Virginia has just passed a bill which will change who can assist others in writing advance directives. Advance directives are legal documents in which people give instructions to healthcare providers in the event that the person is no longer able to make decisions for themselves due to illness or incapacity. Anyone can write their own advance directive and it will become legally valid if they sign and date it in the presence of two adult witnesses, who also sign it and date it. However, research has shown that the most effective advance directives are those that were facilitated. Having a trained individual collaborate in the process results in a much more meaningful, detailed, and appropriately completed advance directive form. Unfortunately, until now, only lawyers, health care providers, or contractors and agents of health care providers acting within the scope of their employment were permitted to assist in writing advance directives. (See Va. Code §8.01-581.1).

Thankfully, Governor McAuliffe has just approved HB 1747, which permits anyone who has completed an advance directive facilitator training program to offer one-on-one facilitation in any context. The law will take effect on July 1st, 2017. There are currently four state-recognized advance directive facilitator training programs, but the Institute of Law, Psychiatry, and Public Policy of the University of Virginia is the only one that addresses the mental health advance care planning. The other programs only discuss end-of-life care planning. Click here to learn more about the UVA advance directive facilitator certification training.

For additional information, please contact:

Cynthia Elledge, Ph.D.
Advance Directive Implementation Coordinator
UVA Institute of Law, Psychiatry and Public Policy
(434) 297.7879

Research on Advance Directives

Elbogen, E. B., Swanson, J. W., Appelbaum, P. S., Swartz, M. S., Ferron, J., Van Dorn, R. A., & Wagner, H. R. (2007). Competence to complete psychiatric advance directives: effects of facilitated decision making. Law and human behavior, 31(3), 275-289. doi:10.1007/s10979-006-9064-6

Elbogen, E. B., Swanson, J. W., Swartz, M. S., Van Dorn, R., Ferron, J., Wagner, H. R., & Wilder, C. (2007). Effectively implementing psychiatric advance directives to promote self-determination of treatment among people with mental illness. Psychology, Public Policy, and Law, 13(4), 273. doi:10.1037/1076-8971.13.4.273

Swanson, J. W., Swartz, M. S., Elbogen, E. B., Van Dorn, R. A., Ferron, J., Wagner, H. R., … & Kim, M. (2006). Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. American Journal of Psychiatry, 163(11), 1943-1951. doi:10.1176/ajp.2006.163.11.1943

Swanson, J. W., Swartz, M. S., Elbogen, E. B., Van Dorn, R. A., Wagner, H. R., Moser, L. A., … & Gilbert, A. R. (2008). Psychiatric advance directives and reduction of coercive crisis interventions. Journal of Mental Health, 17(3), 255-267. doi:10.1080/09638230802052195

Swanson, J. W., Swartz, M. S., Hannon, M. J., Elbogen, E. B., Wagner, H. R., McCauley, B. J., & Butterfield, M. I. (2003). Psychiatric advance directives: A survey of persons with schizophrenia, family members, and treatment providers. International Journal of Forensic Mental Health, 2(1), 73-86. doi:10.1080/14999013.2003.10471180

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