News Release
Mental Health Care Community Working Out the Details of New Advance Instructions Law
Released April 2, 1998
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.
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