In some cases, a mentally ill person is so impaired that he or she is no longer able to care for himself or herself. This can affect his or her own health care, financial or legal matters, and decisions about where to live.
It may be that the person concerned has made his or her own provisions and filled out a health care power of attorney or suggested a legal guardian in a care directive. If there is no health care proxy, a court will examine whether a legal guardian is necessary and decide who this should be. This can be, for example, a relative or a professional guardian.
Health care proxy
In a health care power of attorney, the person concerned specifies who may act in his or her interest and make important decisions if he or she is no longer able to do so, for example because of a serious mental illness. A health care proxy is legally binding and confers on the proxy the right to make decisions on behalf of the principal without the need for a court to rule on it. It can be useful for relatives to motivate a family member with a serious mental illness to fill out a precautionary power of attorney. Because it can be a good way for personal matters to be handled within the family or by a close trusted person. The power of attorney must be signed by the person concerned and should be kept in a place where it can be easily found.
The affected person can authorize his spouse, adult children or other relatives, a close friend or neighbor, a caregiver arranged by a care association or a legal guardian. Spouses or cohabiting partners are also not automatically allowed to make decisions for each other, which is why a health care proxy is important in this case as well.
A relative who is authorized in a health care proxy may have to make important decisions for the mentally ill person in the event that he or she can no longer make decisions for him or herself. For example, he or she has the task of talking to doctors, therapists and other medical staff about the illness and the treatment, and of helping to decide on therapeutic approaches and how to deal with the illness.
In addition, he or she may have to take care of financial, legal, insurance, official and rental matters and decide on the person's place of residence, for example in his or her own home or in an assisted living facility. All of this can be time consuming.
It is therefore important to note that if a relative feels overburdened with the care, it is possible to withdraw from the care. In this case, for example, a professional caregiver takes over the care.
In a health care power of attorney, the grantor of the power of attorney can also specify how the power of attorney is to be structured, for example, whether it is to be valid in the long term or only for a certain period of time and which matters the authorized representative may and may not decide on. Furthermore, the power of attorney can also be divided between two or more persons. These can have the same authorizations and take turns in taking over tasks. However, they can also have different tasks, so that, for example, one takes care of medical matters and the other of financial matters. Furthermore, in addition to the proxy, a substitute proxy can be named, who will only act if the first proxy can no longer perform the tasks.
A person affected can also revoke the advance care directive if he or she is legally capable at that time. He or she must then inform the authorized representative of the revocation, preferably in writing, and ask him or her to return the power of attorney or to destroy it.
Advance care directive
A care directive can be an alternative to a health care power of attorney. In this, someone can specify who is to represent him or her in legal matters if he or she is no longer able to do so himself or herself. The care can refer to one or more areas, namely health care, property care and residence determination. The guardianship order must also be signed by the person concerned and should be kept in a place where it can be easily found.
However, the care directive is initially not legally binding. If care becomes necessary, a court must first decide whether the person named is suitable and should be appointed as a caregiver or not. If so, this person becomes the legal representative of the mentally ill person. The guardian then receives an identity card with which he or she can identify himself or herself to doctors, authorities or banks in order to be able to act in the best interests of the person under guardianship.
The guardianship court monitors the guardian in his or her decisions and demands accountability from him or her in order to prevent him or her from making abusive decisions. The court can also remove the guardian if he or she does not perform his or her duties in the best interests of the person being cared for.
Furthermore, a care directive can also be a supplement to a health care power of attorney. In this way, someone can name a substitute proxy in the care directive if the proxy in the health care proxy dies or is no longer able to exercise the care. If there is no guardianship order, a court would order legal guardianship in this case.
A care directive can also be revoked by the person concerned if he or she is legally capable at that time.
Admission to a psychiatric hospital
Sometimes the relatives are of the opinion that the mentally ill person urgently needs help and should be treated in a hospital, but the person himself does not see it that way. The first thing to consider is whether there are other ways to help the person concerned or to persuade him or her to seek help. For example, relatives may try to convince him to seek professional help voluntarily or to go to a clinic.
Sometimes, however, it may be necessary to take measures against the will of the person concerned, for example to have him or her admitted to a hospital. However, this is only possible if there is an acute, significant risk that the person concerned will harm or endanger himself or others and if there is no other, less drastic way to protect him or those around him.
If such a situation occurs, here's what you should do:
- Call 911 first and describe the issue to them. Then the control center can send a specialist to assess the patient's condition and decide on further action.
- If there is acute danger, for example because the person is attacking others or immediately threatening to kill himself, call the police and the emergency physician.
- Stay in contact with the victim until help arrives to reassure and distract them.