Can Advance Directives Include Mental Health Treatment?

Yes. In Washington, you can put your mental health treatment wishes in writing ahead of time, and the law gives that document its own name and its own rulebook. If you have ever worried about what would happen during a mental health crisis, this is one of the most useful planning tools available to you.

For related help, see estate-planning help, power-of-attorney guide, and Washington probate guide.

A Separate Document From the Standard Living Will

Most people think of an advance directive as a "living will," the document that tells doctors what to do if you are dying or permanently unconscious. In Washington, that document lives under the Natural Death Act, chapter 70.122 RCW, and it focuses on withholding or withdrawing life-sustaining treatment in a terminal condition or a permanent unconscious condition. It is an important document, but it is not built to handle a psychiatric crisis.

Mental health treatment gets its own instrument. Washington has a standalone statute, the Mental Health Advance Directive Act, chapter 71.32 RCW, that lets a competent adult record specific instructions and preferences for behavioral health care. The two documents are cousins, not twins. Your living will speaks to end-of-life medical care, while your mental health advance directive speaks to how you want to be treated during a mental health or substance use crisis. Many people who plan carefully end up with both.

Why This Document Exists

The Legislature was direct about the reason. It found that some behavioral health conditions cause a person to move back and forth between periods of capacity and incapacity, and that during the unclear stretches a person may be unable to give informed consent and therefore may be unable to get the care they need. It also recognized that early treatment can prevent a person from becoming so ill that involuntary treatment becomes necessary. Those findings appear right at the front of the statute, in RCW 71.32.010, and they explain the whole point of the tool: it lets you speak clearly at a calm moment so your voice still counts during a hard one.

What You Can Put In It

A mental health advance directive is a written document in which you, the principal, either give instructions and preferences about your own mental health treatment, name an agent to make those decisions for you, or do both. That definition comes from RCW 71.32.020, and it is broader than many people expect. Within the document you can address the treatments that matter most in a psychiatric setting, including your preferences about specific medications, your consent to or refusal of particular interventions, which hospitals or facilities you prefer, who should be contacted, and other instructions that help providers understand what care fits you.

You can also speak to inpatient admission. Washington law allows a person to consent in advance, through the directive, to voluntary admission to inpatient behavioral health treatment, and it sets out careful protections around how that works. Under RCW 71.32.140, a properly executed directive can allow admission even if you object at the moment of admission, but only when a qualified member of the facility's professional staff evaluates you, determines you are incapacitated, obtains any agent's informed consent, and documents specific findings first. The statute also builds in release protections, including a general rule that you must be released no later than fourteen days after admission if you have not regained capacity or you regain capacity and decline further treatment, unless you are detained under a separate involuntary treatment law. These are meaningful safeguards, and they are the reason it helps to prepare the document with care rather than filling out a form in a hurry.

How the Document Becomes Valid

A mental health advance directive is not effective just because you wrote it down. Washington sets out formal requirements in RCW 71.32.060. The directive must be in writing, must contain language that clearly shows you intend to create a directive, and must be dated and signed by you or at your direction if you cannot sign yourself. It must also state whether you want to be able to revoke it during a period of incapacity or whether you want it to remain unrevocable during that period, which is a significant and personal choice. Finally, your signature must be either acknowledged before a notary or witnessed by at least two adults who each confirm that they know you, that they watched you sign, and that you did not appear to be incapacitated or acting under fraud, undue influence, or duress. The directive is valid when you execute it, though you can set part of it to take effect later.

How It Connects to Your Health Care Agent

You do not have to choose between naming a person and writing instructions. You can name an agent inside the directive itself. If you appoint someone to make mental health treatment decisions through a power of attorney, RCW 11.125.400 addresses how that authority works, including the rule that when more than one agent has authority over mental health decisions, the most recently appointed agent generally controls to the extent of any conflict, unless your appointment says otherwise. That same section notes that consenting in a mental health advance directive to inpatient admission or electroconvulsive therapy is treated differently from the ordinary limits that apply to a guardian, which is one more reason to be precise about what you are authorizing.

A Note for Snohomish County Families

For families in Snohomish County, this planning often overlaps with the rest of the estate and family picture. A mental health advance directive can sit alongside your health care directive, your durable power of attorney, and any parenting arrangements you already have in place, so that if a crisis arrives, the people around you are not left guessing. Coordinating these documents matters most in blended families and in households where one adult carries responsibility for others, because clear instructions reduce conflict at exactly the moment when tempers and stress run highest.

This article explains general Washington law and is meant to help you understand your options. It is not legal or medical advice, and it does not create an attorney-client relationship. If you want a mental health advance directive that fits your situation, or you want to coordinate it with your other estate planning documents, the Law Office of Chad Foster serves families throughout Snohomish County and would be glad to help you get it right.

This article is general information, not legal or medical advice for your specific situation.