I'm from Durham in the north-east of England. I've spoken to Rebecca & Eamonn in Soteria meetings.

Thanks, Chere!

good morning, Carolyn

Felix Ullrich, Cherrry Hill/Delran nj

Hi Felix :)

Hello from sunny Omaha, NE

Welcome, Paulissa

Hi Mia

Where will the webinar about warm lines and respite will be offered? Looking for repite for niece.

Hi Mia

Rachel, they are all posted on the Family Café TA website

Dean Clickner, Director, Warren Washington Rose House/People USA, Glens Falls, NY

Hi Dean

Rose House in the house

Hi everyone, Yulia from New Mexico Tech. Happy to be here on time, finally

We are People people!

Hi Yulia, welcome back

Cannot see anyone waving.

Rachel, look in the archives of this series re: respites.

In BC, psychiatric patients are specifically excluded from the Representaton Agreement Act, the legislation which allows Advance Directives.

So sorry, for some reason I could not mute myself when there was an interruption

BC likely has the most regressive, draconian legislation in North America.

What archives? Where willi

Began supporting individuals using PADs in Oregon in 1993 when they were officially adopted here.

Rachel, all of the recordings are on our website at cafetacenter.net

Where will I look? I'm new here. This is my first on here.

Thank you

it's the second article when you scroll down our homepage

Welcome, Rachel.

Morning Hi it is Anne from Nanaimo, B.C. Sorry to be late.

Hi, Anne!

You will find links to the recordings at https://cafetacenter.net/a-webinar-and-learning-community-series-on-peer-run-crisis-alternatives/

Thanks Stan! I couldn't go get the link myself while running the Zoom.

www.nrc-pad.org

When they're psychotic?

In shock

Note well: "Capacity" is not the same as "competency." Important difference.

When my executive functioning is gone with chronic pain

Jack, do you have a definition for "competency"?

In the UK we have what is known as a Health Passport, I think it's more for physical health like if someone is admitted to the ER. I've been thinking of getting one to explain what my needs are if that ever happens to me. But I have been invalidated and ridiculed by a lot of people so am anxious about it. I don't know if there are people who'd be able to help me with that.

Great, clear explanation, thanks.

That is interesting Mia. In the US there are medical advance directives for physical health too.

Medical advance directives have been around for much longer than psychiatric advance directives.

Could one have a PAD that declines treatment?

I mean, generally.

Same here, Cherene.

What is ECT?

Electro-Convulsive Therapy

They didn't' honour my request for meal replacement. When I'm manic, I can't eat solid food.

electroconvulsive "therapy"

PAD = Self-determination via our chosen proxy.

Thank you

If I can refuse being examined by a physician, can I refuse being "examined" by a shrink?

...the things that are NOT "standards of care" are industry standards and not with concern for individuals' physical/biological/psychological baseline and, therefore, their standards are not necessarily in your best internet, often do not actually heal, and are often variations of harm/violence.

Michele, I agree.

Have to leave early. Great information! Thank you. Carolyn ❤️

Yes, Michele, I think the challenge would be to explain that with specificity in the PAD

Internet = Interest * (typo)thanks auto correct 🥴

From the Bazelon Centre: http://www.bazelon.org/wp-content/uploads/2017/04/PAD-Template.pdf and from SAMSHA: https://www.samhsa.gov/sites/default/files/a_practical_guide_to_psychiatric_advance_directives.pdf

The insurance industry often sets this tone. Unless a doctor is willing to Bill (invoice) outside the insurance ministry nothing will charge unless consumers can afford out of pocket for alternative health practitioners and orthomolecular/functional medicine doctors that are willing to NOT play in the insurance industries sandbox. Then, the consumer would have to pay out of pocket, and have enough wealth to do that. Of course, pHARMa also sets tone of all above but pHARMa topic is another chapter for another day.

charge = change *

Any time these activities become anchored in legal definitions, then common sense and medical definitions get put in second place importance. Just like how "mental illness" in statutes do not necessarily correspond with "mental illness" clinical or commonly used terms.

not if they work for psychiatry

Psychiatric Advance Directives and the Right to Refuse Treatment in Canada: https://journals.sagepub.com/doi/10.1177/070674370705200610. Greetings, fellow Canucks:) We've got a lot of work to do here!

I'm so sorry but I have to leave very soon. Thank you for these wonderful webinars.

Our pleasure!

(ugh) from my previous comment: insurance ministry should be insurance industry *pardon me

Stan, that link is dead.

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793222?fbclid=IwAR3ueUw-Ptqp8ebswK5OyUsTRbGbszxcxfJy0R1RUFUEphvPpRV-BBASwqE

Francesca, it works for me. This one should take you straight to the PDF: https://journals.sagepub.com/doi/pdf/10.1177/070674370705200610

I have found that PADs are responsibly implemented more often in rural settings where there can be more personal relationships among providers, supporters, and community members. No guarantee, and some rural settings can invite even greater stigma at times, but on average I have found that when the relationships are positively developed, the PADs are adhered to more often. Much more likely in large urban settings with multiple hospitals and less personal relationships.

Thank you

much more likely THAN in large urban settings. Sorry.

Have you seen people integrate their PAD with their WRAP in any way? Also, as a person's recovery journey evolves, do you have tips or guidance as to when to review it for accuracy?

It's always about the relationships.🤝 ❤️

Exactly, Stan. Trust and relationship.

