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UNDERSTANDING

UNDERSTANDING. MENTAL HEALTH ADVANCE DIRECTIVES (RCW 71.32). Purpose of RCW 71.32 . To help people express choices for mental health treatment when incapacitated.

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UNDERSTANDING

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  1. UNDERSTANDING MENTAL HEALTH ADVANCE DIRECTIVES (RCW 71.32)

  2. Purpose of RCW 71.32 • To help people express choices for mental health treatment when incapacitated. • A validly executed MHAD is to be respected by (among others) health care providers, professional persons, and health care facilities. March 2005

  3. What is a MHAD? • A written document • by an adult with capacity • Expressing instructions or preferences regarding mental health treatment • For use when a person is incapacitated • And (if desired) naming an agent to act on his/her behalf March 2005

  4. What is in a MHAD? • May include instructions and preferences about any aspect of mental health treatment or care; for example: • Consent for or refusal of specific types of treatment • What has worked well in the past • Appointment of an agent to make treatment decisions on principal’s behalf March 2005

  5. The model MHAD form (RCW 71.32.260) • Includes: • Statement of intent • When it becomes effective • Duration • Revocability • Preferences and instructions • Appointment of agent (language in RCW 71.32.060) • Notification of others and care of personal affairs • Signature March 2005

  6. Requirements of valid MHAD • In writing, dated, signed, witnessed • Clear intent to create MHAD • Designates whether principal can revoke during periods of incapacity • If an agent is appointed, specifies that the agent has authority even if the principal is incapacitated. March 2005

  7. If an agent is appointed... • Must act in good faith • Must make decisions consistent with principal’s instructions or preferences, or if not known, in principal’s best interest • Has same right as principal to make decisions or share information March 2005

  8. Agent (Cont.) • May resign at any time by written notice to principal and providers • Not liable for cost of treatment • May not be paid • May not be the principal’s provider (unless related) • Decisions subordinate to decisions of a competent principal March 2005

  9. Revocation of MHAD • In writing, but no special form needed - just clear intent • Incapacitated principal cannot revoke unless he/she elected to do so when competent • Principal must provide a copy of revocation to agent and providers(s), and it becomes part of record March 2005

  10. Revocation (Cont.) • Can be superceded or revoked by court order, involuntary hospitalization, or incarceration • A new directive revokes previous one • Expiration date revokes directive, unless principal incapacitated at time March 2005

  11. Provider Responsibilities • Act in accordance with provisions of MHAD to “fullest extent possible” unless: • Violates accepted standard of care • Requested treatment is not available • Compliance would violate applicable law • Compliance would endanger anyone • Inconsistent with purpose of court order relating to commitment (e.g.ITA) March 2005

  12. Responsibilities (Cont.) • If the provider does not/cannot comply with the directive, he/she must • Notify the principal and agent • Document the reason for the non-compliance in the principal’s medical record March 2005

  13. What to document • Place Advance Directives in the client record • Note revocation/changes in the client record • Document when unable to comply for any reason March 2005

  14. An MHAD May Not: • Create an entitlement to treatment • Obligate any health care provider or agent to pay treatment costs or be responsible for non-treatment personal care of principal • Be used for consent to inpatient for more than 14 days in any 21 day period March 2005

  15. Some Interpretive Provisions • If more than one directive, most recent MHAD & agent controls • When there is a Healthcare Directive also. • Requiring a directive is prohibited • Principals do not lose their bed at a long-term care facility as a result of an inpatient stay pursuant to MHAD March 2005

  16. Implementing MHADs • Understand the law • Develop policies and procedures • Figure out how access will work • Educate consumers; Ask about MHAD • Document in client record • Integrate with treatment • Monitor use and issues March 2005

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