Mental Health America of Virginia The voice of reason in mental health advocacy

The following is a list of organizations in Virginia that specificaly deal with medical directives for mental health care (also known as psychiatric advance directives)

VOPA (Virginia Office of Protection and Advocacy)
Dana Traynham Esq., a VOPA staff attorney, has been working consumers to develop advance directives for mental health care on a case by case basis for some time. Dana has written her own power of attorney and advance directive forms which she uses with her clients. Dana also tracks legislation related to advance directives and engages in related advocacy. My general understanding however is that demand for VOPA services far outstrips available resources.

  Dana Traynham: 434-971-6733 Dana.Traynham@vopa.virginia.gov

● VOPA advance directive and power of attorney forms can be found at the following address:
http://wellnesswired.org/file_cabinet (see the "advance directive files" folder to the left)

MHAV (in collaboration with VOPA)
MHAV has been developing an Advance Directive online tutorial using their WellnessWired program. This Tutorial consists of a progressive sequence of screens (approximately 10-25 depending on user choices) each of which contains 1-2 instructional videos, instructional text and form fields where users input information which contributes to the end advance directive document. To name a few, these form fields include personal contact info, agent details, opt in/out for agent powers, organ donation and trauma informed care. The script for the tutorial (instructional text) and forms used for final documents were created by Dana Traynham (VOPA). The tutorial is broken into two halves: power of attorney and medical directive. The entire project is still under construction but the first half is up and running: if you go to the website and click through the first few screens it will produce a POA document for you. Please let me know if you have any problems or suggestions, I'm still debugging a lot of it. Hopefully this tutorial will be a resource both to those creating an advance directive and advocates/providers who need general advance directive training. This program has obvious limitations but can also be thought of as a ‘low probability high impact' initiative. If the program gains traction and additional resources become available, the tutorial will hopefully turn into a statewide advance directive database. I would like to add that technical assistance to fellow Virginia mental health advocates/organizations is part of my contract. I can provide free services for webinars/web-meeting, basic web design, file hosting (online streaming video etc.), help with social networking etc. for anything advance directive related.

 Curt White: (804)-257-5591 curt.white@mhav.org

● Advance Directive Tutorial:
http://wellnesswired.org/page/index

NAMI Virginia
NAMI's Peer-to-Peer program includes many aspects of advance directive creation. In addition to numerous local peer-to-peer programs, there are two peer-to-peer mentor (facilitator) trainings in 2010. NAMI Peer-to-Peer mentors may provide a pool for advance directive facilitator training in other projects. Participants in Peer-to-Peer create a relapse prevention plan to help identify tell-tale feelings, thoughts, behaviors, or events that may warn of impending relapse and to organization for intervention; mindfulness exercises to help focus and calm thinking; and survival skills for working with providers and the general public. In addition, the program has a focus on advance directives: what they are, why they are important, and what good they can do for a person who has experienced psychiatric crisis. The class facilitators spend time during at least two of the classes addressing the value of advance directives, facilitating discussion about how to thoughtfully identify a health care agent, and many other decisions a person should think about when completing an advance directive. Participants receive an advance directive template to fill out, customize, and integrate into their wellness planning. NAMI will be changing the structure of their peer-to-peer program during the coming months which may change the role of advance directives in this program.
Mira Signer (NAMI VA Executive Director) oversees all advance directive activity at NAMI VA. Sarah Eisenman is program coordinator for NAMI peer-to-peer and handles activity at an operational level. Elyse Hunt and Chris Cox were the two consumers on the panel at the DBHDS Richmond Advance Directive training.

