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Declaration for mental health treatment
Oregon has a form called a Declaration for Mental Health Treatment. This form is a legal document. It allows you to make decisions now about future mental health care in case you are unable to make your own care decisions.
You may also use this form to name an adult who can make mental health choices for you when you cannot make them for yourself.
This person must agree in writing to represent you. The person you name must follow your wishes. If no one knows your wishes, the person you name must make them for you. They must make decisions that are in your best interest.
A Declaration of Mental Health Treatment is good for three (3) years. If you become unable to make decisions, this document will remain in effect until you are able to make your own decisions.
You may change or cancel your Declaration at any time as long as you are capable of making decisions for yourself.
It is important to give this form to your doctor and a copy to the person who represents you.
You may request this form by:
Calling the State of Oregon at 1-503-945-5763. TTY: 1-800-875-2863.
Requesting a copy from your current provider.
Downloading from https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf
For more information on the Declaration for Mental Health Treatment, go to the State of Oregon’s website at: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf
If you are an adult 18 years and older, you can make decisions about your own care. That includes refusing treatment.
If you are awake and alert your providers will always listen to what you want. It’s possible that someday you could become so sick or injured that you can’t tell your providers whether you want a certain treatment or not. An advance directive, also called a living will, lets you decide what kind of care you want in the event you can’t tell your providers what you want. If you are admitted to a hospital, the staff may talk to you about advance directives.
A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directive would describe what kind of care you want if you have an illness from which you are unlikely to recover or if you are permanently unconscious. If you do not want certain kinds of treatment, like CPR, a breathing machine or feeding tube, you can write that down in an advance directive.
If you don’t have an advance directive, your providers may ask your family what to do. If your family can’t or won’t decide, your providers will take the usual steps in treating your conditions.
You can get an advance directive form at most hospitals and from many providers. You also can find one online: https://www.oregonhealthdecisions.org/product/advance-directive-digital-download/
If you write an advance directive, be sure to talk to your providers and your family about it and give them copies. They can only follow your instructions if they have them.
If you change your mind, you can cancel your advance directive anytime. To cancel your advance directive, ask for the copies back and tear them up, or write “cancelled” in large letters, sign and date them.
If you feel the instructions in your advance directive have not been followed, you may file a complaint with the agency below:
Oregon Public Health Division
Health Care Regulation and Quality Improvement
P.O Box 14450
Portland, OR 97293
For questions or more information, contact Oregon Health Decisions at www.oregonhealthdecisions.org.