Our brief supported the position that psychiatrists should not be required to testify to a new, higher legal standard for the involuntary medication of patients who are deemed incompetent to proceed in court. This position aligns with current medical and legal practice, ensuring that psychiatric testimony remains grounded in accepted standards of care.

You can read our amicus brief—along with other briefs in this case—on the Wisconsin Supreme Court and Court of Appeals Case Access (WSCCA) Case History.

What’s Next?

Oral arguments for State v. JDB will take place on September 8 at 9:45 a.m. and will be streamed live on Wisconsin Eye. We encourage our members and the public to tune in to see this important issue discussed before the Court.

The Psychiatric Advance Directive Subcommittee of WPA’s Legislative Committee has been working diligently toward introducing Psychiatric Advance Directive (PAD) legislation in Wisconsin. After developing a framework and working closely with our lobbyists, in June we received our first draft bill from the Wisconsin Legislative Reference Bureau. Since then, we have provided clarifications and feedback and are awaiting the next draft.

In Wisconsin, individuals with serious mental illnesses often face repeated hospitalizations or crises without a formal mechanism to ensure their treatment wishes are followed. Without a recognized and enforceable PAD law, providers and families are left navigating uncertainty—sometimes resulting in treatment that patients find distressing or that undermines trust in the mental health system.

What is a PAD? While most people are familiar with medical advance directives—which outline preferences for end-of-life or serious medical care—PADs serve a similar role for mental health treatment. Both empower individuals to make their wishes known in advance, but PADs are specifically designed to address the unique decisions that arise during a mental health crisis, such as preferred medications, hospitalization options, and de-escalation strategies. Just as medical advance directives have become a standard tool for honoring patient autonomy in physical health care, PADs offer the same protection and clarity in psychiatric care.

PADs are already recognized in dozens of U.S. states, giving individuals a clear, legally enforceable way to shape their mental health care in advance. Wisconsin, however, remains one of the states without comprehensive PAD legislation—leaving patients, families, and providers without the legal clarity and protections that are commonplace elsewhere. Passing PAD legislation would bring Wisconsin in line with national best practices and ensure our residents have access to the same rights and safeguards available across most of the country.

The APA affirms that Psychiatric Advance Directives preserve autonomy, respect treatment preferences during crises, and smooth coordination between patients and providers. A 2009 APA–approved resource outlines that PADs, much like medical advance directives, bridge periods when a person’s decision-making capacity is impaired and ensure that care aligns with patient values. The APA also promotes tools—like the My Mental Health Crisis Plan app—developed with SMI Adviser (a SAMHSA-supported initiative) to make PAD creation accessible and practical.

SAMHSA calls PADs a cornerstone of recovery-oriented care. In its 2024 Practical Guide to Psychiatric Advance Directives, SAMHSA emphasizes that PADs:

• Empower individuals to guide their treatment even during incapacitation.
• Strengthen crisis planning and reduce the likelihood of coercive interventions.
• Support equity by giving all patients, regardless of setting, a clear voice in their care.

Both APA and SAMHSA acknowledge that while PADs are widely recognized in most states, their integration into routine practice remains limited—often because providers lack familiarity with them or they are hard to access in emergencies. That’s why SAMHSA stresses public education, training, and accessible registries—features built into the WPA’s draft legislation.

The current draft bill would create, for the first time in Wisconsin law, a formal, enforceable PAD framework that:

• Defines and authorizes PADs – Establishes a legally recognized document where individuals can specify treatment preferences, including medication choices, hospital admission preferences, use of electroconvulsive therapy, de-escalation techniques, and preferred contacts during treatment.
• Allows appointment of a mental health care agent – Provides the option to designate a specific person to make mental health care decisions, with clear rules on priority if there are conflicting directives.
• Sets capacity and revocation standards – Requires capacity determinations by two qualified clinicians (or by court order) and outlines when and how a PAD can be revoked, with safeguards for individuals experiencing episodic mental illness.
• Requires provider compliance – Directs health care providers and facilities to follow PAD instructions unless doing so is unlawful, infeasible, or contrary to prevailing medical standards, and mandates documentation of any noncompliance.
• Establishes a statewide Advance Directive registry – Creates a secure system where individuals can store and share their AD and/or PAD with authorized providers and agents.
• Promotes awareness and education – Requires the Department of Health Services to launch a public education campaign, provide training to health care professionals, and ensure PAD information is offered to patients during intake.

We are encouraged by the support we’ve received from legislators on both sides of the aisle, advocacy organizations, and fellow mental health professionals. This momentum underscores the shared belief that Wisconsin needs a clear, compassionate, and legally sound process for honoring psychiatric advance directives.

Enacting psychiatric advance directives into Wisconsin law would be a landmark step in-line with patient-centered mental health care. This legislation ensures that treatment decisions honor the individual’s voice, strengthens collaboration between patients, families, and providers, and establishes a clear legal framework for delivering care during psychiatric crises. By passing this bill, Wisconsin can join other states in affirming that dignity, autonomy, and recovery remain at the heart of our mental health system.