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 indiv idual to indicate in writing who can act on his behalf when he lacks the ca pacity 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 hospit al. Method. A point in time study of a state hospital's entire census was d one by reviewing all patients' records for demographic, diagnostic, and leg al 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 ful l guardians and were ineligible to complete their own proxies. Of the remai ning 90 patients, 53 (33% of the total population) had a proxy form in thei r 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 e xecuted meaningful health care proxies. Conclusions. This preliminary analy sis reveals that only 10% of a state hospital population had meaningful hea lth care proxies. Further outcome studies are needed to determine if the pr ocess of offering health care proxies and the presence of properly executed proxies are meaningful and beneficial to chronically ill psychiatric patie nts.