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Modified on
Aug 02, 2026
Estate planning is not limited to deciding what happens to property after death. A complete plan should also address who can make decisions and what instructions should be followed if a person becomes unable to communicate during a medical or behavioral health crisis.
Louisiana law allows an adult to create a specific advance directive addressing future behavioral health treatment. Although it is commonly called a mental health advance directive, the Louisiana statutes now generally refer to it as an advance directive for behavioral health treatment.
This document is different from a general advance directive for healthcare, a living will, or a financial mandate. It is designed specifically for decisions involving mental illness, psychotropic medication, admission to a treatment facility, and outpatient behavioral health services.
Who Can Create a Louisiana Mental Health Advance Directive?
Under La. R.S. 28:222, any adult who is not incapable may create an advance directive for behavioral health treatment. The person does not have to wait until a crisis develops, and the statute does not limit these directives to people with a particular diagnosis.
A mental health advance directive may be especially useful for someone who:
- Has experienced recurring behavioral health crises
- Has previously required inpatient treatment
- Has a condition that may periodically affect decision-making
- Knows that certain medications have worked well in the past
- Has experienced serious medication side effects
- Wants to identify preferred physicians, facilities, or outpatient programs
- Wants a trusted person to communicate with treatment providers
- Has strong preferences about behavioral health treatment
- Wants to provide family members and medical professionals with guidance before an emergency occurs
Someone with bipolar disorder, schizophrenia, severe depression, post-traumatic stress disorder, a substance-related or addictive disorder, or another condition that may sometimes impair decision-making may benefit from this planning. The decision should be made while the person can understand the available treatment choices and communicate reasoned decisions.
What Can the Directive Address?
La. R.S. 28:221 defines behavioral health treatment to include treatment of mental illness with psychotropic medication, admission to and retention in a treatment facility, and outpatient services.
A directive may include consent to or refusal of certain behavioral health treatment. Depending on the individual’s circumstances, it may address:
- Medications the person is willing to receive
- Medications the person prefers to avoid
- Known allergies or serious side effects
- Preferred treatment facilities
- Physicians or providers familiar with the person’s history
- Outpatient treatment preferences
- People who should or should not be contacted
- Treatment methods that have previously helped
- Approaches that have been ineffective or harmful
- Circumstances under which the person would consent to admission to a treatment facility
Louisiana law does not permit a behavioral health advance directive to authorize admission to or retention in a treatment facility for more than 15 days.
The Louisiana Department of Health’s advance-directive form provides a useful framework, but the directive should be completed carefully and coordinated with the person’s current treatment plan.
Can You Appoint Someone to Make Decisions?
Yes. A mental health advance directive may contain treatment instructions, appoint a representative, or do both.
Under La. R.S. 28:223, the principal may appoint a competent adult to make behavioral health treatment decisions. An alternate representative may also be named in case the first person is unable or unwilling to serve.
The representative must accept the appointment in writing. The representative’s authority begins only after the principal has been determined to be incapable under the statute.
When making decisions, the representative must follow the principal’s expressed wishes. If the directive does not address a particular issue and the representative does not otherwise know the principal’s wishes, the representative must act in what the representative believes in good faith to be the principal’s best interests.
The representative can also receive information about proposed and administered treatment and, subject to the directive and applicable law, review behavioral health records.
Choosing the right person is important. The representative should understand the principal’s treatment history, be willing to communicate with medical professionals, remain calm during a crisis, and be prepared to advocate for the principal’s stated preferences.
What Is Required to Make the Directive Valid?
A Louisiana mental health advance directive requires more than the principal’s signature.
Under La. R.S. 28:224, the directive is valid only if:
- It is signed by the principal;
- It is signed by two competent witnesses; and
- It is accompanied by a written psychiatric examination performed by a physician or psychologist attesting that the principal can make reasoned decisions concerning behavioral health treatment.
