The difference between psychiatric and medical advance directives

Both medical and psychiatric advance directives relate to medical decisions for patients. While psychiatric advance directives cover psychiatric care, medical advance directives relate to general healthcare decisions. 

What is a psychiatric advance directive? 

According to the American Psychiatric Association, “Psychiatric advance directives (PADs) provide an opportunity for patients to outline their preferences about their mental health treatment if they become unable to make such decisions for themselves in the future.” They provide patients with autonomy and dignity even in the face of incapacitation. It can cover medication handling, future hospitalizations, emergency care planning, and the nomination of proxies (trusted decision-makers). 

What is a medical advance directive? 

A medical advance directive is a way for patients to express their preferences for medical care in case if they can’t make decisions themselves. These decisions are generally placed in a patient's living will and can vary. Some may specify treatment and interventions or end-of-life care.

Legislation has advanced over the last four decades. A study from the Journal of the American Geriatrics Society stated, “The Patient Self-Determination Act (PSDA) was passed in 1991 and requires hospitals, skilled nursing facilities, home healthcare agencies, and providers of home health care to provide patients with a written summary of patients’ healthcare decision-making rights and the facilities’ policies concerning advance directives.”

Major differences

1. Medical advance directives cover general healthcare decisions like physical health. 
2. Psychiatric advance directives focus on mental health treatment during psychiatric crises. 
3. Medical advance directives address decisions like life support, surgery decisions, and appointing proxies. 
4. Psychiatric advance directives outline preferences for medications, hospitalization, and the appointment of mental health agents. 
5. Medical directives are used for cases of physical incapacity like terminal illness. 
6. Psychiatric advance directives are used when someone cannot make decisions as a result of mental illness. 

How to securely share directives

Use a HIPAA compliant email service: 

• Choose a HIPAA compliant email service designed to protect patient information. 
• Choose a service that encrypts the email and its attachments from rest to transit. 

Secure storage: 

• Keep copies of all directives for potential audits or legislative action. 
• In cases where physical copies are used, log and store them in a secure location with limited access. 

Maintain a direct line of communication: 

• Promote a two-way line of communication with patients about directives. 
• Mental health practitioners take on more of an advisory role, with providers offering advice on treatment options.

Detail treatment plans: 

• Include medical and psychiatric directives into patient treatment plans to create a well-rounded approach to care that considers the patient's autonomy.

Related: Top 12 HIPAA compliant email services

FAQs 

What is informed consent? 

Informed consent is when a patient is given all the necessary information about a treatment or procedure. 

Can EHRs be used to track consent? 

EHRs can be used to track consent and store patients' approval. 

What is a medical directive?

A medical directive outlines a person's preferences related to general medical care.