November 2025

Psychiatric Advance Directives (PADs) can empower individuals with serious mental health conditions to document their treatment preferences and support person-centered care throughout all stages of engagement and crisis. The new PADs & the CARE Process Toolkit provides guidance for county behavioral health incorporating PADs into the CARE process. It includes information about the what, when, who, and how of incorporating PADs into CARE. It also includes information about system barriers and a unique California solution; resources, and county approaches to PADs in CARE.

What’s included:

• Background on PADs, including definitions, benefits, and general provisions in California.

• Implementing PADs in CARE, including What, When, Who, and How.

• System Barriers and California Solutions, including the PADs Mental Health Services Act (MHSA) Multi-County PADs Innovations Project, which aims to develop best practices and scalable tools.

• Resources to help understand PADs.

• County Approaches to PADs in the CARE process, including examples from San Diego, Los Angeles, Riverside, and Orange counties.
• Checklist to help CARE participants, CARE teams, facilitators, and support networks support people in creating PADS.

Some ideas of practical steps counties can take to communicate CARE to the community:

• Download and localize the PADs Creation Checklist — Disseminate the Checklist with county BH staff, peer specialists, case managers, counselors, family members, and CARE volunteer supporters to support the development of PADs.
• Incorporate PADs throughout the CARE process — Encourage clinicians and county BH staff to prioritize PAD discussions during intake into services, regular status reviews, and as part of graduation planning.
• Support the completion of PADs — Integrate PADs into county BH work by supporting individuals in completing PADs with the help of peers and supports.

Access the PADs & the CARE Process Toolkit & Checklist here.