Mental Health Advance Directive

Maryland law gives the right to anyone 16 years of age and over to be involved in decisions about their mental health treatment. However, a parents or guardian of a person under the age of 18 may authorize treatment, even over the objection of the minor. The law also notes that, at times, some persons are unable to make treatment decisions. Maryland law states that you have the right to make decisions in advance, including mental health treatment decisions, through a process called advance directive. An advance directive can be used to state your treatment choice or can be used to name a healthcare agent, that is someone who will make healthcare decisions for you. 

1. If you are a person with a mental illness, this document provides you the chance to take part in a major way in your mental healthcare decisions when you are not able to do so. This document allows you to express your consent or refusal to medications for your mental illness(es) and other healthcare decisions, including use of seclusion or restraints. Please know that Maryland law allows a healthcare provider to override your refusal for medication for a mental health disorder in limited situations if you are involuntarily committed to a psychiatric hospital. 

2. This document may be completed by any individual 18 years of age and has not been determined to be not capable of making an informed decision. An advance directive may be oral or written. If written, it must be signed and dated. Two witnesses must also sign the document. The healthcare agent may not be a witness. And, at least one witness may not be a person who is knowingly entitled to benefit by your death. For example, one witness may not inherit money or insurance benefits. The witnesses must sign the document sitting that the person making the directive is personally known to them and appears to be of sound mind. 

3. If you wish to guide your healthcare providers on what treatment you wish to have if you should become unable to give consent, and you do NOT want a health agent, fill out the form titled, "Advance Director for Mental Health Treatment." If you want an agent to make health decisions for you, fill out the form "Appointment of Healthcare Agent." You may fill both forms if you want an agent to make healthcare decisions for you, and you also want to assist in those decisions. If the directive is made orally, it must be made in the company of your attending physician and one witness. 

4. You can also make an advance directive naming a person as your healthcare agent. This person will make mental health decisions when you are not able to do so. The agent must make decisions in line with any desires you have expressed in this document. If your wishes are not expressed and not known by the agent, the agent must act in good faith for what is believed to be in the best interest for you. It is your job to inform the agent that the agent has been named in your advance directive and to make sure that there is agreement to be your agent. It is important that your healthcare agent be informed about your mental illness and the decisions you have made in this form. It is highly recommended that you discuss the contents of this form with your family and close friends and your mental health providers. 

5. The Office of Attorney General has issues an opinion that a healthcare agent may sign an individual into a facility, including a psychiatric hospital. If you wish your healthcare agent to be able to make this decision, you should specify this on the document. 

6. Maryland law allows giving a medication for the treatment of a mental health disorder over the person's expressed wishes or placing the person in seclusion or restraints against the person's expressed wishes under certain circumstances. 

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