While California lawmakers have struggled to pass comprehensive legislation around psychiatric advance directives (PADs), six counties are moving forward with their own solutions. These counties – Contra Costa, Fresno, Mariposa, Monterey, Orange and Shasta along with a tri-city group representing Claremont, La Verne and Pomona – are part of a pilot project aiming to create a standardized, user-friendly PAD that will help people plan for their mental health care before a crisis happens.
Psychiatric advance directives are legal tools that allow individuals to express preferences about the mental health treatment they would want – or refuse – during times when they may be unable to make decisions for themselves. While California has long recognized the importance of medical advance directives, the legal framework for PADs remains vague. There’s no official form or standardized process in place, which makes it difficult to implement or enforce consistently.
This gap in the law has not gone unnoticed. In 2024, a bill introduced by Assemblymember Jacqui Irwin (AB 2352) aimed to spell out how PADs should be created and used, aligning them with the rules already in place for standard medical directives. Unfortunately, the bill didn’t make it past the committee stage.
Meanwhile, on the national level, the Uniform Law Commission has proposed updates to the Uniform Health Care Decisions Act, which California originally adopted in the 1990s. These updates include guidance on “mental health directives,” another term for PADs. The proposed framework outlines a person’s ability to document their treatment goals, preferences for medications or therapies and opinions about specific providers or facilities. Although a few other states have adopted these changes, California has yet to follow suit.
In the absence of state action, local governments are stepping in. The Multi-County Psychiatric Advance Directives Innovations Project is working to create not just a standard PAD form but also a digital system to support it. The goal is to give people a simple way to draft, revise and store their directives online, making them easier for health care providers to access during a crisis. This would be a major improvement over the state’s little-known and rarely used paper registry maintained by the Secretary of State.
Each county involved in the project is tailoring its efforts to meet the needs of specific groups. For example, Contra Costa County is testing a mobile app that allows users to complete a PAD from their phones, while Orange County has already had more than 270 people try out its online tool. Shasta County, on the other hand, is focusing on community outreach and education. Populations being prioritized include unhoused individuals, those involved in the criminal justice system and young adults.
These grassroots efforts may provide the roadmap California needs to develop an effective statewide PAD system – one that gives people more control over their mental health care and reduces the reliance on conservatorships and emergency interventions.
Send your questions to ccolan@colanlegal.com and use “Alpine Mountaineer estate planning question” as the subject. We’ll answer your questions in our upcoming issues. This article is provided by your local estate planning attorney, Corina Colan. The Law Office of Corina I. Colan / (909) 265-3315 / www.colanlegal.com
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