Mental Illness-Related Projects
Project: NAMI North Carolina Advance Instructions News Release, Fact Sheet
Client: NAMI North Carolina, Raleigh, North Carolina
Service Provided: Writing
Mental Health Care Community Working Out the Details of New Advance Instructions Law
At first glance, North Carolina's new advance instruction for mental health treatment law seems straightforward enough. As of January 1, any North Carolina adult who is able to understand and communicate decisions can prepare instructions concerning treatment he or she might receive in case of a mental health crisis.
The document may detail the patient's consent to or refusal of specific treatments, such as electro-convulsive treatment, psychotropic drugs and hospitalization. The individual may also appoint an attorney-in-fact who is authorized to make mental health treatment decisions on behalf of the individual, based on the provisions of the document.
Advance instructions may also include:
- Names and telephone numbers of people to contact
- Situations that may trigger a mental health crisis
- Suggestions for stabilizing the individual
- Medicines and their effects
- The preferred treatment facility
- Names of people who may visit the individual while in treatment
"The purpose of the advance instructions law is to allow people to plan in advance for a mental health crisis," said Paula Wilcenski, director of the North Carolina Mental Health Consumers Organization, which was active in getting the law passed. "But in trying to implement this new law, some legitimate concerns are coming up that need to be addressed."
Wilcenski is one of 20 speakers and panelists slated to participate in "New Frontiers in Treatment and Research," the spring conference of the North Carolina Alliance for the Mentally Ill (NC AMI). The conference will be held April 3 and 4 at the Holiday Inn in Research Triangle Park.
According to Wilcenski, during its first three months, a variety of questions have emerged about the details of the new law. For example, the law states that an advance instruction document becomes effective once the person gives it to his or her doctor or mental health care provider and remains effective for two years. "Some people think the law might work better without the two-year limit," said Wilcenski. "They're also concerned about documents filed on different dates with several different caregivers. When does that document expire?"
With medical records already bulging with living wills, health care powers of attorney and other such directives, Wilcenski said providers are also concerned about having to train staff to follow yet another set of treatment instructions. Another issue for providers is potential liability associated with following-or not following-the patient's instructions.
For patients, privacy issues are a concern. "Someone going in for an appendectomy may not want the hospital staff reading all the details of his or her mental illness," said Wilcenski. "As the law stands now, once the document is in the hands of a doctor or health care provider, it becomes part of the patient's medical record."
Wilcenski said these issues need to be resolved before mental health care consumers can realize the full benefits of the advance instructions law. "In the coming weeks and months, we're going to try to hammer out a better way, and we hope the end result will be productive for everybody," she said.
Wilcenski will present a workshop on North Carolina's Advance Instructions Law Friday afternoon, April 3, from 1:45 to 3:15 at the Research Triangle Park Holiday Inn. The "New Frontiers in Treatment and Research" conference is open to the public, with one-day and two-day registrations still available.
Fact Sheet
North Carolina's Advance Instructions Law
Senate Bill S 757 ratified August 19, 1997, effective January 1998
Provides a means by which an individual can exercise the right to consent to or refuse mental health treatment when the individual lacks sufficient understanding or capacity to make or communicate decisions.
"Advance instruction" or "advance instruction for mental health treatment" is a document signed by an individual and two qualified witnesses providing the individual's instructions, information and preferences regarding mental health treatment.
"Mental health treatment" includes electro-convulsive treatments, psychotropic drugs and admission to and retention in a facility for care or treatment of mental illness.
Any adult of sound mind may make an advance instruction regarding mental health treatment. For the purpose of advance instructions, a mind is sound when an individual understands and can make and communicate mental health treatment decisions.
The individual may use advance instructions to consent to or refuse specific treatments.
Advance instructions may include (but are not limited to):
Names and telephone numbers of people to contact in case of a mental health crisis
Situations that may cause the individual to experience a mental health crisis
Responses that may help the individual remain at home during a mental health crisis
Types of assistance that may help stabilize the individual
Medicines the individual is taking or has taken in the past and their effects
Preferred treatment facility
Names of people who may visit the individual while in treatment
May be combined with or incorporated into a properly executed health care power of attorney or general power of attorney.
May also use the advance instruction document to appoint an attorney-in-fact authorized to make mental health treatment decisions on behalf of the individual, based on the provisions of the advance instruction document.
Becomes effective when delivered to the individual's physician or other mental health treatment provider who makes the document part of the individual's medical records.
Remains valid for two years or until revoked.
When treating an individual in a mental health crisis, physicians or other treatment providers must comply with advance instructions to the fullest, unless:
The provisions are inconsistent with the best medical practice
The requested treatments are not available
The provisions require violating applicable law
Physicians and providers may also provide treatment contrary to advance instructions if the individual is committed involuntarily or in case of an emergency endangering life or health.
The existence of an advance instructions document does not limit any authority provided by law to take a person into custody, or to admit, retain or treat a person in a facility.
While following advance instructions, the individual's physician or mental health care provider also continues to obtain informed consent to all mental health treatment decisions as required by law.
More Projects for NAMI North Carolina
Logos and stationery designs
- Who We Are & What We Do
- Understanding Mental Illness
- Understanding Your Needs as a Mental Health Care Consumer
- Understanding Bipolar Disorder
- Understanding Depression
- Understanding Schizophrenia
- Understanding Serious Emotional Disorders in Children
- Support, Education, Advocacy & Resources for Children
- Young Families
News Releases, Backgrounders & Fact Sheets:
- NC Psychiatric Hospital Study Report
Documents Severe Problems
- NAMI North Carolina's Guide to the Efficiency Study of the State Psychiatric Hospitals, including summaries, fact sheets, findings & recommendations, tables
- The Wendell Williamson Case: A Statement by the Board of Directors
- Mental Health Advocates Criticize Critics of Williamson Verdict
- Criticize Less, Understand More, an editorial by Shirley Strobel, President
- 1998 Congressional Candidates' Questionnaire Submitted to congressional candidates
- State Senate Bill Calls for Mental Health Insurance Parity
- Mental Health Advocates Accuse Small Business Group of Misrepresenting Parity to Legislators
- Disputing NFIB's "Facts" About Mental Health Insurance Parity
- Organizations Supporting the Parity Bill
- 'Singin' Scientist' Featured at Spring Conference
- Workshop to Focus on Law Enforcement Response to Mentally Ill People in Crisis
- Facts: Crisis Intervention by Law Enforcement
- Mental Health Care Community Working Out the Details of New Advance Instructions Law
- Facts: North Carolina's Advance Instructions Law
- Leading Brain Researcher to Address Conference
- 'Survivor Skills' Author to Lead Workshop for Parents of Children with Mental Illnesses
& Serious Emotional Disorders
- NAMI North Carolina Receives National Award
- Health Care Providers Asked for Input on Redesigning North Carolina's Mental Health Care System
- Bruton to Address Mental Health Advocates
- Undercurrents Author to Address Conference
- News & Observer Staff Members Receive Media Award
- NAMI North Carolina Facts
- The NAMI Lexicon
- Family-to-Family Education Facts
In addition to distributing news releases by mail and fax, I posted all releases and fact sheets to a NAMI North Carolina News & Information web site I created. |
