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Implementation of self-binding directives: Recommendations based on expert consensus and input by stakeholders in three European countries.
Scholten, M.
Efkemann, S.A.
Faissner, M.
Finke, M.
Gather, J.
Gergel, T.
Ham, L.
Juckel, G.
Melle, A.L.
Owen, G.
Potthoff, S.
Stephenson, L.A.
Szmukler, G.
Vellinga, A.
Vollmann, J.
Voskes, Y.
Werning, A.
Widdershoven, G.
2023. Implementation of self-binding directives: Recommendations based on expert consensus and input by stakeholders in three European countries. World Psychiatry 22 (2): 332-333. https://doi.org/10.1002/wps.21095
Self-binding directives (SBDs) are psychiatric advance directives including a clause in which mental health service users give advance consent to involuntary hospital admission and treatment, and grant mental health professionals permission to overrule anticipated treatment refusals during future mental health crises1, 2. They are also known as “Ulysses contracts” or “Ulysses arrangements”. SBDs can enable people with mental disorders which involve fluctuating mental capacity and regular treatment refusals during crises (e.g., psychotic and bipolar disorders) to stay in control of their life and treatment1. During episodes, these people may make decisions that are incompatible with their deeply-held values, convictions and preferences. Such decisions regularly involve refusal of hospital admission or treatment and can have far-reaching consequences. By enabling service users to authorize professionals to overrule such refusals, SBDs are essential to advance care planning in people with psychotic or bipolar disorders.