Autonomy in health decision-making – a key to recovery in mental health care

The power to make decisions about one’s life – including the right to choose one’s mindset.

Health care – is the key to a person’s independence and personality.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) obliges states to recognize that people with mental health conditions have legal capacity on an equal basis with everyone else. However, involuntary admissions to hospital, and care against the wishes of a person with a mental health condition, are practiced routinely and widely around the world. This coercion is facilitated by laws and practices that give guardians of people with mental health conditions broad alternative decision-making powers.

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Voices of experience

By making an alternative decision, people with mental health conditions lose their rights to informed consent, confidentiality, privacy, and communication with family members. Too often, people end up in institutions and experience isolation or self-control.

People who are cared for without their consent report feeling dehumanized, often with long-term effects on their mental health. Coercive practices undermine people’s trust and confidence in mental health services and can prevent people from seeking help when they need it.

Autonomic therapy can also amplify existing conditions. Alexandra M. Schuster from the UK was diagnosed with a mental illness when she was seven years old. “Throughout my childhood and adolescence, I had no say in my own recovery: my own ideas of what would be right for me were often denied,” says Alexandra. “This lack of independence has eroded my already low self-esteem and exacerbated my mental illness.”

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At the age of 19, Alexandra says it was a serendipitous individual. “Years of having to engage in specific care pathways and bubble-covering by caring adults had shattered my confidence. I hardly thought I could make basic decisions, let alone help myself.”

Positive partnerships for care

Respecting people’s autonomy can be challenging, but good practice around the world shows that it is possible, particularly by involving people in the planning, evaluation and management of healthcare, for example through shared decision-making, advanced planning, supported self-management and a healing-centred approach. About the person to care.

Empowering people to take control of their lives and mental health care instills personal dignity, value and respect. It can increase self-esteem and self-confidence. It also gives people a level of choice and autonomy they might not have received otherwise.

“Having independence in mental health care has been the biggest contributor to my recovery,” says Alexandra. “My current therapist views me as a person, not as a mental illness. [When I first met her]She asked me about interests, wanted to know about my approach, and was eager to work together to build a path to mental well-being.”

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The meaningful participation of people with lived experience builds trust and understanding among those who give and receive care. The potential outcome is better therapeutic relationships and more equal and effective care partnerships. Individuals and health care providers can work together to identify care options and choose those that are most appropriate and acceptable.

Alexandra recalls: “We started small, but with [my therapist’s] Guidance, I gradually gained the confidence to make complex decisions about my health and well-being. Her willingness to collaborate with me, creating care plans that work for me as an individual, while still giving me the space to make independent decisions, helped me build the confidence to succeed not only mentally, but in all other areas of my life. To this day, I attribute my recovery to her collaborative nature.”

The transition from care that ignores people’s perspectives, priorities and human rights towards person-centred, human rights-based, recovery-oriented care that involves people as active participants in care rather than as passive recipients of care is one of the twelve key shifts needed to achieve the transformation of mental health for all.


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