A psychiatric advance directive (PAD) is a legal document that lets you spell out your mental health treatment preferences in advance — so that if a crisis makes it hard to communicate or make decisions, your care still reflects your values, your experience, and your choices. Think of it as a letter from your well self to the people who may need to help your future self.
This page covers what a PAD is, why it matters, how New Hampshire law supports it, and the steps to create one. Use the free, private worksheet tool to organize your preferences into a summary you can bring to an attorney or your treatment team.
AI-assisted content — clinician review required. The content on this page was assembled with AI assistance using evidence-based sources and NH legal references. It is intended for education and is not a substitute for legal advice or professional clinical guidance.
Your voice, preserved
During a mental health crisis, you may not be able to clearly communicate your wishes. A PAD ensures your preferences guide your care even when you can't advocate for yourself.
Legal standing in NH
New Hampshire recognizes advance directives under RSA 137-J. A properly executed PAD is legally binding on healthcare providers, giving your documented wishes real authority.
Recovery-oriented
Creating a PAD is an act of self-determination. Research shows that people who complete advance directives report feeling more empowered and experience better treatment alliance with providers.
Reduces conflict
When family members, providers, and emergency responders know your wishes in advance, there's less guesswork, less conflict, and less risk of treatments that could set back your recovery.
A psychiatric advance directive can address any aspect of your mental health care. These are the five core areas most PADs cover — and the areas our worksheet tool walks you through.
Treatment preferences
What helps — and what doesn't
Specify which treatments you consent to and which you refuse — including therapy modalities, hospitalization conditions, and electroconvulsive therapy. Your directive can include both "I want" and "I do not want" instructions.
Medication preferences
Medications that work for you
List medications that have helped in the past, those you want to avoid (and why), known allergies, and dosage preferences. This is especially valuable when you're unable to communicate during a crisis.
Hospital & facility preferences
Where you'd want to receive care
Name preferred hospitals or treatment facilities, and any you want to avoid. You can also specify preferences about inpatient vs. outpatient care and conditions under which you'd accept voluntary admission.
Trusted decision-makers
Who speaks for you
Designate one or more people authorized to make mental health treatment decisions on your behalf when you're unable to do so. In New Hampshire, this person is your "agent" under your advance directive.
Crisis intervention preferences
What to do — and not do — in a crisis
Describe de-escalation strategies that work for you, triggers to avoid, who to contact (and who not to), and instructions for law enforcement or emergency responders. This can prevent retraumatization during vulnerable moments.
New Hampshire’s advance directive statute (RSA 137-J) provides the legal framework. Here’s what you need to know:
New Hampshire's advance directive statute (RSA 137-J) allows any competent adult to create a written directive for healthcare decisions, including mental health treatment.
You can name an "agent" (healthcare proxy) to make decisions when you're unable to — and you can limit or expand the agent's authority as you see fit.
A PAD takes effect when your attending physician determines you lack capacity to make treatment decisions. It remains in effect until you revoke it or regain capacity.
You can revoke or amend your PAD at any time while you have capacity. Revocation can be oral, written, or by any act showing intent to revoke.
Healthcare providers who act in good faith on a valid advance directive are protected from liability under NH law.
If a provider cannot in good conscience follow your directive, they must make reasonable efforts to transfer your care to a provider who will.
Important: This summary is for educational purposes. For legal advice specific to your situation, consult an attorney familiar with NH health law.
Reflect on your experiences
Think about past crises or hospitalizations. What helped? What made things worse? What do you wish had been different? Use our worksheet tool below to organize your thoughts.
Choose your agent
Select someone you trust deeply — someone who understands your values, knows your treatment history, and is willing to advocate on your behalf. Talk with them about your wishes before formalizing anything.
Write it down
Document your preferences in detail. Our interactive worksheet produces a comprehensive summary you can bring to an attorney or your provider. The more specific you are, the more useful the document.
Make it legal
In New Hampshire, your advance directive must be signed by you, dated, and witnessed by two adults (or notarized). Your witnesses cannot be your agent, your healthcare provider, or the provider's employee.
Share it widely
Give copies to your agent, your therapist, your psychiatrist, your primary care provider, your local emergency department, and any family members involved in your care. A directive that no one can find during a crisis can't help you.
For individuals
For providers & advocates
NH Legal Aid — Advance Directives
Free legal assistance for NH residents on advance directive preparation.
NAMI New Hampshire
Peer support, education, and advocacy. Can help connect you with PAD resources.
Disability Rights Center — NH
Legal advocacy for people with disabilities, including mental health advance directive guidance.
Your Community Mental Health Center
Many NH CMHCs have staff who can help you think through and formalize a PAD as part of your treatment plan.
Creating a PAD is proactive planning — but if you’re in a mental health crisis right now, help is available immediately. Call or text 988 anytime, reach NH Rapid Response (833-710-6477), or text HOME to 741741.
All crisis resources