In Maine law, it’s called an “advance health-care directive.” But in the sometimes unpredictable world of Mark Cadrette, it’s nothing short of a lifeline.

“I tell everyone I meet who has mental illness to do it,” Cadrette, 51, said Friday in an interview from his home in Buxton. “It gave my family something to do other than to watch me go through hell.”

Much like the family of Timothy Courtois is doing right now.

Courtois, 49, of Biddeford, faces multiple charges after police stopped him for speeding on the Maine Turnpike last weekend and found an AK-47 assault rifle and several semi-automatic handguns in his just-purchased black Mustang convertible.

Also inside the car, police found news clippings about the July 20 massacre that left 12 dead and 58 wounded in an Aurora, Colo. theater during a midnight premiere of the new Batman movie, “The Dark Knight Rises.” Worse yet, according to police, Courtois claimed he’d attended the same movie with a loaded gun at a Saco theater on July 21.

Enter Cory Courtois, Timothy’s younger brother.

In a poignant interview with the Press Herald last week, Cory Courtois recalled how his brother went off his medication for bipolar disorder in early July, how his family and others close to Timothy Courtois watched his behavior deteriorate and how, try as they might, there was nothing anyone could do about it.

“(Police) asked if he had threatened to harm himself or others. I said, ‘No, he’s not at that state yet,'” recalled Cory Courtois. “They said that without the intent of harm there was nothing they could do except to unfortunately wait for something to happen.”

Which brings us back to Mark Cadrette and a piece of paper that, more than once over the past 15 years, has kept him out of handcuffs.

Cadrette, like Timothy Courtois, has bipolar disorder. One day in 1997, he was off his meds while cleaning his in-laws’ house in Rangeley.

At least that’s what he thought he was doing.

“I went overboard,” Cadrette recalled. “I threw the TV out the door and a few other things. And (his in-laws) didn’t know what to do, so they called the cops.”

The police told his in-laws the only way to get Cadrette out of there was to press charges. And so they did. “I spent 81 days in jail in Franklin County,” Cadrette said.

Upon his release, Cadrette vowed that he would never, ever let himself get arrested again. So with the help of Helen Bailey, general counsel for the Disability Rights Center in Augusta, he executed an advance health-care directive authorizing his mother and a close friend to act on his behalf should his mental illness leave him unable to act rationally on his own behalf.

It’s worked.

Four times since he signed the document, Cadrette has run into trouble with his medications. And each time, his “agents” (his mother no longer lives nearby, so his sister stepped in) have held the directive up to police and medical personnel and insisted that he be medicated and, if necessary, hospitalized — regardless of what Cadrette might be saying at the time.

“The purpose of these directives is that these people, when they’re competent, want something to happen when they lack capacity or when certain circumstances arise,” Bailey said last week. “It’s a very, very serious document.”

The directive mirrors advance health-care directives involving end-of-life care and other medical contingencies — the mental health component was added to the statute by the Maine Legislature in 1999. But 13 years later, it remains both controversial and, according to several mental health professionals contacted last week, woefully under-used.

“Most of the folks that I’ve worked with don’t have something in place,” said Hannah Sturtevant, the program director for Amistad, a Portland day center for people with mental illness that serves upward of 125 lunches per day.

“I just don’t think people think of it,” Sturtevant said. “It doesn’t occur to them.”

Bailey, who’s helped only 60 or 70 people prepare mental health directives over the past 15 years (Cadrette was her first), said it’s not a foolproof strategy: In the absence of an actual court order, some emergency room doctors remain reluctant to medicate someone against their wishes — regardless of what a legally executed directive might say.

Still, Bailey said, the directive is a start for those who simply want to “protect themselves from themselves.” The Disability Rights Center has published a handbook ( to guide people with mental illness and their loved ones through the process.

Bailey recommends that any directive be distributed in advance to case managers, psychiatrists, local hospitals and anyone else likely to be involved in a mental health emergency. She also suggests the designation of an “agent,” or surrogate, to act on behalf of the patient when necessary.

“Even with anything you write and with all the instructions you give, you’re never going to be able to anticipate all the circumstances,” Bailey said. “So it’s best to have somebody there who can talk to your doctor, who knows you well and can make those decisions for you.”

Some in the mental health community might bristle at the mere mention of medicating or hospitalizing someone over their objections — lucid or not — in the heat of a crisis.

But not Cadrette. He’ll take a trip to the emergency room over the local lock-up any day.

“I’ve done things I could have been charged with, but they didn’t charge me with anything,” Cadrette said. Thanks to his advance directive, “they took me to a hospital — and I’d much rather spend a week in a hospital rather than spend a week in jail.”

Contacted Friday, Cory Courtois said he and his family had never heard of advance health-care directives.

“I think it’s a great idea,” said Courtois. Had his family known about that option sooner, he added, “I would like to think we could have gotten something done.”

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