The following declaration should be signed and witnessed by a notary public, clergyman, attorney or at least by a trusted friend or reliable family member. Make several copies of the signed document and keep the original in a safe place. Give one copy to each of the persons named below (see pg. 2, item #6). Provide a copy to your attorney, if you have one.
Should you be in a position where you are subject to unwanted psychiatric treatment and/or hospitalization, ensure that the person(s) attempting such are shown and are aware of this signed and witnessed declaration. Immediately let your attorney and all other persons in your confidence know so that they may come to your aid.
Such things as apparent or undetected physical illnesses, diseases and deficiencies can manifest in mental or behavioral symptoms which can be mistaken by emergency medical personal, hospital staff and others as “psychiatric” illness. For this reason, during any attempt at involuntary hospitalization or psychiatric treatment by another, repeatedly declare your desire for a clarification of your condition of physical health. Explain that you wish to have this declaration abided by, however, do not physically resist or become aggressive. Demand to see an attorney.
A copy of your signed declaration should also be sent to the local or international branch of Citizens Commission on Human Rights® (CCHR®). The International address is: CCHR, 6616 Sunset Blvd., Los Angeles, California, United States, 90028.