Sometimes mental health treatment is given involuntarily. This happens for two reasons:

• for the best interests of someone who is unable to make decisions, or
• in an emergency.

If you don't say what kinds of treatment you want in these circumstances then involuntary treatment will occur in the ways allowed by law.

If you have listed what treatment you want in an emergency, or when you are unable to make decisions, an advance directive is very helpful.

I. Involuntary Treatment When You Can't Make Decisions

Involuntary treatment can be given when you can't make a decision on your own. This happens after you have been found to lack capacity. If you don't have an advance directive, this determination that you lack capacity occurs either in a guardianship proceeding or in an administrative hearing while you are an involuntary patient in a psychiatric hospital.

Your advance directive can affect this kind of treatment in several ways.

• You can state that you want a determination of incapacity to happen sooner (like in an emergency room by an examining doctor). In this way, you allow yourself to get treatment sooner, and can possibly avoid the involuntary hospitalization or the guardianship proceeding.
• If a guardianship proceeding occurs, you can name who you would like to have appointed as your guardian.
• If a guardian is appointed, and you have an advance directive, your advance directive is still in effect unless the court rules that it doesn't apply.
• If you are an involuntary patient in a psychiatric hospital and they hold an administrative hearing to determine whether treatment may be given involuntarily, your advance directive must be considered as evidence of what you wanted when you had capacity. A hearing officer cannot authorize treatment without your informed consent if you can show that you would have refused the proposed treatment when you had capacity because of your personal convictions or beliefs. You can use your instructions as evidence of your previously expressed convictions or beliefs. If your advance directive is found to be valid, its terms must be applied.

II. Involuntary Treatment Given in an Emergency

The two most common forms of mental health treatment given in an emergency are commitment to a hospital, and emergency treatment once you are in a hospital - such as medication, seclusion or restraint.

Involuntary Commitment

Even though you have an advance directive, you may still be involuntarily hospitalized if you meet the criteria for involuntary hospitalization. Your advance directive doesn't change the laws on involuntary hospitalization.

Still, your instructions can be very helpful.

• You can write your instructions so that you will be able to get treatment before involuntary hospitalization would be considered.
• You can say in your instructions under what conditions you want to be admitted to a hospital as a voluntary patient.
• You can say in your instructions when it is you want to be admitted to a hospital as a voluntary patient EVEN THOUGH YOU MAY BE OBJECTING at the time.

If you include this last instruction in your advance directive, you may be admitted to a hospital as a voluntary patient for up to 5 workdays even though you were objecting at the time.

Involuntary treatment in a hospital

If you are in a hospital and an emergency arises and you pose a risk of imminent bodily injury to yourself or others, the hospital can take emergency measures to make you and others safe without having to consider your advance directive.

Your instructions can be helpful and cut down on the risk of your being treated involuntarily in an emergency:

• You can set out the kind of treatment you would agree to receiving in order to avoid an emergency.
• You can set out the kind of treatment you would agree to receiving voluntarily in the event of an emergency.