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" It was the sunlight the first time and the stars the second time, but inevitably it is the sky that grants me reprieve from my demons."

Friday, September 12, 2025

Resource: Psychiatric Advance Directives (PAD)

Obligatory I am not a lawyer disclaimer here. 

A Psychiatric Advance Directive (PAD) can be one of the most empowering tools you have at your disposal if you have chronic mental illness that needs crisis intervention. Unfortunately, not all states recognize a PAD although you may be able to alter a advance directive ("Living will") to include mental health provisions in other jurisdictions. You can read more about what US states accept here.

What is a Psychiatric Advance Directive?

A Psychiatric Advance Directive is a legal document in which you describe the types of mental health treatments that you would or would not be filing to receive. It also allows you to designate an authorized decisionmaker for mental health decisions on your behalf.

It is essentially a "living will" for mental health.

How does it work?

You fill out a PAD form with your preferences. The forms are fairly self explanatory where it asks a question and you fill in a blank. A witness or notary may be required to be present when you sign the form to make it legally binding. (FYI: Many banks and post offices have a notary on staff in the US)

This form is then copied and put on file with your therapist, psychiatrist, or doctor for use in medical emergencies. It may also be wise to carry a copy on your person or take a copy with you to the hospital if necessary in a crisis.

You can request this form be removed from your file at any time if you need to update it.

Where do I find the form?

Forms for the US can be found here - https://nrc-pad.org/states/

Form provided by the NHS here


"I am going to be honest, this is not going to be an easy form to fill out for most people. You will need to sit and think about where you are at your worst and be realistic about the treatment you will need as well as what you want to happen. The idea is you let your most stable self make decisions for your most unstable self. 

This also means you are designating someone else to be able to make decisions for you and it will require at least one big conversation with that person to ensure they know what you want and agree to act in that capacity. 

Personally, while my husband knows my mental illness the best and I trust him the most, I did know that he will need emotional support if I am in crisis. I made the decision to make additional notes that he should reach out to two friends we refer to as "The Vulcans" if he was ever unsure of what I wanted because one could emotional support him while being rational and the other is someone I know would make the same choice as me in that spot 98% of the time, so if he was unsure she could provide insight. I know this may not be an option for everyone, especially if you don't have a community that talks about mental illness as openly as mine does. " - D.M.

An important part of being an adult is making sure you have a plan in place for when things go wrong. This includes ensuring you have done some estate planning, even if you are younger, because it ensures your wishes are followed when you do not have control. This can include having a Power of Attorney, Advance Directive (Living Will), and Will drawn up. A Psychiatric Advance Directive may be an excellent addition to these documents. 

" I am a firm believer in my mental illness not being my fault but being my responsibility.

Before I had surgery I needed to get my legal documents in order and I wasn't sure where to begin. My grandma gave me a little list of documents people normally put together so I could google forms. I ultimately decided to sign up for the free trial for Law Depot and use their software to create my forms. They do an excellent job of breaking down this process (here) and I was able to get everything notarized at the post office." - D.M.




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