The physician or psychologist should consider whether the principal understands the nature of the illness, available treatment, and the risks, benefits, and alternatives. The fact that the principal makes a choice someone else considers unwise does not, by itself, mean that the decision is not reasoned.
The witnesses must attest that they know the principal, saw the principal sign, and do not believe the principal is acting under duress, fraud, or undue influence.
Louisiana law prohibits certain people from serving as witnesses. Under La. R.S. 28:234, prohibited witnesses include:
- The treating physician or provider, or a relative of that physician or provider
- An owner or operator of a behavioral health treatment facility where the principal is a patient or resident, or a relative of that owner or operator
- Anyone related to the principal by blood, marriage, or adoption
These requirements make it important to coordinate preparation of the directive with the appropriate physician or psychologist instead of relying on a generic online form.
When Does the Directive Take Effect?
Under La. R.S. 28:225, the directive becomes operative when it is delivered to the principal’s treating physician or another behavioral health treatment provider. The provider must act in accordance with the directive after the principal has been found incapable.
Incapacity is not determined informally by the representative or family. La. R.S. 28:226 requires two physicians who have personally examined the principal to determine that the principal is incapable and sign a written certificate. That certificate becomes part of the principal’s medical record.
Even after that determination, the provider should continue trying to communicate with the principal. If the principal can give informed consent or refusal concerning a particular decision, the provider should continue seeking the principal’s own decision.
A physician may determine that the principal has regained capacity while the principal remains in a treatment facility. The principal also automatically regains capacity upon discharge from the facility.
Can Providers Ever Disregard the Directive?
A mental health advance directive provides meaningful instructions, but it does not eliminate every form of emergency or involuntary treatment.
La. R.S. 28:230 permits treatment contrary to the directive in limited circumstances. Those circumstances include an emergency in which the principal presents an imminent and significant danger of physical harm to the principal or others and the instructions have not reduced the behavior causing the emergency.
The statute also establishes an administrative-review procedure when the treating physician believes psychotropic medication is medically essential despite the directive or the representative’s refusal.
A directive does not prevent authorities from taking the principal into protective custody or using Louisiana’s involuntary-admission or commitment procedures when the legal requirements for those actions are satisfied.
Outside those circumstances, a provider presented with the directive must place it in the principal’s medical record and comply with it to the fullest extent possible, consistent with the appropriate standard of care, reasonable medical practice, available treatment, and applicable law.
How Long Does a Mental Health Advance Directive Last?
A Louisiana mental health advance directive generally remains effective for five years or until it is revoked, whichever occurs first.
There is an important exception. If the directive has been delivered to the treating physician or provider and the principal is incapable when the five-year period expires, the directive remains effective until the principal is no longer incapable.
A principal who is not incapable may revoke the directive in whole or in part. The treating physician or provider should be informed so the revocation can be included in the medical record.
Because treatment, medications, providers, and personal preferences can change, the directive should be reviewed periodically rather than placed in a file and forgotten.
Who Should Receive a Copy?
A directive cannot guide treatment if no one can locate it during a crisis. Copies should generally be provided to:
- The appointed representative and alternate representative
- The treating psychiatrist, psychologist, or other behavioral health provider
- The primary-care physician
- Any treatment facility that regularly provides care
- The attorney who assisted with the document
- A trusted family member or support person, when appropriate
The principal should also keep an accessible copy and consider carrying information identifying the representative and explaining where the complete directive can be found.
Field Law Can Help Coordinate Your Advance Directives
A mental health advance directive can preserve a person’s voice during a time when illness makes communication or reasoned decision-making difficult. However, the document must satisfy Louisiana’s specific execution requirements and should be coordinated with the person’s healthcare documents, contract of mandate, and broader estate plan.
Field Law can help Louisiana clients understand how these documents work together, prepare the appropriate legal documents, and coordinate the plan with the client’s chosen representatives and healthcare professionals. Contact Field Law to schedule an estate-planning consultation.
