ADVANCE PLANNING FOR CRISIS

Today’s Topics

• Background• Legal Framework• Practical Suggestions• Q&A

DECISIONS, DECISIONS

Stating the Obvious

• When crisis hits, you are better off with a plan!

• A good plan requires many features!• Access to Information• People• Preferences• Resources• Authority

Declaration for Mental Health Treatment

• Who can use it: An adult of “sound mind” who is not being coerced.

• Who decides person is of sound mind: two witnesses.

• What does it cover: convulsive treatment, psychiatric medications, 17 days inpatient, outpatient

Declaration for Mental Health Treatment• How long does it last: 3 years or until revoked by the capable adult. If invoked, when person regains capacity.

• How is it invoked: when two physicians find a person “incapable.”

• What is “incapable”: a person’s ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that the person currently lacks the capacity to make mental health treatment decisions

Declaration for Mental Health Treatment• What can the Declaration do:

• Give or withhold consent to certain treatment • Name a representative (attorney-in-fact) to make decisions during incapacitation

• Give information about background, symptoms, allergies, desires, etc.

• Allow another person to see medical records related to mental health treatment

Declaration for Mental Health Treatment• What are the duties of the attorney-in-fact: • Must agree to act if and when person becomes

incapable. • May receive otherwise confidential information related

to treatment.• Is not personally liable for the cost of care. • In making decisions, must act consistently with the

desires of the principal as expressed in the declaration. • If not expressed, or otherwise known by the attorney-in-

fact, must act in what the in the best interests of the adult. Has “good faith” immunity.

Guardianship: Capacity to Meet Needs

• Impaired Ability • To receive and evaluate

information effectively, or• To communicate decisions

• Can’t meet the essential requirements for physical health or safety.

Guardianship: Capacity to Meet Needs

• Actions necessary to provide the: • health care, • food, • shelter, • clothing, • personal hygiene and • other care

• Without which serious physical injury or illness is likely to occur.

Guardianship: Limitations

• Appointed only as necessary to promote and protect the well-being of the protected person.

• Designed to encourage the development of maximum self-reliance and independence

• Ordered only to the extent necessitated by the person’s actual mental and physical limitations.

Guardianship: Powers

• Placement• Care• Comfort• Maintenance• Training• Education• Health Decisions• Spending for Above

Guardianship: Limitations

• No sterilization• Keep rights not given

guardian• Voting• Hire lawyer• Right to records

• Need court approval for restrictive placements and charging room and board.

Supported Decision-Making

USES:•Relationships•Practices•Arrangements•Agreements

Supported Decision-Making

IN ORDER TO:•Maximize independence•Promote self-advocacy•Avoid intrusive interventions

Substituted Judgment

• Power of Attorney• Advance Directive• Protective Services• Guardian Ad Litem• Representative Payees• Medicaid Representative• Civil Commitment• Criminal Penalties• Emergency Medical • Guardian/Conservator

From NAMI Minnesota

• Identify people willing to help

• List the phone numbers of the mental health providers and the mental health crisis team

• Include a list of current medications and their dosages

• List treatments that have been used in the past (CBT, DBT)

• Identify key words or calming techniques that have worked in the past

• Identify your loved one’s preferred treatment facilities

• Include a copy of their advanced psychiatric directive (if available)

Resources• Declaration form and instructions:

http://www.oregon.gov/OHA/amh/Pages/services/planning.aspx

• DRO booklets on Oregon mental health laws, guardianship, and more: http://www.droregon.org/need-help/dro-publications

• Mental Health Crisis Planning booklet from NAMI Minnesota: http://www.namihelps.org/Crisis-Booklet-Adults.pdf

Bob Joondeph, Executive Directorbob@droregon.org