It can be useful to make plans with the person when they are relatively well about what to do if they become severely ill. Making plans in advance can help you to feel more prepared. It can also help the person to be treated in ways they would prefer to be treated when severely ill. A plan made with the person about who to contact in a crisis, what treatment and hospital the person prefers, and when and how to act on the person’s behalf is a type of advance directive.
Deciding with the person in advance about who does what to share tasks (with yourself and others) that the person is temporarily unable to do when they are very ill can make things easier too.
Who to contact in a crisis?
Find out who the person would prefer you to contact if they become severely ill and you need to access treatment on their behalf. There may be local service options to assist the person in a crisis (e.g. mental health crisis team, ambulance). If the person has established a good relationship with a particular clinician over time, this clinician may be helpful in a crisis.
You might also need to enquire if certain emergency services will assist a person with bipolar disorder when they are very ill, but not in immediate danger of harming themselves or others. If you live in a remote area where there are no local emergency services, find out where you can get help if you need it urgently.
What treatment and hospital?
Based on their previous experience the person may prefer certain treatments over others. You might need to discuss what hospitals will admit the person, as in certain places hospitals might only accept people with specific medical insurance or who have been referred by affiliated doctors. If there is a choice, the person may prefer a particular hospital. Make sure you have directions to the hospital in case you need them.
When and how to act on the person’s behalf?
Ask the person about information that you may need to provide to clinicians or hospitals (e.g. information about the history of their illness and treatment, and about their health fund and social security). Reassure the person that you recognize the sensitivity and confidentiality of this information.
You may need to discuss when to intervene on the person’s behalf (e.g. when certain symptoms or behaviour occurs). If necessary, discuss Power of Attorney agreements to arrange for yourself or others to make urgent decisions on the person’s behalf, temporarily and in specific situations (e.g. regarding treatment or finances).
People who are severely ill sometimes refuse treatment. If the person has been severely ill in the past, you may need to discuss with them under what conditions to consider involuntary hospitalisation. If possible, confirm with the person that actions that you have both agreed upon about obtaining involuntary hospital admission are acceptable to them and will not damage your long-term relationship.
Advance directives are sometimes drawn up between the person and their clinician. Including caregivers in developing advance directives increases the likelihood that these plans will be carried out if the person becomes very ill. 1
- Srebnik D, Russo J. Use of psychiatric advance directives during psychiatric crisis events. Adm Policy Ment Health 2008; 35(4):272-282.