Mental Health Declaration and Power of Attorney

When to use Mental Health Declaration and Power of Attorney

Accidents happen, illnesses strike without warning and previously manageable health conditions can evolve into unmanageable challenges. None of us knows what the future holds. It is therefore important to put safeguards in place designed to ensure that our interests (and the interests of those we care about) are protected and respected in the event that we are no longer in a position to make legal, financial and/or medical decisions for ourselves. Putting a power of attorney designation in place will allow you to have a trusted loved one or professional make decisions on your behalf in the event that you can no longer do so. There are many different kinds of power of attorney designations. For example, they can be made for financial decision-making authority, medical treatment decision-making authority and mental health decision-making authority.


If you have been diagnosed with a mental health condition and are concerned that there may come a time when you may be unable to make certain treatment decisions on your own behalf, consider using this form to make a mental health power of attorney designation. This authority will allow someone of your choice to make mental health decisions on your behalf if/when you cannot do so yourself. You can limit the scope of this authority, if you choose to do so. In addition, you can update this document or revoke it at any time that you are of sound mind. You can also use the “declaration” portion of this document to leave specific instructions regarding the types of treatment you will or will not consent to in the event that this power of attorney authority becomes necessary. Your directions noted in the declaration will take precedence over the decisions made by your power of attorney.

Alternative Names

Mental Health Declaration and POA
Mental Health Care Declaration and Power of Attorney