Psychiatric Advance Directives and Health Care Proxies in New York

New York does not have a separate psychiatric advance directive law. Instead, New Yorkers use the state's health care proxy law (Public Health Law Article 29-C) to name a trusted person, called a health care agent, and to write instructions about future mental health treatment. The law defines health care as any treatment, service or procedure to diagnose or treat a physical or mental condition, so a proxy covers psychiatric decisions unless you limit it.

This guide explains how the proxy works when the reason you cannot decide is a mental health crisis, what to write in it, where its limits are, and how it fits with a clinical crisis plan. It is general information, not legal advice; for a complicated situation, a New York attorney can review your documents.

Your options in New York at a glance

People often use "psychiatric advance directive" (PAD) to mean any document that records mental health treatment wishes ahead of time. SAMHSA describes a PAD as a legal document that states your preferences for treatment in a crisis and takes effect when you cannot speak for yourself, for example during severe confusion, psychosis or mania. In New York, those goals are met with the tools below.

The practical message: if you want a specific person to speak for you in a psychiatric crisis, the health care proxy is the document that gives that person legal authority. Instructions alone, without an agent, carry less weight.

How a New York health care proxy works in a mental health crisis

Who can sign and who can serve

Any competent adult can appoint an agent, and every adult is presumed competent to do so unless a court has ruled otherwise. Your agent and alternate must be 18 or older. If you name a doctor, that doctor must choose between acting as your agent and acting as your attending doctor. There are also restrictions on naming staff of a hospital or mental hygiene facility where you are a patient, unless the person is a relative.

Signing requirements

You sign and date the proxy in front of two adult witnesses, who also sign. The person you name as agent cannot be a witness. You do not need a lawyer or a notary, and you do not have to use the state's form. If you live in a mental hygiene facility operated or licensed by the Office of Mental Health, at least one witness must be unaffiliated with the facility, and if that facility is also a hospital, at least one witness must be a qualified psychiatrist or psychiatric nurse practitioner. The law also allows remote witnessing by audio-video technology if specific conditions are met.

When your agent's authority begins

Your agent starts making decisions only after your attending practitioner determines that you lack capacity to make health care decisions. The law defines capacity as the ability to understand and appreciate the nature and consequences of health care decisions, including the benefits, risks and alternatives, and to reach an informed decision. A psychiatric diagnosis does not by itself mean you lack capacity.

When a patient in a general hospital or mental hygiene facility is found to lack capacity because of mental illness, the attending practitioner must be, or must consult, a qualified psychiatrist to confirm that determination, and the consultation goes in the medical record. You must be told about the determination promptly, orally and in writing, if there is any sign you can understand it.

Your objection still counts

This is the feature of New York law that matters most in psychiatry. If you object to the finding that you lack capacity, or to a decision your agent makes, your objection prevails unless a court determines that you lack capacity. The state's form instructions add that for as long as you are able to make your own decisions, treatment cannot be given to you or stopped over your objection, and your agent has no power to object for you.

That means a New York proxy is not a "Ulysses contract" that binds you in advance to accept treatment you refuse in the moment. It works best for the situations where you are too unwell to engage at all, and as a way to make sure the right person is at the table and your known preferences are on paper.

When it ends

Once your attending practitioner determines that you have regained capacity, the agent's authority stops, and it resumes only if you lose capacity again. The proxy itself stays valid indefinitely unless you set an expiration date or condition.

What your agent can and cannot decide

Unless you limit it, your agent can make any health care decision you could make, including choosing among treatments or declining them, in line with your wishes and interests. Your agent must follow your wishes and your moral and religious beliefs; if your wishes are not known, the agent must act in your best interest. Providers must give your agent the same information they would give you and honor the agent's decisions as if they were yours.

• Your agent can decide about artificial nutrition and hydration only if they know your wishes from what you said or wrote.
• The proxy does not cover financial or other non-health decisions; that requires a separate document such as a power of attorney.
• If you name your spouse and later divorce or legally separate, that appointment is canceled unless you state otherwise.
• Your agent cannot be held liable for good-faith health care decisions, or for the cost of your care simply because they are your agent.

On privacy, HHS guidance says that a health care power of attorney currently in effect makes the named person your personal representative under HIPAA, with the same right to access your records that you have. A psychotherapist's separate session notes are excluded from that right of access. Because a New York proxy gives your agent authority only after a determination that you lack capacity, and that authority stops when you regain it, this access applies only during that period.

What to write in the mental health section

The state form leaves space for your instructions, and you can attach more pages. SAMHSA's sample PAD form asks people to list medications they agree and do not agree to, hospitals they would and would not want, who may visit, how staff can help, and what needs to be taken care of at home. Specific, practical entries help an agent and a hospital team far more than general statements.

Two cautions. First, any instruction may limit your agent, so write limits only if you mean them; broad authority plus a clear conversation often works better. Second, review medication preferences with your prescriber before you write them. A drug that caused a rash years ago may matter more than one you simply disliked, and only your prescriber can help you weigh that. Do not stop or change a current medication because of what you plan to write.

Limits to understand before you rely on it

A proxy is powerful, but it does not control every situation. The National Resource Center on Psychiatric Advance Directives summarizes New York's position this way:

• Providers may decline to follow your proxy if it conflicts with their religious beliefs or moral convictions, but they must then find another provider who will.
• A court can override an agent's decision made in bad faith or without the required kind of judgment.
• If you are considered a danger to yourself or others, or in another emergency, providers may decline to follow a proxy or living will.
• Instructions that ask for something a provider cannot do, such as a hospital with no beds available, may not be followed.