  Mira Signer: 804-285-8264 ext 200 msigner@nami.org
Sarah Eisenman: 804-285-8264 x 203 seisenman@nami.org
Elyse Hunt: ehunt3@verizon.net
Chris Cox: 757-224-3104 chrislcox1@cox.net

VOCAL
John Otenasek manages VOCAL's WRAP facilitator training program and is interested in integrating advance directives into WRAP classes as a natural next step in the Crisis Planning that is already part of WRAP . VOCAL closely observes advance directive activity (legislative and otherwise) and strives to provide a consumer perspective on this activity. Bonnie Neighbour is VOCAL's chief legislative advocate in this regard. VOCAL has suggested that WRAP facilitators would provide a great way of identifying CSB advance directive facilitators in Dr. Bonnie's study. The Virginia Peer Support Coalition would seem to have similar advantages (http://vpsc.groupsite.com). Because great lengths have already been taken to identify consumers (including those in CSBs) with a desire to participate in advocacy it seems likely that potential facilitators would already have made contact with one of our organizations.

  John Otenasek: (866) 647-9500 john@vocalvirginia.org
Bonnie Neighbour: (804) 343-1777 bonnie@vocalvirginia.org

The UVA-Duke Study
Dr. Bonnie is conducting an in-depth study of the implementation of the new advanced directive law in Virginia funded by the Robert Wood Johnson Foundation and the John D. and Catherine T. MacArthur Foundation Research Network on Mental Health and the Law. The study will involve (1) a web-based survey of stakeholder groups, (2) training of facilitators/mentors in a few select sites, (3) completion of advance directives at these sites (4) follow up interviews etc. to determine effectiveness of advance directives. Because the funds for the study must be spent during 2010, longer-term effects cannot be measured in this study. The research team is interested assuring that standardized advance direct forms are used in the study, and it will use those recently developed by the Virginia Hospital and Health Care Association using a ‘tiered' strategy combining a standalone basic form with a more in depth advanced form.

"Between seven and 10 researchers from the two universities (UVa & VATech) will work on the study. The group includes psychologists, economists and epidemiologists. Dr. Bonnie said the researchers are looking into additional funding to keep the study going past 2010." (Tasha Kates, The Daily Progress)

Dr. Richard Bonnie: 434-924-3209 rbonnie@virginia.edu

● Article about Dr. Bonnie's study in the RTD (originally Daily Progress):
http://www2.timesdispatch.com/rtd/news/state_regional/article/UVAA21_20091220-202602/312694/

● UVA article about Dr. Bonnie's research following a conference
http://www.law.virginia.edu/html/news/2009_fall/health_decisions.htm

● Publicly available PowerPoint from a presentation on advance directives by Dr. Bonnie
http://www.virginia.edu/aginginstitute/Richard%20Bonnie%20Adv%20Dir%20Overview.ppt

DBHDS & VACSB
Trainings: DBHDS (co-sponsored by VACSB) held an advance directive training in Richmond 11/05/09. This training was recorded on video which will be distributed in DVD form by the department ($10 per DVD). MHAV has agreed to host this video online in streaming form.
Mary Clair O'Hara handled logistics: mary.ohara@dbhds.virginia.gov

● Advance Directive form from Virginia code:
http://www.vacsb.org/images/ADVANCE_MEDICAL_DIRECTIVE_eff_Jul_01_2009.pdf

● All of the PowerPoint presentations from the Richmond training can be found at the following address:
http://www.dbhds.virginia.gov/omh-mhreform.htm

● A very brief outline of Virginia advance directive resources:
http://www.dbhds.virginia.gov/OMH-MHReform/091116AdvanceDirectiveResources.pdf

● Bill tracking for Virginia advance directive code including revision tracking and links to related legal code:
http://leg1.state.va.us/cgi-bin/legp504.exe?091+ful+CHAP0211

● VACSB Guide to Consent & Substitute Decision Making (old, 2006)
http://www.vacsb.org/images/Guide_to_Consent_06.pdf

● Piedmont CSB "Surrogate Decision Making, a Help Guide"
http://www.piedmontcsb.org/qmc/VACSB%20QMC%20Surrogate%20Decision-Making%20from%20Mark.doc

COMMISSION ON MENTAL HEALTH LAW REFORM
The Commission developed the new advance directive provisions of the Health Care Decisions Act. For the background and the Report of the Task Force of Empowerment and Self-Determination and the Report of the Task Force on Advance Directives, see:
http://www.courts.state.va.us/programs/cmh/home.html