People with mental illness can make psychiatric advance directives. We need to encourage them to do so

In medicine, we talk a lot about advance directives, mainly in the context of end-of-life treatment. But, recently, while treating a patient with schizophrenia, I realized how powerful and important that same document could be in caring for someone living with mental illness.

My patient had catatonia, and was gripped by psychosis. He could barely move or speak. He refused treatment, and in suffering from paranoia, also refused food and water. He wouldn't even let us talk to his family. Soon, his electrolytes were imbalanced, and his kidneys started to malfunction.