NAMI North Carolina Facts: North Carolina’s Advance Instructions Law

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.


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