85R7451 GCB-F
 
  By: Rodríguez S.B. No. 819
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the execution of a declaration for mental health
  treatment.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Section 137.003, Civil Practice
  and Remedies Code, is amended to read as follows:
         Sec. 137.003.  EXECUTION AND WITNESSES; EXECUTION AND
  ACKNOWLEDGMENT BEFORE NOTARY PUBLIC.
         SECTION 2.  Section 137.003(a), Civil Practice and Remedies
  Code, is amended to read as follows:
         (a)  A declaration for mental health treatment must be:
               (1)  signed by the principal in the presence of two or
  more subscribing witnesses; or
               (2)  signed by the principal and acknowledged before a
  notary public.
         SECTION 3.  Section 137.011, Civil Practice and Remedies
  Code, is amended to read as follows:
         Sec. 137.011.  FORM OF DECLARATION FOR MENTAL HEALTH
  TREATMENT. The declaration for mental health treatment must be in
  substantially the following form:
  DECLARATION FOR MENTAL HEALTH TREATMENT
         I, __________________, being an adult of sound mind, wilfully
  and voluntarily make this declaration for mental health treatment
  to be followed if it is determined by a court that my ability to
  understand the nature and consequences of a proposed treatment,
  including the benefits, risks, and alternatives to the proposed
  treatment, is impaired to such an extent that I lack the capacity to
  make mental health treatment decisions. "Mental health treatment"
  means electroconvulsive or other convulsive treatment, treatment
  of mental illness with psychoactive medication, and preferences
  regarding emergency mental health treatment.
         (OPTIONAL PARAGRAPH)  I understand that I may become
  incapable of giving or withholding informed consent for mental
  health treatment due to the symptoms of a diagnosed mental
  disorder. These symptoms may include:
  ________________________________________________________________
  PSYCHOACTIVE MEDICATIONS
         If I become incapable of giving or withholding informed
  consent for mental health treatment, my wishes regarding
  psychoactive medications are as follows:
         _____ I consent to the administration of the following
  medications:
  ________________________________________________________________
         _____ I do not consent to the administration of the following
  medications:
  ________________________________________________________________
         _____ I consent to the administration of a federal Food and
  Drug Administration approved medication that was only approved and
  in existence after my declaration and that is considered in the same
  class of psychoactive medications as stated below:
  ________________________________________________________________
         Conditions or limitations: ________________________________
  CONVULSIVE TREATMENT
         If I become incapable of giving or withholding informed
  consent for mental health treatment, my wishes regarding convulsive
  treatment are as follows:
         _____ I consent to the administration of convulsive
  treatment.
         _____ I do not consent to the administration of convulsive
  treatment.
         Conditions or limitations: ________________________________
  PREFERENCES FOR EMERGENCY TREATMENT
         In an emergency, I prefer the following treatment FIRST
  (circle one) Restraint/Seclusion/Medication.
         In an emergency, I prefer the following treatment SECOND
  (circle one) Restraint/Seclusion/Medication.
         In an emergency, I prefer the following treatment THIRD
  (circle one) Restraint/Seclusion/Medication.
         ______ I prefer a male/female to administer restraint,
  seclusion, and/or medications.
         Options for treatment prior to use of restraint, seclusion,
  and/or medications:
  ________________________________________________________________
         Conditions or limitations: ________________________________
  ADDITIONAL PREFERENCES OR INSTRUCTIONS
  ________________________________________________________________
         Conditions or limitations: ________________________________
         Signature of Principal/Date: ______________________________
  SIGNATURE ACKNOWLEDGED BEFORE NOTARY PUBLIC
  State of Texas
  County of_________
  This instrument was acknowledged before me on ______(date) by
  ___________(name of notary public).
  _____________________
  NOTARY PUBLIC, State of Texas
  Printed name of Notary Public:
  _____________________________
  My commission expires:
  _____________________________
  SIGNATURE IN PRESENCE OF TWO WITNESSES
  STATEMENT OF WITNESSES
         I declare under penalty of perjury that the principal's name
  has been represented to me by the principal, that the principal
  signed or acknowledged this declaration in my presence, that I
  believe the principal to be of sound mind, that the principal has
  affirmed that the principal is aware of the nature of the document
  and is signing it voluntarily and free from duress, that the
  principal requested that I serve as witness to the principal's
  execution of this document, and that I am not a provider of health
  or residential care to the principal, an employee of a provider of
  health or residential care to the principal, an operator of a
  community health care facility providing care to the principal, or
  an employee of an operator of a community health care facility
  providing care to the principal.
         I declare that I am not related to the principal by blood,
  marriage, or adoption and that to the best of my knowledge I am not
  entitled to and do not have a claim against any part of the estate of
  the principal on the death of the principal under a will or by
  operation of law.
  Witness
  Signature: ______________________________________________
  Print
  Name: _____________________________________________________
  Date: ______________________
  Address: _______________________________________________________
  Witness
  Signature: ______________________________________________
  Print
  Name: _____________________________________________________
  Date: ______________________
  Address: _______________________________________________________
  NOTICE TO PERSON MAKING A DECLARATION FOR MENTAL HEALTH TREATMENT
         This is an important legal document. It creates a
  declaration for mental health treatment. Before signing this
  document, you should know these important facts:
         This document allows you to make decisions in advance about
  mental health treatment and specifically three types of mental
  health treatment: psychoactive medication, convulsive therapy,
  and emergency mental health treatment. The instructions that you
  include in this declaration will be followed only if a court
  believes that you are incapacitated to make treatment decisions.
  Otherwise, you will be considered able to give or withhold consent
  for the treatments.
         This document will continue in effect for a period of three
  years unless you become incapacitated to participate in mental
  health treatment decisions. If this occurs, the directive will
  continue in effect until you are no longer incapacitated.
         You have the right to revoke this document in whole or in part
  at any time you have not been determined to be incapacitated. YOU
  MAY NOT REVOKE THIS DECLARATION WHEN YOU ARE CONSIDERED BY A COURT
  TO BE INCAPACITATED. A revocation is effective when it is
  communicated to your attending physician or other health care
  provider.
         If there is anything in this document that you do not
  understand, you should ask a lawyer to explain it to you. This
  declaration is not valid unless it is either acknowledged before a
  notary public or signed by two qualified witnesses who are
  personally known to you and who are present when you sign or
  acknowledge your signature.
         SECTION 4.  The changes in law made by this Act to Sections
  137.003 and 137.011, Civil Practice and Remedies Code, apply to a
  declaration for mental health treatment executed on or after the
  effective date of this Act. A declaration for mental health
  treatment executed before the effective date of this Act is
  governed by the law as it existed on the date the declaration for
  mental health treatment was executed, and the former law is
  continued in effect for that purpose.
         SECTION 5.  This Act takes effect September 1, 2017.