Ulysses Directives for Advanced Mental Health Care Planning

One of the papers delivered on 25 Feb 2023 at the ACLM was by Prof Judy Clausen on the recent Nebraska legislation to introduce Advanced Mental Health Care Plans in that State. So called ‘Ulysses directives’ enable psychiatric patients such as bipolar or schizophrenic patients subject to episodic relapses to make advanced decisions regarding what they wish to receive when they are incapacitated by psychotic states.

As Ulysses and his men were returning home after the Trojan War, they passed the island of the Sirens, creatures who sang so beautifully that anyone who heard the sound would lose all ability to control the impulse to get closer. Such sailors would crash their ships and die. Ulysses wanted to hear the song of the Sirens but also wanted to make it home to his family. He told his men to tie him to the mast and no matter how much he begged or threatened, they were not to untie him until they safely passed the island. He then had his men fill their ears with wax so they would not hear the song.

An Advanced MH Care Plan may include such things as:

1. What medications they would allow

2. Nominated family members to be contacted

3. To what facility they should be admitted

4. Whether they would accept ECT

5. Persons nominated to be responsible for child care, home and pet care, and financial matters

6. Preferences regarding community-based alternatives to hospitalization

7. Willingness to be approached about participation in experimental treatments or research studies

8. Methods for handling emergencies, such as use of restraint, seclusion, or sedation

10 US States have such statutory provisions.

NSW Advanced MH Treatment Plans are in existence and NSW Health supports their use to allow people who have capacity to make directives about how they are treated if they were to lose capacity.

Medicare items for Mental Health Treatment Plans, Reviews and Consultations are available for patients living in the community (or privately funded residents of aged care facilities). MBS items 2700, 2701, 2715 or 2717 can be claimed. MBS item 2712 is used when reviewing the GP Mental Health Treatment Plan. A significant drawback of this type of mental health advance directive is the difficulty of anticipating future events with enough specificity to provide adequate instructions.

The promise of mental health advance directives to increase consumer empowerment, to improve crisis treatment planning, to improve consumer–provider– family relationships, and to reduce hospitalizations makes implementation of mental health advance directives and the study of their processes and effects important goals.

Further Reading:

4. Debra Srebnik PhD (2004) Benefits of Psychiatric Advance Directives: Can We Realize Their Potential?, Journal of Forensic Psychology Practice, 4:4, 71-82,