What
is an Advance Directive for Mental Health Treatment (ADMHT)?
The 2003 Kentucky General Assembly passed HB 99, thus
creating a means for individuals to develop an Advance
Directive for Mental Health Treatment (ADMHT). The
ADMHT is a legally binding document (KRS 202A.420)
that an adult consumer of mental health services can
write in order to communicate your decisions and preferences
for mental health treatment.
What
instructions may I give in my ADMHT?
In the ADMHT, you may state your wishes about the
mental health treatment you want to receive at a time
when you are not able to clearly communicate them.
If you become symptomatic, your ADMHT can be your
"voice" until your symptoms lessen. For
example, you can list specific psychotropic medications,
not an entire class of drugs, that you will not take.
You also have the opportunity to list medications
that you prefer to take as a part of your treatment.
In another section, you can tell your doctors whether
you consent to have electroconvulsive therapy (ECT).
You may also list in the ADMHT your preferences for
emergency interventions to be used if a crisis occurs
and there is danger to yourself or others.
What
is a surrogate? Do I have to choose one?
You may choose to designate someone else (a surrogate)
to act on your behalf according to what you have written
in your ADMHT. You do not have to choose a surrogate
in order to write your advance directive for mental
health treatment. If you do choose to have a surrogate,
be sure you trust that the person knows you and will
follow your wishes. Family members or friends can
be your surrogate. People who provide mental health
services to you cannot be your surrogate. The person
you choose as a surrogate must be willing to accept
this responsibility and must sign the ADMHT form.
If you do not choose a surrogate, then your wishes
as expressed in your written ADMHT stand by themselves.
How
do I write and complete an advance directive for mental
health treatment (ADMHT)?
An ADMHT form that was a part of HB 99 has been included
with this packet. While it is not necessary to use
this exact form, it is a good idea to do so because
the law says that a valid advance directive for mental
health treatment must "substantially comply"
(be nearly the same as) the form that was provided
in the statute.
Either two adult witnesses must sign the ADMHT or
it must be notarized for it to be complete. Neither
the witnesses nor the notary public can be your current
health care provider nor can they be relatives of
the health care provider.
What
do I do with the advance directive (ADMHT) form once
it is completed?
Your completed AMHDT is put into effect once it is
given to a facility where you are being treated. You
should also give a copy of the completed ADMHT form
to:
· Your surrogate
· The health care facility (hospital, home
health agency, nursing home, hospice) where you are
being treated
You may also want to have a copy of your ADMHT on
file with your current primary care physician and
your current mental health professional.
EXPLANATION OF THE ADMHT FORM
"Advance directive for mental health treatment
(ADMHT)" means a written document, such as
the enclosed form, or one very much like it.
"Grantor" means you as the consumer
when you make an advance directive for mental health
treatment. You should use your full legal name on
the form. To make an ADMHT, you must be 18 years of
age or older and must not have been declared by a
court to be unable to make a legal document.
"Surrogate" is an adult you can name
in the ADMHT to see that your instructions are carried
out. If you want to name a surrogate, put a check
by that statement. If you choose not to name a surrogate,
check that you are not naming one.
"Psychotropic Medications Provisions"
There are two parts to this provision. First, you
may list specific psychotropic medications, but not
a class of drugs, with which you do not want to be
treated. You may refuse to take these medications
because, for example, they didn't work for you (lack
of efficacy); you had an allergic reaction (drug sensitivity);
or intolerable side effects (experience of adverse
reaction). You do not have to give a specific reason
for your refusal.
In the second part of the Medications Provision, you
may list medications that you would be willing to
take if medication becomes necessary. For example,
at a time when you were symptomatic, you may have
been treated with a medication that quickly reduced
your symptoms, but you are not currently taking that
medication because of its side effects. However, you
may decide that if you get sick again, you would be
willing to use it because it worked so well. The second
part is where you would write the name of that medication
and any other medications you have had experience
with and would be willing to take if it became necessary.
Both
parts of your ADMHT's Psychotropic Medications Provision
will provide extremely valuable medication information
to those caring for you when you are in crisis. You
are able to provide this information through the "clear
voice" of your ADMHT, thus affording you the
opportunity to still be an active participant in your
treatment.
"Electroconvulsive or Electric Shock Therapy
(ECT)"
In this section, you may check that you either agree
to have electroconvulsive therapy (ECT) if the provider
recommends it, or that you do not want ECT to be used.
If you check that you do not consent to ECT, the facility
and doctor may not administer ECT without an order
from the court.
"Preferred Procedures for Emergency Intervention"
Emergency intervention means the use of physical or
chemical restraint or seclusion which might be necessary
to be used in an emergency situation for your protection
or the protection of others. In this section of the
ADMHT, you may list your order of preference for different
kinds of emergency interventions and may provide important
information to the facility and provider about the
reasons for your preferences.
"Signature of Grantor"
After you have completed the ADMHT form, you should
wait to sign it until you have two witnesses to watch
you sign it or until you have a Notary Public to witness
your signature.
"Signature of Surrogate"
If you name a surrogate, that individual will need
to sign your ADMHT form and to write down their contact
information on the form. This is also true for an
alternate surrogate, if you name one in your ADMHT
form.
Information in this brochure is not legal advice.
If you have questions, you may contact KYCAN at 1-888-743-0493
or P&A at 1-800-372-2988. This brochure and the
ADMHT form may be downloaded from www.kypa.net .
All
human services face severe cuts in the present effort
to solve Kentucky's budget crisis. Medicaid alone
may face up to $250 million dollars in cuts. This
is an especially foolhardy way to save money for several
reasons. First, of every dollar spent on Medicaid,
the federal government pays 70y cents and the state
30. When the state cuts Medicaid that 70 cents on
the dollar is lost. Secondly, such cuts hurt the people
who need help the most, the mentally ill, the mentally
retarded, the elderly, those with disabilities, and
those unable to afford health insurance.
Call or send your state legislators with this message:
No
Cuts in Human Services
Find
New Revenue for Kentucky
The
number to call to leave your legislators a message
is:
(502)564-8100.
The
address would be:
The Honorable (name)
The
Capitol
LRC Mailroom
700 Capitol Ave
Frankfort KY 40601