You can revoke a proxy by telling your agent or a health care provider, orally or in writing, or by any act that shows you intend to revoke it; signing a new proxy also revokes the old one. According to the national resource center, that remains true even if your attending physician considers you incapable, unless a court has declared you incompetent. This protects your autonomy, but it also means the document cannot guarantee a particular treatment during an episode.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room. A proxy is planning for later, not a substitute for urgent help now; the guide to psychiatric emergencies and urgent needs in New York City covers where to go.

Step by step: making a proxy that works for mental health

1. Choose your agent and an alternate. Pick people who can stay calm, will advocate firmly, and will follow your wishes rather than their own. Ask whether they are willing before you name them.
2. Talk through scenarios together: a manic episode, a severe depressive episode, a hospitalization you did not want. Your agent can only follow wishes they know.
3. Draft your instructions using the table above, then review the medication parts with your prescriber.
4. Sign in front of two adult witnesses who are not your agent. Use the New York State Department of Health proxy form or another document that meets the statute.
5. Distribute copies to your agent, alternate, doctors, attorney and close family, and keep one where people can reach it, not in a safe deposit box. Bring a copy to any hospital admission.
6. Review it after major changes: a new diagnosis, a hospitalization, a new medication that worked, a breakup or divorce. A new form replaces the old one.

If you already have a proxy from another state, New York treats it as validly executed if it complied with the law of the place where it was signed.

Choosing the right agent

Families supporting someone through repeated episodes may also find the guides on helping someone who refuses psychiatric help and a first episode of psychosis useful, since a proxy is easiest to create during a period of stability.

A proxy, a crisis plan and a safety plan work together

A legal document answers "who decides." A crisis plan answers "what helps," and a safety plan answers "what do I do tonight." Most people living with a recurring condition such as bipolar disorder, recurrent depression or psychosis benefit from all three.

The guide to safety planning for suicidal thoughts explains how a safety plan is built, and the first 30 days after a psychiatric hospitalization is a natural time to create or update all three documents.

Bringing it into your psychiatric care

Tell your psychiatrist and therapist that you have a proxy, give them a copy, and ask them to note your agent in your chart. Useful questions for your prescriber include: which medications in my history should I list as helpful or harmful, what are my personal early warning signs, and is there anything about my treatment my agent should understand in advance. If you also want family members to be able to talk with your clinicians while you are well, ask about a signed authorization, which is separate from the proxy; the practice's HIPAA Notice of Privacy Practices explains how it handles health information.

At this practice, ongoing care includes psychiatric evaluation and medication management alongside psychotherapy, so the people who know your history best are often on one team. If you are considering care, a free discovery call covers care options, scheduling and insurance questions, and you can raise how your proxy and crisis plan would be used. Individual care starts with the Patient Interest Form. For more on comparing clinicians and settings, see the guide to choosing psychiatric care.

Frequently asked questions

Do I need a lawyer or a notary to make a health care proxy in New York?

No. New York's form instructions say you need two adult witnesses, not a lawyer or a notary, and the person you name as agent cannot be one of the witnesses. A lawyer can still help if your situation is complex.

Can my health care agent have me admitted to a psychiatric hospital against my will?

A proxy is not a commitment order. Under New York's proxy law, your objection to an agent's decision prevails unless a court determines you lack capacity, and in emergencies involving danger to yourself or others, providers may not be bound by a proxy. Ask a New York attorney about your specific situation.

Can my agent read my therapy notes?

HHS guidance says an agent acting under a health care power of attorney that is in effect has the same right of access to your records that you have (for a New York proxy, only while you lack capacity and the agent's authority is in effect), but a psychotherapist's separately kept session notes are not part of that right of access.

What happens if I never appoint an agent?

If you lack capacity and have no agent, New York law sets a priority list of surrogates for care in a hospital, nursing home or hospice: a court-appointed guardian, then a spouse or domestic partner, an adult child, a parent, an adult sibling, and finally a close friend. That person may not be the one you would have chosen.

I signed a proxy in another state. Is it valid in New York?

New York treats a proxy signed elsewhere as valid if it followed the law of the place where it was signed. It is still worth adding mental health instructions and confirming your agent's contact details.

Should my agent be the same person as my emergency contact?

Not necessarily. An emergency contact is simply someone to call. An agent makes decisions, so choose the person most likely to follow your wishes under pressure, and list the other person as an alternate or contact.

Sources

1. New York Public Health Law Section 2980: Definitions. New York State Senate (NY statutes), 2026. nysenate.gov
2. New York Public Health Law Section 2981: Appointment of health care agent; health care proxy. New York State Senate (NY statutes), 2026. nysenate.gov
3. New York Public Health Law Section 2983: Determination of lack of capacity to make health care decisions. New York State Senate (NY statutes), 2026. nysenate.gov
4. Health Care Proxy: Appointing Your Health Care Agent in New York State (Form 1430). New York State Department of Health, 2022. health.ny.gov
5. Ten commonly asked questions about PADs for New York. National Resource Center on Psychiatric Advance Directives, 2026. nrc-pad.org
6. A Practical Guide to Psychiatric Advance Directives. Substance Abuse and Mental Health Services Administration (SAMHSA), 2019. samhsa.gov
7. HIPAA Privacy Rule and Sharing Information Related to Mental Health. U.S. Department of Health and Human Services, Office for Civil Rights, 2026. hhs.gov
8. New York Public Health Law Section 2994-D: Health care decisions for adult patients by surrogates. New York State Senate (NY statutes), 2026. nysenate.gov
9. New York Public Health Law Section 2990: Health care proxies executed in other states. New York State Senate (NY statutes), 2026. nysenate.gov
10. New York Public Health Law Section 2985: Revocation. New York State Senate (NY statutes), 2026. nysenate.gov
11. New York Public Health Law Section 2994-B: Applicability; priority of certain other surrogate decision-making laws and regulations. New York State Senate (NY statutes), 2026. nysenate.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.