All in the Family

Mental Illness and Caregiving Across the Generations

Happy Birthday, Dear 18-Year Old

Two legal documents that can alleviate heartbreak.

In July, my baby boy will be 18 years old. As he shops for dorm room necessities, gets to know his roommate, and worries about getting lost on campus, I’m readying to make sure that he executes a Durable Power of Attorney and a Health Care Proxy.

Why?

  • Because without a Durable Power of Attorney, if my son is travelling and can’t access his bank or credit card account, I won’t be able to help him.
  • Because without a Heath Care Proxy, if he falls off the back of a motorcycle on a midnight dare and sustains a concussion or eats putrid fish in Thailand and falls into a coma, his doctors won’t be able to communicate with me and no one will be authorized to speak for his medical care.

We tend to think that legal planning documents are necessary only for middle-aged and older adults, yet the reality is that they are equally important for young adults. Once a child reaches the age of 18, even if he’s still in high school, he is an adult in the eyes of the law.  His privacy must be respected and parents become outsiders.

For most parents, this reality hits the first time they take their 18-year old to the dentist or the doctor or they try to check a bank account balance for them.  The dentist or doctor will ask the adult child whether he wants the parent to be dismissed while they speak. The bank will not provide parents any information about the account.

For some less fortunate parents, this reality hits when something catastrophic happens, rendering their child unable to make medical or other decisions. Absent a Durable Power of Attorney and Health Care Proxy, parents must go through court proceedings to be appointed a conservator and/or guardian. Such court proceedings are time-consuming and expensive, requiring a doctor’s letter, a significant notice period to the protected person, and a hearing in probate court before appointment as guardian and/or conservator.

I wish someone had told me about these legal documents four years ago, when my daughter turned 18. Diagnosed with ADHD at 11, bipolar disorder at 16, and borderline personality disorder shortly after her 18th birthday, my daughter’s psychiatrist, psychologist, and social worker agreed that she was unable to make decisions about her health care.  All said that she suffered from anosognosia, she lacked awareness about how ill she was. Yet not one of them suggested that my husband and I encourage our daughter to sign a Durable Power of Attorney or a Health Care Proxy.

Shame on them.

If she’d had a Health Care Proxy, more likely than not, she’d be graduating from college this Spring. She’d have remained on her medications and continued her therapy sessions. She wouldn’t have become addicted to methamphetamines.  She wouldn’t be homeless and she wouldn’t have a jail record.

Here are some other good reasons to be sure your 18-year old signs a Durable Power of Attorney and a Health Care Proxy:

  • Schizophrenia often first appears when people are in their late teens and early 20’s.1
  • Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5.2
  • A nationwide survey of college students found that about 30 percent of college students reported feeling "so depressed that it was difficult to function" at some time in the past year.3

Without a Health Care Proxy, parents can’t help their children secure the care they need. Moreover, when mental illness strikes, it’s critical that parents be able to talk with their child’s doctors because parents hold important information about their children that doctors need to make the right diagnoses and recommend the best course of treatment.

It’s easy and inexpensive to protect our children from a legal system that demands they be treated as independent adults.  But if children aren’t encouraged to plan, decisions about care will be made without parent involvement.

Helpful information about developing Health Care Proxies and Durable Power of Attorney documents is available on the American Bar Association website.  Take a look at this document for an example of a Health Care Proxy form used in New York.

Enjoy those senior pictures, the excitement of prom and the magic of graduation. But do yourself – and your child – a favor, and ask him to sign a Durable Power of Attorney and a Health Care Proxy.

 

 

  1. Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
  2. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.
  3. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2011. Hanover, MD: American College Health Association; 2012.

Rachel Pruchno, Ph.D. is Endowed Chair and Professor of Medicine at Rowan University School of Osteopathic Medicine. Her memoir Surrounded by Madnessis available at online bookstores.

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