Information for Loved Ones
You may be reading this information because a loved one has a DMHT, has asked you to be involved in creating or managing their DMHT, or because you think a DMHT might be a good option for someone you care about.
If your loved one has a DMHT or is creating one, you could support them in a variety of ways:
Offer encouragement and pragmatic support (e.g., printing the documents for them, driving them to a notary appointment to sign the document, driving them to a provider appointment to talk through their DMHT, storing a copy of the document once completed, helping them share the document with relevant providers, etc).
Advocate for them, when appropriate, to be sure providers know about the DMHT and follow it as best they can. Even if a DMHT is not technically enforceable, it still has valuable information for doctors to know.
If your loved one asked you to be a representative or witness, carefully consider if and how you can serve in that role. Have an honest conversation with them about what they want from you in that role and any concerns you have about being in that role.
To be a representative, you have to be willing to make mental health treatment choices for your loved one if they are determined to not have capacity to make those choices for themselves; you also have to be willing to follow their instructions to the best of your ability and in good faith. It is best, but not required for you to sign the DMHT with them, as a show of your willingness to be in this role. If your loved one has ever been removed from your care, you likely cannot serve as a representative (see ORS127.727 for more information). Also, if you are the person’s provider, an employee of their provider, or an owner, operator or employee of the facility where the person resides, you cannot serve as a representative unless you are related to them. A representative is not required to have a DMHT.
To be a witness, you and one other witness must observe the person sign their DMHT. Then both witnesses must also attest that they know the person signing the DMHT, that the person signing the DMHT appears to be “of sound mind”, and they do not appear to be under duress, fraud, or undue influence. If you have ever witnessed the signing of a will, this is the same standard. You do not need to see the contents of the DMHT to be a witness. If you do not know if the person is “of sound mind”, you can always request a professional to evaluate their capacity to make healthcare choices. You cannot be a witness if you are the person’s provider or related to their provider, if you are an owner / operator of a facility they receive care in, if you are related to the owner / operator of a facility they receive care in, or if you are related to the person signing a DMHT via blood, adoption, or marriage. Alternatively, one notary can replace both witnesses.
If you think a DMHT might be a good option for someone you care about, share this website with them, and if applicable, their providers. Talk with them about why you think a DMHT could help. Offer them support if they need it.
Regardless of where your loved one is in the process of creating and managing a DMHT, remember that the power of DMHTs appears to come from the person freely going through the process of completing a DMHT and sharing it with their providers. It is also powerful because it authentically represents the person’s values and choices for themselves. Pressuring someone to complete a DMHT or to include (or exclude) particular information short-circuits that process and undermines the authenticity - in those circumstances, the DMHT is subsequently less likely to be as helpful.
Here are some examples of things people put in their DMHTs, to generate topics of conversation for you and your loved one:
The name and contact information of the representative. A back-up representative can be named as well.
Desired treatment: current medications and dosage, trusted residential or inpatient facilities, trusted providers, preferred deescalation strategies, information from a relapse prevention plan or wellness recovery action plan
Undesired treatment: allergies, medications that didn’t work, medications that might set the person back in their recovery (e.g., benzodiazepines or narcotics if those have caused trouble before), treatment options to delay unless everything else has already tried (e.g., no hospitalization unless phone coaching with a therapist already failed or respite care is not available).
Information about where to get important medical record information
Contact information for attorneys or loved ones
Anything else a doctor should know before treating the person
It’s important to know that your loved one can make their own decisions unless a court or two physicians decide they are unable to make decisions about their mental health treatment. Then, the representative or instructions in their DMHT will guide treatment until they regain the capacity to make their own mental health treatment decisions.
There are some circumstances in which doctors don’t have to honor the DMHT, like if there is an emergency or the person with a DMHT is civilly committed. Otherwise, doctors are required to follow the DMHT in good faith; if their medical judgment says something would be harmful (e.g., prescribing two medications that cannot go together), they don’t have to do it.
DMHTs expire after three years unless they are actively in use (i.e., the person does not have capacity to make their own healthcare choices at the time the DMHT would have otherwise expired).
A DMHT can be revoked or changed at any time, provided the individual has the capacity to make their own mental health treatment choices at the time of revocation or change.
An Oregon DMHT may not work outside of Oregon - every state has its own rules.
For more information on research about DMHTs, please see the “Available Research” page.