Lorraine A. Winsey, RN
Manager, Bryn Mawr Hospital Psychiatric Unit

In the past, the subject of mental illness was surrounded with mystery and fear.  Today, we have made tremendous progress in our understanding and, especially in our ability to offer effective treatments.  However, questions about mental illness often go unanswered and stand in the way of people receiving help.

Mental illness is common, and the milder conditions are very common.  One fifth of Americans suffer from a diagnosable mental disorder during any given year.  One fifth of school-age children are also affected by these conditions.  Severe and persistent mental illness is less common, but still afflicts 3% of the population.  The vast majority of individuals with mental disorders continue to function in their daily lives, although with varying impairments.  Overall medical care costs are driven up enormously by costs associated with unrecognized psychiatric syndromes.

The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.  We can say that certain inherited dispositions interact with triggering environmental factors.  Poverty and stress are well known to be bad for your health, which is also true for mental health.  In fact, the distinction between "mental" illness and "physical" illness can be misleading.  Like physical illness, mental disorders can have a biological basis.  Many physical illnesses also have a strong emotional component.

We like to think that we all live in a humane and healthy society in which all people are accorded respect, dignity and the opportunity to achieve their full potential free from stigma and prejudice.  Consistent with that philosophy, all States permit some form of legal advance directive for healthcare.  A Psychiatric Advance Directive offers a clear written statement of an individual's medical treatment preference or other expressed wishes.  It can also be used to assign decision-making authority to another person who can act on that person's behalf during times of incapacitation.  It is important to note that the Psychiatric Advance Directive is completed during a period of stability when the patient is in a competent state and has the ability to make decisions.

Psychiatric Advance Directives offer several key benefits:

• Promote individual autonomy and empowerment in the recovery from mental illness
• Enhance communication between individuals and their families, friends, healthcare providers, and other professionals
• Protect individuals from being subjected to ineffective, unwanted, or possibly harmful treatments or actions; and
• Help in preventing crisis and the resulting use of involuntary treatment or safety interventions such as restraint and seclusion.

Individuals considering the creation of a Psychiatric Advance Directive must be fully informed about the benefits and limitations of these legal instruments.  If you want more information on creating a Psychiatric Advance Directive, contact your local chapter of the National Alliance for the Mentally Ill (NAMI) by telephone or online at www.nami.org or organization or your attorney.

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