Declaration for Mental Health Treatment

A Declaration for Mental Health Treatment can give you more control over your mental health care.

You can make decisions now about how you would want to be treated during a mental health crisis. You can also name someone who could make decisions for you if you become unable to make them yourself.

You can use the Form Assistant on this site to create a Declaration for Mental Health Treatment.

Who can create a declaration

To create a Declaration for Mental Health Treatment:

• You must be at least 18 years old.
• You must be capable of making decisions for yourself.
• You should not be forced into creating it.

Once you create the document, you will need to give it to your health care providers and loved ones so that they know about it.

Decide what’s important to you

You can choose how much information you want to include in your declaration. Take your time to consider what you want. It can lead to important decisions about your care. In times of crisis, it can ensure that your voice is heard and help the people around you understand what works best for you.

Think about what you would want if you were in a mental health crisis. For example:

• Doctors: What physicians or therapists would you want to treat you?
• Hospitals: Where would you want to be treated? Is there anywhere you wouldn’t want to be treated?
• Admission to a facility: Would you be ok with being admitted to a facility for mental health treatment? For how many days?
• Visitors: Is there anyone you wouldn’t want to visit you?
• Medications: What medications would you be ok with taking? Are there some you wouldn’t want to take? Think about psychiatric medications like anti-psychotics, anti-depressants, anti-anxiety medications and mood stabilizers.
• ECT: Would you be ok with electro-convulsive treatment (ECT)? If you’re not familiar with ECT, you can find an overview from the Mayo Clinic.
• Care for a child or pet: If you were in the hospital, is there someone who could take care of your child, pet or anyone else you’re responsible for? What about your other responsibilities, like paying rent or bills?
• Emergency treatment: In a crisis, what treatments would work best for you? Do you have a crisis intervention plan? How could staff help you? How would you react to hospitalization or medications? If health care providers believed you needed to be restrained or secluded, what would you prefer? Do you have other preferences, like the gender of the health care professionals who treat you?

Writing down your preferences in advance can give you more control and peace of mind.

You can use the Declaration for Mental Health Treatment Form Assistant on this site to think about the details you want to include. You can choose what kind of information to provide.

Medical professionals have a duty of care, but you can help them understand the kind of treatment you would want.

Naming a proxy to make decisions for you

You can name a person to make decisions for you if you become unable to make them yourself. This person is called your proxy.

Your doctor or treatment provider can’t be your proxy. It has to be someone else.

Choose an adult you:

• Know well
• Trust to make decisions for you
• Believe will follow your wishes

You can also name an alternate proxy, or another person who could make decisions for you if the first person is unable to.

Anyone you name as a proxy must agree that they could make decisions for you.

Signing the declaration

You and any proxy you name must sign the declaration in front of one notary or two adult witnesses.

If you choose witnesses, make sure they know you personally but are:

• Not your family (by blood, marriage or adoption)
• Not your proxy
• Not your doctor or mental health treatment provider
• Not an owner or employee of your treatment provider

Your Declaration for Mental Health Treatment won’t be valid until it’s properly signed.

Giving the declaration to others

Once you have completed the document, you will need to give it to others so they know about it and can use it in an emergency.

You should give it to:

• Your doctors
• Your proxy
• Your family or loved ones

When it could take effect

A Declaration for Mental Health Treatment is for emergency or crisis situations. It only takes effect and becomes “operative” if:

• Your treatment providers know about it.
• A doctor and one other mental health professional decide you are unable to make decisions.

A Declaration for Mental Health treatment can last up to 3 years, and then you can renew it for another 3 years.

Once a Declaration for Mental Health treatment becomes operative, you cannot change it.

If you change your mind

You generally can cancel or revoke a Declaration for Mental Health Treatment at any time, except when it’s operative.

Once you’re in a crisis, and doctors have determined you’re unable to make your own decisions, the declaration will stay in effect throughout the crisis.