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“We’re compatible and we love each other … and have the same interests — fighting for people’s rights,” said Dorio, who, along with Clough, pushed for legislation — signed by Gov. Gavin Newsom — giving families more authority to determine medical decisions for loved ones even in the absence of an advance directive.

In Washington, people who fill out a mental health advance directive can list medications they prefer, and physicians or hospitals where they’d like to be treated.

Lack of awareness is a problem across states that have tried to strengthen the role of mental health directives, said Dr. Marvin Swartz, a psychiatrist and professor of psychiatry at Duke University Medical Center who runs the national mental health advance directive center with Swanson.

“We lost our son because he lost hope … Hope is a huge aspect of a well utilized mental health advance directive because of that participatory element. That’s really the crux of it.”

Virginia, for instance, funneled funding into a campaign to train health providers and peer recovery specialists and built an online, interactive map showing where people could get help filling out an advance directive.