Queering Psychiatric Care : Why Every Queer and Trans Person Needs an Advance Directive (and How to Create One)

This article originally appeared on the Gaysi Family website, here

Okay, let’s get real for a sec. Advance directives (ADs) might not be the hottest topic at brunch, but trust me — this is something we need to talk about. Especially if you’re queer or trans, this can literally be life-changing.

Let’s face it — we’ve all had moments when we felt too overwhelmed, anxious, or just out of it to explain exactly what we needed. Sometimes, articulating your needs isn’t easy, and during a crisis, it can feel downright impossible. That’s why having a plan in place ahead of time can make all the difference.

Here’s the deal: an advance directive is a legal doc that lets you lay down the rules for your future medical and mental health care in case you’re ever unable to speak for yourself. It’s like sending a voice memo to the future when things get tough. You’re basically telling the world how you want to be cared for when you’re not in the headspace to make those calls.

Usually, people put their spouse or a family member in charge of making decisions for them. Sweet, right? But here’s the thing — for queer and trans folks, that’s not always the vibe. Family dynamics can be messy. Sometimes there’s estrangement, rejection, or just a lack of understanding. And let’s be honest, the last thing you want during a mental health crisis is for someone who doesn’t get you (or your identity) calling the shots.

That’s why this convo is crucial. In India, the Mental Healthcare Act of 2017 is a game-changer. It lets you choose anyone you trust to step in as your proxy — not just your bio fam or legal spouse. Your bestie who’s been through it all with you? The partner you’ve built a life with but who your family refuses to acknowledge? They can officially have your back.

This matters because queer and trans communities face higher rates of mental health challenges, and traditional family structures might not always provide the support we need. Having an AD in place means you’re in control of your care, even if life throws a curveball.

TL;DR: Advance directives = self-care power move. It’s a way to make sure your voice is heard when you need it most, and for queer and trans folks, it’s a lifeline that lets chosen family step up when bio fam can’t. Don’t sleep on it.

The Importance of Advance Directives for Queer and Trans Individuals

Let’s talk facts — mental health isn’t a level playing field, and for LGBTQIA+ folks, the scales are often tilted in the wrong direction. Studies consistently show that queer and trans people experience higher rates of depression, anxiety, and suicidal thoughts. And it’s not hard to see why. From dealing with discrimination to rejection by natal families and the exhausting act of masking one’s identity, the weight of it all adds up fast.

One study highlighted that queer and trans individuals are way more likely to face mental health crises compared to their cis-het peers. It’s a glaring reminder of why we need mental health support systems that actually respect and protect LGBTQIA+ lives — not just in theory but in real, practical ways.

Enter the Mental Healthcare Act of 2017 — a much-needed win. This Act gives people the right to set the terms for their mental health care through advance directives. Section 5 of the Act is particularly important because it allows anyone to choose a proxy or representative to make decisions on their behalf during a psychiatric emergency. For queer and trans folks, this is a big deal. It means that even if your bio family isn’t exactly your biggest cheerleader, you can appoint someone who actually understands and supports you.

But (and there’s always a but), just because the law is inclusive doesn’t mean the process is easy or well-known. A lot of people — especially queer and trans individuals — don’t know this option exists. Plus, let’s be real, healthcare hasn’t always been a safe space. From being misgendered to receiving subpar care (or no care at all), bad experiences can make people hesitant to engage with the system. And honestly, who wants to navigate more bureaucracy when past run-ins have left you feeling unseen or invalidated?

That’s why breaking down this process and making it more accessible is crucial. Advance directives aren’t just paperwork — they’re tools for empowerment and protection. So, let’s make sure you know how to use them. We’re here to walk you through it step by step, and hopefully, by the end, it won’t feel nearly as intimidating.

Barriers to Creating Advance Directives for LGBTQIA+ Individuals

Alright, let’s get into why advance directives aren’t as widely used in the LGBTQIA+ community — and spoiler alert, it’s not because people don’t care about their mental health. One of the biggest roadblocks is simply not knowing these options exist.

