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Division of Mental Health Services

Declaration for Mental Health Treatment

The Declaration for Mental Health Treatment is a legal document that any Tennessee citizen can fill out in order to declare their preferences if in a mental health crisis.

The Tennessee Department of Mental Health and Substance Abuse Services developed this form based on Tennessee Code Annotated, Title 33, Chapter 6, Part 10, which gives the right to individuals, 16 years of age and older, to be involved in decisions about their mental health treatment. The law also recognizes that, at times, some individuals are unable to make treatment decisions. A “Declaration for Mental Health Treatment” allows persons receiving services to plan ahead; it may also assist service providers in giving appropriate treatment.

The “Declaration for Mental Health Treatment” form (see link below) describes what an individual wants to occur when receiving mental health treatment. It describes mental health services that an individual might consider, the conditions under which a declaration may be acted upon, and directions on how an individual can revoke or cancel a declaration.

For example, completion of a “Declaration for Mental Health Treatment” form allows an individual to state:

 

  • Conditions or symptoms that might cause the declaration to be acted upon;
  • Medications you are willing to take and medications you are not willing to take;
  • Specific instructions for or against electroconvulsive or other convulsive treatment;
  • Mental health facilities and mental health providers which you prefer;
  • Treatments or actions which you will allow or those which you refuse to permit; and
  • Any other matter pertaining to your mental health treatment which you wish to make known.

Declaration for Mental Health Treatment

Frequently Asked Questions

Information for Providers

Division of Mental Health Services Links