Mental Health Advance Directive in West Virginia: What It Covers and How It Works

Most people think of advance directives as end-of-life documents. West Virginia's Mental Health Advance Directive (MHAD) serves a different purpose — it lets you document your psychiatric treatment preferences while you're well, so those preferences guide your care during a mental health crisis when you may not be able to advocate for yourself.

What the MHAD Covers

The MHAD is a statutory planning tool that allows you to specify preferences for psychiatric treatment across several categories:

• Medications — Which psychoactive medications you consent to and which you refuse. If a particular medication has caused unbearable side effects in the past, you can document that refusal.
• Inpatient facilities — Which hospitals or psychiatric facilities you prefer and which you want to avoid.
• Outpatient therapies — Your preferences for specific therapeutic approaches, counseling formats, or alternative treatments.
• Electroconvulsive therapy (ECT) — Whether you consent to or refuse ECT.
• Care for dependents — You can designate temporary custodians for children and companion animals during periods of hospitalization, so your family responsibilities don't fall through the cracks during a crisis.

The Unique Revocation Choice

The MHAD includes a feature found in no other West Virginia advance directive: a binding revocation restriction.

When completing the document, you must choose between two options:

• Choice A: The directive may be revoked at any time, for any reason, regardless of your mental state.
• Choice B: The directive may only be revoked when you have the capacity to make competent decisions.

Choice B is the significant one. By selecting it, you're telling your treatment team: "If I'm in the middle of a psychiatric crisis and I'm refusing medication or demanding discharge, don't listen to the crisis version of me — follow what I documented when I was well."

This is designed for conditions like bipolar disorder, schizophrenia, and severe depression, where a person in crisis may resist the very treatment they know they need when stable. Choice B prevents a future incapacitated version of you from overriding your competent decisions.

It's a powerful tool, but it carries weight. Choosing to limit your own future right to revoke deserves careful thought and possibly a conversation with your psychiatrist or therapist before executing.

Execution Requirements

The MHAD follows the same execution requirements as other West Virginia advance directives:

• Must be in writing, dated, and signed by you
• Requires two qualified adult witnesses who are present at signing
• Must be notarized by a commissioned notary public

The same witness exclusion rules apply: no relatives by blood or marriage, no one entitled to inherit from your estate, no one financially responsible for your medical care, and your designated representative cannot serve as a witness.

Who Should Consider an MHAD

The MHAD is particularly valuable for anyone who:

• Has been hospitalized for a psychiatric condition and wants to ensure continuity of care preferences
• Has experienced unwanted medication changes during previous hospitalizations
• Lives with a condition that periodically impairs decision-making capacity
• Wants to ensure their children or pets are cared for during an unexpected hospitalization
• Has strong preferences about specific treatment approaches or facilities

You don't need a diagnosed psychiatric condition to complete an MHAD. Anyone who wants to document mental health treatment preferences can execute one.

MHAD and Dementia

While the MHAD is designed for psychiatric conditions, its provisions can address behavioral symptoms associated with dementia. The Choice B revocation option is relevant for individuals in early-stage cognitive decline who want to lock in their treatment preferences before capacity diminishes further.

For comprehensive end-of-life planning with a dementia diagnosis, pair the MHAD with a combined MPOA/Living Will that covers the broader range of healthcare decisions.

Registering Your MHAD

Submit your completed Mental Health Advance Directive to the WV e-Directive Registry by fax (844-616-1415) or mail, along with the registry opt-in form. Registration ensures your psychiatric treatment preferences are accessible to any treating facility across the state.

The West Virginia Advance Directive & Living Will Kit includes guidance on all four types of West Virginia advance directives, including the MHAD, with execution checklists and registry instructions for each.

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