The use of advance directives by persons with serious mental illness for psychiatric treatment

Objective. A health care proxy is an advance directive that allows an individual to indicate in writing who can act on his behalf when he lacks the capacity to make health care decisions, and what limitations he is placing on this authority. Of great interest in medical settings, health care proxies are beginning to receive more attention in psychiatric settings. Are these proxies useful when applied to psychiatric treatment decisions? This paper examines health care proxies in Massachusetts and their potential use for decisions about psychiatric interventions at one Massachusetts state hospital. Method. A point in time study of a state hospital's entire census was done by reviewing all patients' records for demographic, diagnostic, and legal data, and for the presence and content of the state required health care proxy form. Results. Of the 161 patients in the hospital, 71 (44%) had full guardians and were ineligible to complete their own proxies. Of the remaining 90 patients, 53 (33% of the total population) had a proxy form in their chart, but 34 (21%) of these patients refused to sign them. Of the 19 (12%) signed proxies, 16 (10%) of the patients were deemed competent to have executed meaningful health care proxies. Conclusions. This preliminary analysis reveals that only 10% of a state hospital population had meaningful health care proxies. Further outcome studies are needed to determine if the process of offering health care proxies and the presence of properly executed proxies are meaningful and beneficial to chronically ill psychiatric patients.