Studies show that a lot of queer and trans folks have never even heard of advance directives, let alone considered creating one. In fact, one study in India found that nearly 72% of LGBTQIA+ respondents had little to no clue about these legal provisions. And guess what? Even healthcare professionals are in the same boat. Only a small fraction knew what advance directives were or had actually put one in place. When both the patients and the providers are in the dark, you can see how this becomes a cycle.

Then there’s the other, more gut-punchy reason — fear of discrimination. For LGBTQIA+ individuals, talking about healthcare preferences often comes with the added stress of having to out yourself, sometimes in environments that feel anything but safe. Many avoid these conversations altogether because they worry about being judged, misgendered, or dismissed. And honestly, who can blame them? When past experiences include conversion therapy, family violence, or outright rejection, trusting the system isn’t exactly the easiest thing to do.

These barriers aren’t just inconvenient — they’re actively preventing queer and trans people from protecting their mental health rights. The good news? Awareness changes the game. By unpacking this process, we can help close the knowledge gap and, hopefully, ease some of those fears.

Why You Should Still Create an Advance Directive

So, here’s the good part — advance directives give queer and trans folks a way out of potentially harmful family dynamics. Instead of your natal family swooping in and making decisions that might not vibe with your identity (or worse, pushing treatments to “fix” you), you get to choose your own proxy. That’s right — your best friend, partner, or chosen fam can officially be the one to call the shots during a mental health crisis. This isn’t just about having someone who gets you — it’s about protecting your right to affirming, respectful care when you need it most.

Thinking of making an AD? Good call. Here’s the lowdown on how to get started (and a few tips to dodge common roadblocks).

How to Create an Advance Directive 

Honestly, the process is pretty simple once you know what to do. Here’s the play-by-play:

1. Pick Your Person (or People)
   Choose someone you trust with your life — literally. This could be your partner, bestie, or anyone who knows your values and won’t let you down. If your natal fam is supportive, cool, they can be your proxy too. You can even name more than one person, just in case.
2. Put It in Writing
   Now for the paperwork part. Use Form CR-A (yep, that’s the official form under the Mental Healthcare Act, 2017). This is where you lay out your treatment preferences — what you want, what you don’t want. You sign it, your proxy signs it, and you’ll need two witnesses to make it official.
3. Register It
   Take that signed form and register it with your state’s Mental Health Review Board (MHRB). Not sure if your state has one? You can check row 14 on this sheet. Once you submit, the directive should pop up online within 14 days. Easy peasy.
4. Make Changes Anytime
   If life (or your preferences) changes, no worries — you can update or revoke your directive whenever. Just keep your proxy and doctor in the loop.
5. Your Proxy’s Job
   Your chosen person isn’t just there for moral support — they’ll need to make sure the healthcare team knows about your directive. They can also ask questions about your treatment to make informed decisions. Basically, they’re your healthcare MVP.

Having an AD isn’t just about legal safety — it’s about peace of mind. And for queer and trans folks, that’s priceless.

Practical Tips

So, creating an Advance Directive (AD) is super important, but dealing with bureaucracy can be a real drag. To make things easier, here are a few tips to make this process easier: 

Get your ducks in a row: Make sure you have all the paperwork ready. This includes your filled-out Form CR-A and copies of your IDs, your proxy’s IDs, and the IDs of your witnesses. If you’re going to a mental hospital or the Mental Health Review Board, bring a physical file with everything organised. Trust us, it’ll save you time.

Talk it out: Let your representative, doctor, and close friends know your wishes. This ensures everyone understands your plan and that your AD is legit.

Know your stuff: Familiarise yourself with the Mental Healthcare Act, 2017, especially sections 5 (about ADs) and 82 (about the Review Board). Having these sections handy can help answer questions and show you know your rights. You can find the Act and Rules here and here.

Why is this important? ADs give queer and trans folks control over their mental healthcare. It means your trusted people can make sure your wishes are respected, even in a crisis.

Don’t let the process scare you! Creating an AD is a powerful way to protect yourself and ensure your care aligns with your values.

As more people understand the importance of ADs and healthcare systems become more inclusive, we can create a system that truly respects the dignity and autonomy of all queer and trans individuals.

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Note: This article is not legal advice. This is the research we’ve done thus far and an attempt to share the information to help our community.

References :

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