Declaration for Mental Health Treatment Q & A
The Declaration form and other resources can be found under the Related Links to the right.
1- What is your Declaration for Mental Health Treatment?
This is an official form that you may choose to complete, stating that you understand that if you become incapable of, or are withholding informed consent for your mental health treatment due to the symptoms of your diagnosed mental disorder, that your Declaration will go into effect.
2- How do you fill out your Declaration for Mental Health Treatment?
First, thoughtfully consider treatment you wish to receive in the event you are incapacitated; treatment for psychoactive medications, for electro convulsive treatment and/or for your retention in a mental health facility.
Second, decide if you wish to appoint someone as your Attorney-in-Fact, and if so, whom?
Third, ask two individuals to serve as witnesses. They will affirm that you are personally known to them, that you sign your Declaration forms in their presence, and that you appear to be of sound mind, and do not appear to be under duress.
3- When are you eligible to fill out your Declaration for Mental Health Treatment?
You are eligible if you are an adult, age 18 or older, and are mentally capable at the time to declare your preference or instructions regarding your mental health treatment, to be carried out at such time as when you are considered incapable.
4- What if you want to add more information about your wishes to be carried out during a time you are incapable?
Your Declaration form has space near the end where you may designate additional people you wish to communicate with, or requests such as care of additional people you wish to communicate with, or care of dependent children or pets, etc. during the time your Declaration is in effect.
5- How long will my Declaration be in effect?
Your Declaration will be effective for three years, unless you remain incapable beyond that time.
6- What is an "Attorney-in-Fact"?
If you decide that you wish to appoint an Attorney-in-Fact, his/her role will be to see that:
your Declaration is carried out correctly, and
to see that decisions of desires not stated in your Declaration, in accord with what he/she believes in good faith, to be in your best interest.
An Attorney-in-Fact has the same rights as you do to receive information regarding proposed mental health treatment. However, an Attorney-in-Fact is not solely, as a result of acting in that capacity for you, personally liable for the cost of treatment provided to you.
Your Attorney-in-Fact also has the right to withdraw acting for you in this capacity at any time, just as you have the right to revoke your appointment of him/her at any time, as long as you are considered mentally capable at the time.
7- Who may act as my Attorney-in-Fact?
You may appoint any person you choose who is not your attending physician, or an employee of your doctor, the Division of Substance Abuse and Mental Health, or your local mental health center.
If you don't want to ask a relative or friend to act as your Attorney-in-Fact, you may wish to appoint a volunteer from your local chapter of NAMI Utah or other grass-roots groups.
8 - Do you need a lawyer to execute a valid Declaration for Mental Health Treatment?
No, a lawyer is not needed.
9 - At any time that you need mental health treatment, will your Declaration be in effect?
No. If you are capable at the treatment time, you will still consent to mental health treatment decisions. If you are incapable, your Attorney-in-Fact will act for you. He/she will not be subject to criminal prosecution or civil liability for any action taken in good faith based on your Declaration.
10- Where should you keep copies of your Declaration?
Deliver a copy of your Declaration to your attending physician, to your Attorney-in-Fact, and to any other person you wish to retain a copy.