Mental Health Care Preferences printable pdf download

Mental Health Care Preferences

If you have a serious mental health condition, you should let your doctors and loved

ones know your wishes for mental health care. This is just as important as letting them

know your wishes for other types of medical care.

Think about your experiences with your mental health condition. If you recognize signs

that your mental health is getting worse, you may want your providers and loved ones to

know those signs, too. Have certain treatments or drugs helped you while others

haven’t? Have you been hospitalized before? If so, was it helpful? You may have had

either good or bad experiences with other approaches your providers have tried, too.

You can use this worksheet to:

Record your mental health care choices.

Ensure that your spokesperson, loved ones, and health care providers clearly

understand your wishes.

Be sure to discuss your choices with your spokesperson, loved ones, and health care

providers.

You may attach a copy of this worksheet to your VA Advance Directive if you choose to

complete one. Be sure to initial each page. If you do this, VA will treat the worksheet as

part of your directive. Please review this worksheet with your spokesperson, loved ones,

and health care providers before you attach it to your advance directive.

Talk to your legal advisor if you want a state-authorized mental health advance directive.

Your advisor can help you incorporate your preferences onto that document.

This worksheet has four parts:

Mental Health Symptoms

Medication and Treatment Preferences for Mental Health

Entering a Mental Health Facility

Other Information and Preferences

Mental Health Symptoms

The signs that my mental health condition may be getting worse include:

Initial here:________ Date last updated:________

Mental Health Care Preferences