for future mental health treatment and name someone to make decisions for you if needed. Most states will honor a PAD to help guide your treatment, even if they don’t have formal laws in place.

If your state does have PAD guidelines, you’ll likely need to complete a specific form, sign it in front of a witness, and share it with your mental health care team.

Could a PAD Be Harmful?

Some people have raised ethical concerns about using PADs. For example, a few doctors have worried that individuals might use PADs to avoid all treatment— even care they might truly need. However, research does not support these concerns.

In practice, most people use PADs to shape their care in ways that reflect their preferences, not to refuse care entirely. In an analysis of 42 studies, researchers found that only 0.3 percent of participants utilized their PAD to say they never wanted to be hospitalized. Instead, people mostly utilized PADs to set boundaries around specific treatments they didn’t want — such as group therapy — or to outline conditions under which they would accept certain treatments.

Example: “Only use electroconvulsive therapy (ECT) if I have expressed thoughts of self-harm.” (ECT is a treatment that uses controlled electric currents to relieve certain mental health symptoms.)

Overall, people living with schizophrenia do want care — they just want care that aligns with their needs and preferences. PADs give individuals the chance to receive treatment in a way that supports their dignity, preferences, and overall well-being.

You Have Choices

Don’t be afraid to advocate for yourself. Talk with your family, loved ones, and mental health care team about your desire to make treatment choices that reflect what works best for you. Many health experts believe that PADs are an underused care planning tool, often due to a lack of awareness.

If you decide to create a PAD, you might need to explain what it is to your care providers or support network. That’s OK. Taking that first step can be empowering. A PAD can help you get care that supports your needs and values — and avoid treatments that don’t feel right for you.

Talk With Others Who Understand

MySchizophreniaTeam is the site for those with schizophrenia and their loved ones. On MySchizophreniaTeam, people come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia.

Do you have a psychiatric advance directive in place? How has it influenced your care? Share your experiences in the comments below.