Advance Directive and Mental Health in Queensland: What You Can and Can't Control

Can an Advance Health Directive Cover Mental Health Treatment?

Yes, but with significant limitations that make this one of the most misunderstood areas of advance care planning in Queensland.

An Advance Health Directive for Mental Health allows you to document preferences about future psychiatric treatment. You can state, for example, that you consent to or refuse specific psychiatric medications or electroconvulsive therapy (ECT).

The caveat is that Queensland's Mental Health Act 2016 creates a separate framework for involuntary treatment. Understanding where that framework may limit the effect of a mental-health direction is critical for anyone creating a directive with mental health provisions.

Where the Mental Health Act Creates a Separate Framework

Under the Mental Health Act 2016, involuntary-treatment processes can apply to mental-health care in circumstances covered by that Act. When that framework applies, treatment may not follow a person's stated preference in the same way as a general AHD direction. The precise effect depends on the order and the clinical circumstances, so the treating team should explain how the documents interact.

This is why mental-health directions should be considered alongside the Mental Health Act framework, rather than treated as an unconditional refusal.

What an AHD Can Still Do for Mental Health

Despite the separate mental-health treatment framework, an AHD isn't useless in mental health contexts. It serves several practical functions:

Preferred treatments: Documenting which medications have worked well for you in the past, which caused intolerable side effects, and which you'd prefer the treating team to try first gives them useful information when planning care.

Non-crisis situations: When the separate mental-health treatment framework is not engaged, a valid and applicable AHD direction can guide treatment, subject to the document's statutory conditions and clinical applicability.

Cognitive decline vs mental illness: If your concern is dementia or cognitive decline rather than psychiatric illness, the standard Powers of Attorney Act 1998 framework may apply rather than the mental-health-specific framework. An AHD that addresses treatment preferences for someone with progressive dementia — resuscitation, hospitalisation, feeding and hydration, medication — operates under that standard framework, subject to its validity, applicability, and treatment thresholds.

Appointing an attorney: The AHD (or a separate EPOA) can appoint someone to make health decisions on your behalf. An attorney can communicate your preferences and advocate for them, but a mental-health treatment authority may limit what the attorney can decide.

Cognitive Decline: A Different Legal Path

For people planning ahead for dementia, Alzheimer's, or other forms of progressive cognitive decline, the AHD works under the standard framework. Once capacity is lost due to cognitive decline, the AHD's directions become operative subject to their validity, applicability, and treatment thresholds, and the appointed attorney or statutory health attorney makes decisions within its framework.

Key treatment decisions to document for cognitive decline include:

• Whether you want to be transferred to hospital for acute events (falls, infections) or managed in place at your residential facility
• Whether you consent to artificial nutrition and hydration if you can no longer eat or drink
• Your preferences about antibiotics for infections that arise in late-stage dementia
• Whether you want CPR attempted
• Your comfort care priorities — pain management, familiar surroundings, family presence

These directions are legally binding on the treating team under the standard AHD framework, provided they're specific enough to apply to the clinical situation and the relevant treatment thresholds are met.

Creating an AHD With Mental Health Provisions

If you want to include mental-health preferences in a directive, be as specific as possible:

• Name the medications you've tried and your response to each
• Specify which treatments you consent to and which you refuse, including ECT
• State your preferred treatment setting (inpatient vs community treatment)
• Name the person you want consulted about your psychiatric care (whether through the AHD's attorney appointment or a separate EPOA)

For a Form 4, the registered medical practitioner completing Section 5 (the capacity certificate) should be aware that the AHD includes mental-health provisions, as this may affect the clinical discussion about the document's scope and limitations.

For a complete guide to creating an AHD that covers both general medical and mental health scenarios — including the interaction between the Powers of Attorney Act 1998 and the Mental Health Act 2016 — the Queensland Advance Directive & Living Will Kit walks through the full framework.

See more Queensland guides →