Marcia Anders has battled manic depression for most of her life.

"I have had several instances of traumatic experiences," said Marcia.

Robert Chokan has dealt with bipolar disorder for more than 30 years. He tried to kill himself three times.

"My life was not worth living. I couldn't see any end to it," said Robert.

Two patients with two real problems. And one of their biggest fears -- not being in control when an episode strikes.

"I wanted to have something available, living as a single person that would speak for me in the event of an emergency."

Now, there is. It's a document called a psychiatric advance directive, or "pad." Pad is aimed at recovery. Patients can give instructions on who should be the decision maker, what hospital they want to be treated at, and which meds work best.

"People with psychiatric illnesses often have recurrences and so they have experiences with treatments that work for them or don't work for them," said Dr. Marvin Swartz, Professor of Psychiatry and Behavioral Sciences.

Duke researchers studied pads extensively and found they reduce the use of forced treatments during a mental health crisis and improve patient-doctor relationships.

"Its actually part of a number of important trends towards a more collaborative mode of decision-making," said Dr. Jeffrey Swanson, Professor of Psychiatry and Behavioral Sciences.

About 25 states have pads available. Less than 15 percent of mentally ill patients have completed them. One warning, a doctor can always override parts of the document if he believes there's a better treatment.

Pad worked for Marcia. During her last hospital visit, doctors pulled her charts and were given instant info.
"The PAD speaks for me when I can't speak for myself."

Robert and his wife know how tough living with a mental illness can be.

"It's something I have to resign myself to having the rest of my life."
But with new innovations, that might get a little easier for some.

For More Information, Contact: Melissa F. Schwarting Senior Media Relations Strategist Duke Medical Center News Office Durham, NC (919) 660-1303
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