North Carolina's law seems to have particularly weak protection compared to other states I know about. Thus, I don't know about this for North Carolina, but my experience is being a substitute decision maker is more likely to be successful than being the person's attorney.

Because the number one reason I have seen for ignoring PADs I recommend having someone sign the PAD that the person is competent or has capacity. The higher ranking letters after their name, the better.

Most medical providers I have met know that there is no consistent legal precedent across regions of the country to protect a physician who honors a PAD, but then gets sued when a practice standard was ignored and the "patient" experienced severe changes or medical decline. So, they are very wary about honoring a PAD when the terms are more unique.

The question is whether you had capacity when you signed it.

No guarantees.

I am Japanese and living in Japan. On my job as a journalist, I have been covering some involuntary hospitalization cases related to heritage disputes. Someone in family easily make other one inpatient because of fictional psychiatric symptoms. I read a report about these problems about 50 years ago when I was a child. I am sad I have to report similar cases half a century later.

Terrible!

also shows you how not clever the mh people are

The point I made about a physician getting sued when a PAD was honored but the "patient" experienced a serious/dangerous event afterward, have become important when a family member sued the physician believing the physician irresponsibly ignored standard practices.

I wonder if we can create a database of such cases as this person hospitalized by roommate? I heard about cases of domestic abuse, when people call about the alleged mental crisis their partner is having for the purpose of retaliation. It would be good to publicize such cases to raise awareness about how problematic the current laws are

How can children/adolescents/teens create a document? I have a grandchild with ongoing mh issues and I know it would be helpful. When she was hospitalized recently, under IVC, her mother tried to advocate for certain things but it took a Dr's order for anything the mother knew would be helpful for her daughter.

Court findings re: PADs are all over the map across the country.

They (docs/psychs) actually don't have to follow these legal papers and speaker just gave case example. Medical can err on medical judgment and they have that protected medical liberty, even if wrong, causes injury and made in good faith. Also, an injured patient is more lucrative to the system than a healed one.

I don't like it but is what it is.

Cheren, this is the root at the issue. This is a legal discrimination on the basis of a medical diagnosis. What about framing this as a case of systemic discrimination and fight the underlying laws as unconstitutional? Also. it appears that campaigning against the laws making MH professional liable for not committing someone, but not liable for any bad things that happen after, or in the course, of treatment

There is DEFINITELY an assumption of incapacity pertaining real or perceived mental health issues, indeed.

that is why i'm surprised that MH industry allows a pad, it is basically assumed that competency is lacking

Psychiatric advance directives are subject to the same limitations as the concept of "mental illness" treatment because "mental health" is far different than physical illness/health in the "medical model." The concept of "mental illness" does not conform to the medical model.

along with pads perhaps we should struggle and approach governments to have crisis centers that are totally free of "clinicians"

The challenge is how to define shared decision making in legal terms to protect everyone involved.

I feel PAD like guns in the US. Once some people have tools of force against others, the people addicted to the tools, I think. The PAD and involuntary treatment addiction should be treated :-)

There are those with IDD issues that may well be in a position to need a PAD. So how does that affect the use of a PAD?

Medical/Psychs - and others - do go into a mind controlled trance and are seemingly unable to think out of the box surrounding their perceptions and limited understandings of patient competencies. I guess the legal definition wins and everyone else loses ?

I am "autistic," and I have a PAD. Never used it, but I don't see how the diagnosis would be different than my diagnosis of Schizophrenia or PTSD.

Not just autism, but all across the IDD spectrum

I agree to Michele. The US did not ratified UN CRPD, so no international legal force can affect.

So if the mother develops a PAD for her child/teen, is that a legal document that has to be followed?

Children should have the right to make one imo. I think children should have more rights in general.

or... regarding requests... language that simply empowers. Such as: "No medication may be administered without my consent, or the consent of my advocate". Is that possible?

((( Not all things LEGAL are ethical, moral, for the good or betterment of others, etc. and are often in place to protect those driven by greed like industry giants ))) Meaning, closer to home, some doctors (and others) are blinded by fears of legal repercussion and not driven by common sense or what's actually in best interest of patient. Darn those standards of "care"!...me, preaching to the choir with this group, howeverthank you

I have heard from those providing services here how helpful it is to have an already developed crisis plan in the record they can refer to in these incidences.

Same here, Mary Ann.

It might be helpful to filter this through the Power Threat Meaning Framework lens: https://www.bps.org.uk/power-threat-meaning-framework. Power begets violence begets trauma. The greater the power the greater the violence the greater the trauma. Who holds the power? Hint, follow the money.

Is there any reference or link to the statistics of Black men being overdiagnozed? I am trying to change MH policies in my school, and for this purpose, I am trying to get it inserted into the DEI initiatives. This statistics about racial disparities will help greatly

thanks Stan

This has been a wonderful presentation. You covered so many aspects of PADs and their use. Very helpful. Thank you.

Thank you. I have some questions

Thank you, very interesting

my email: ccaraco@promiseresourcenetwork.org

Thank you, Cherene and Jeremy, it was great

Thank you Cherene and Jeremy for another great presentation. Once more, I feel enlightened and inspired.

I e-mailed you yesterday Cherine. Sorry it was a bit long and intense.

Thank you so much for this offering and the comments that allow us to sound of.Love your offerings!!!!!have a lovely day

thanks Jeremy and Cherene

Thank you this series. Good night from Tokyo

I struggle being heard so I find it hard to say what I need to in a concise way sometimes.

Thank you and good evening from the UK

🤍