Conservatorship, the legal act of one person assuming legal responsibility for the financial and life decisions of another person due to that person being deemed incompetent to do so, has been hotly debated as Brittney Spears conservatorship has played out before us in court. We encourage everyone to keep in mind these points when thinking about conservatorship:
- Almost all people with disabilities, including mental illness, are able to make their own decisions.
- A person’s ability to make their own decisions should not be determined on the basis of a few decisions.
- Conservatorships and guardianships, once implemented, are very hard to undo, in part because the person now has to prove they are not incompetent and they may have lost their right to legal representation because of the conservatorship.
- When people with mental illness need additional support to make decisions, there are ways to provide that support without the restrictiveness of a conservatorship.
In supported decision-making, the person with a disability is advised by a team of supporters that they have chosen to get input on decisions, but the person themselves makes their own decisions. There are promising outcomes with this approach. This article from Salon describes the real-world experiences of individuals and families dealing with conservatorships and supported decision-making.
A related concept, shared decision-making, means that clinicians and other health care providers make medical and treatment decisions in partnership with the person receiving care and those decisions are based on evidence and outcomes that matter to the patient. In order for the decisions to be shared, the person receiving care has the same access to information about treatment options and related information that the medical care provider does.
A psychiatric or mental health advance directive (PAD) is “a legal tool that allows a person with mental illness to state their preferences for treatment in advance of a crisis. They can serve as a way to protect a person’s autonomy and ability to self-direct care. They are similar to living wills and other medical advance planning documents used in palliative care.” A person who chooses to have a PAD designates who they would like to make decisions for them in case they are unable to do so during a psychiatric emergency. They also describe how they would like for such emergencies to be addressed. The PAD is discontinued when the person is no longer in acute crisis.