Creating a MHAD

Either the name of someone to make decisions for you (i.e., your representative) OR specific information about treatments you do or do not want (you can include both, but you need at least one)
The Oregon DMHT form
A notary or two witnesses to watch you sign the Oregon DMHT form (more information on witnesses below)
If you name a representative, they will need to sign the form as well, but it does not have to be at the same time as you.
Make sure to talk to your representative, your loved ones, and your treatment providers to help you fill out the form and so they know what you want!
If you aren’t sure exactly what you want, you can always start by creating a MHAD with a trusted representative or provider and update it later with more information.

The name and contact information of someone you trust to make mental healthcare decisions for you if you can’t make decisions for yourself, also known as your “representative”. You can also have a back-up representative named as well.

Desired treatment: current medications and dosage, residential or inpatient facilities with providers you trust, deescalation strategies that work well for you, information from your relapse prevention plan or wellness recovery action plan.

Undesired treatment: allergies, medications you’ve tried before that didn’t work for you, medications that might set you back in your recovery (e.g., benzodiazepines or narcotics if you have had trouble with those before), treatment options to delay unless you’ve already tried everything else (e.g., if you don’t want to be hospitalized unless phone coaching with your therapist already failed or respite care is not available).

You cannot be required to complete a DMHT for insurance purposes, to receive treatment, or to discharge from treatment. It is against the law.

For more information on research about DMHTs, please see the “Available Research” page.

Once you and the notary or witnesses sign the DMHT form, it is in effect. However, doctors can only use it if they know about it. Make sure that if you have a representative, they have a copy. Then, give it to any providers or loved ones you trust so it can be accessible when you need it.
Once doctors have your DMHT, it can only be used or “activated” if a court or two physicians decide you are unable to make decisions about your mental health treatment. Until that happens, you make your own decisions.
While the DMHT is in use, if you regain the capacity to make mental health treatment decisions, then the DMHT is no longer activated, and you can make your own decisions again.
DMHTs expire after three years, unless it is being used, in which case it won’t expire until it is no longer in use. Make sure to mark down when you need to update it!
You can revoke or change the DMHT at any time, unless you’ve already been determined to not have capacity to make your own healthcare choices.
The following people cannot be your representative, unless they are related to you:

Your provider or their employee
An owner, operator, or employee of the facility where you are a patient
Anyone from whose care you have previously been removed, regardless of whether you are related to them

To be legally binding, the DMHT form must be signed by you in front of a notary or two witnesses. The notary or witnesses must also sign to attest that they saw you sign the DMHT, they know who you are, you appeared to be “of sound mind”, and you did not appear to be under duress, fraud, or undue influence. This just means that you appear to be signing knowingly and of your own free choice. The notary and witnesses do not need to know what is in your DMHT. These people cannot be witnesses for you:
- Your provider or someone related to them
- An owner, operator, or relative of an owner or operator of your health care facility
- A person related to you through blood, marriage, or adoption.

A DMHT does not 100% guarantee that your treatment wishes will be followed. If there is an emergency, you are civilly committed, you are found guilty except insanity of a crime, or found not fit to proceed in a criminal case, doctors are allowed to follow the DMHT but they do not have to. Outside of those circumstances, doctors and your representative have to try their best to respect your wishes. However, if a doctor thinks something you’ve asked for could hurt you, they don’t have to do it. For example, if the medication you listed on your DMHT can’t be combined with medication you started since signing your DMHT, the doctor won’t prescribe it.
Your DMHT may not work outside of Oregon - every state has its own rules.

Any providers you regularly see
Any emergency rooms or other healthcare facilities you might be to taken to for care in a crisis
Your representative
Family, friends, or loved ones who might be there to help you in a crisis.

You can voluntarily disclose your medical information to your local Community Mental Health Program. The information is accessible in a database shared with law enforcement agencies. This information helps them best work with you in the community should you come in contact with them during a mental health crisis. OHA has a consent form you can complete to have your Declaration information added to the Voluntary Mental Health Database. Whether you should add your information to the Voluntary Mental Health Database is entirely up to you. No one can force or coerce you into completing the consent form. Possible disadvantages are that law enforcement now has access to your mental health information, it may not result in access to treatment, and you might still be arrested. A possible advantage to having the information accessible by law enforcement is for them to better serve you when in contact with them, such as helping you get access to the treatment you’ve already consented to rather than arresting you.

MyMHAD.org