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evaluation (COE) to
admit the ward to the
hospital, even though
the ward already had
an MHG or MHPOA in place authorizing a guardian/agent
to consent to hospitalization. Some agencies
declined to accept the authority of a guardian/agent to forcibly medicate a patient,
and required a court-ordered treatment
(COT) to be obtained through the involuntary treatment system. When a COT and an
MHG exist at the same time, Arizona state
law stipulates that the treatment and placement decisions of the treatment agency under the COT are controlling, unless the
court orders otherwise.
Some psychiatric providers, wards, and
even attorneys completing the survey re-
ported a limited understanding of the differ-
ences between MHG and MHPOA. One of
the major hurdles faced by psychiatric pro-
viders is the ability to learn of or locate the
agent/guardian at the time of a mental
health emergency in order to access their le-
gal powers. The guardian/agent must pres-
ent the proper legal documents to the treat-
ment provider at the time of the intervention,
and may not have these documents readily
available. (Arizona has a free Registry for
Advance Directives through the Arizona
Secretary of State’s office; however, medical
providers can only gain access to the docu-
ments if the ward, principal, guardian, or
agent provides the user ID and password.)
Some agents expressed a lack of clarity
about the extent of their legal powers. As a
result, they did not always feel comfortable
or confident enough to challenge decisions
made by a treatment facility or a psychiatric
provider when attempts to obtain care for a
ward were questioned or refused. First responders (such as police officers) are a key
group of individuals who intervene during
psychiatric emergencies. Often, they neglect
to honor the agent’s powers and are reluctant or unwilling to “force” a ward to be
transported to a psychiatric-care facility
against the ward’s wishes.
Positive feedback about the MHG/MH-
POA process included that these powers
provide consistency for the agent to make
important treatment decisions for the ward.
These powers reduced the number of diffi-
culties and barriers to admitting a ward to a
Level 1 behavioral health unit or to obtain-
ing substance abuse treatment for the ward.
Agents expressed that they were able to ad-
vocate successfully for their ward’s treatment
and discharge planning, obtain Releases of
Information for medical records, and act in
the ward’s best interests.
MHG and MHPOA are necessary to address
situations in which a person is not compe-
tent to make mental health decisions for
himself or herself. Current feedback from
Arizona mental health providers and attor-
neys indicates that the processes of obtain-
ing and using these legal powers are not well
understood and can be cumbersome. Proce-
dures for obtaining mental health powers
must be streamlined while protecting the
rights of the potential ward/principal.
Although there are self-service MHG
and MHPOA packets, a lay person may find
Mental Health Power of Attorney, Guardianship