Some providers ignore psych patients’ directives

EDITOR’S NOTE: Due to stigma attached to mental illness and psychiatric hospitalization, this article assigns the pseudonyms Sue and Michael to a mother and son in Charlotte. NC Health News verified their identities and reviewed legal and medical records relevant to this story. 

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By Taylor Knopf

In late summer 2021, Sue came home from work to find her 24-year-old son Michael confused. He shrugged in response to most questions and muttered words that didn’t make much sense. Sue knew something was wrong because this wasn’t the first time this had happened.

Michael was involved in the Eagle program at Atrium Health, an outpatient project designed to support young people in Charlotte after an initial psychotic episode. Sue called the Eagle program nurse, and they suggested that Michael go to the hospital before his symptoms got worse. 

Sue and Michael were nervous because Michael had suffered adverse reactions to some psychiatric medications in the past. But this time, they had one source of reassurance as they headed to the hospital: a psychiatric advance directive. That’s a legal tool allowing someone with mental illness to instruct medical providers about what kind of treatment and medications they prefer — and which ones they do not — in the event of a mental health crisis.

“They can serve as a way to protect a person’s autonomy and ability to self-direct care. They are similar to living wills and other medical advance planning documents used in palliative care,” says a guide on the federal Substance Abuse and Mental Health Services Administration website.

Sue and Michael had a copy of this legal document in hand as they walked into Atrium hospital that day. It was also on file in Michael’s medical records, which North Carolina Health News reviewed with his mother’s permission. 

Michael’s psychiatric advance directive listed five medications that he did not consent to, and the document explains that they’ve made him aggressive and paranoid in the past. But after Sue left the hospital for the night, Michael was given one of those five medications.

“The advance directive clearly had medicine that he was allergic to listed on there, and they just disregarded it,” Sue said. “So once they did that, he spiraled downward quick.” 

Psychiatric advance directives have been around for several decades, but researchers have found

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