World Psychiatry, Volume 22, Number 2, June 2023.
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 crises. 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 treatment. 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.