Declarations for Mental Health Treatment

A Declaration for Mental Health Treatment (DMHT)—also called a psychiatric advance directive (PAD)—is a legal document that lets you say what mental health care you want in the future or name someone to make decisions for you if you are in crisis and cannot decide for yourself.

The declaration does not immediately become legally binding once you make it. It is not legally binding unless a judge decides you are incapacitated, meaning the judge thinks you are unable to understand the risks and benefits of treatment and to make rational decisions about your care. But even if your declaration is not legally binding, you can still use it informally to communicate your preferences to your healthcare providers.

A Declaration for Mental Health Treatment is valid for up to three years. If you cannot make your own decisions when the three years end, the document stays valid until you are able to make decisions again.

A Declaration for Mental Health Treatment must either be signed in front of a notary or two witnesses. If you sign in front of two witnesses, those witnesses cannot be a relative, a care provider, or anyone entitled to inherit from your estate.

A Declaration for Mental Health Treatment expires after three years, so if you want to keep using it you will need to make a new one every three years.

But remember that a Declaration does not become legally binding unless a judge finds you incapacitated. If a judge finds you incapacitated, your declaration will stay in effect until you are no longer incapacitated. This is true even if you’re incapacitated at the time the declaration would have expired. If you want to keep using your declaration once you have capacity again, you would need to make a new one.

If you have more questions about Declaration for Mental Health Treatment or how to prepare one, or if you want to customize one, talk to a lawyer.

A declaration for mental health treatment helps you preserve your dignity and independence while ensuring you get proper care. It can also help prevent involuntary treatment. You can share your declaration with your local hospitals, providers and police departments so that your preferences about care are clear. Also, your family members will know about your preferences so that they can advocate for you.

Yes. In some situations, your providers may not have to follow your Declaration for Mental Health Treatment.

For example, they may refuse to follow it:

• during an emergency,
• if you are ordered to receive treatment under Texas involuntary commitment laws, or
• if the provider believes the instructions do not meet professional standards of care.

If a provider refuses to follow your declaration because of professional standards, they must try to help you find another provider.

Texas law does not clearly say when a provider can refuse instructions from your agent. But the same rules will likely apply.

The law lets you write advance instructions about psychoactive medication, electroconvulsive therapy (ECT), or emergency mental health treatment, which may include hospitalization. You can also use your Declaration to refuse consent to any of these treatments.

Read Disability Rights Texas’ guide about advance directives for more details.

No. But your declaration must be signed by two competent adult witnesses. The witnesses must attest that when you were creating the declaration, you were (1) of “sound mind” and (2) understood its effect. The witnesses cannot be employees of your health care provider, your relatives, or beneficiaries of your estate.

See Chapter 137 of the Texas Civil Practice and Remedies Code.

You can hire a lawyer to draft one for you, draft one yourself using the form in Texas Civil Practice and Remedies Code 137.011, or use this Declaration for Mental Health Treatment form.