Abstract

When faced with significant life decisions most people will consult with and seek the support of others. Yet laws relating to decision-making in health care are generally couched in terms of individual rights to consent to or refuse treatment with no mention of the involvement of carers, friends, partners or family members. In relation to individuals with severe mental health problems, laws enabling involuntary detention and treatment are usually based on a model of substituted decision-making whereby psychiatrists make decisions about treatment providing certain criteria are met. The advent of the United Nations Convention on the Rights of Persons with Disabilities has provided the impetus for the exploration of supported decision-making models in mental health care including psychiatric advance directives. This presentation looks at recent law reform endeavours to take into account the preferences of those with severe mental health problems and to provide for supported rather than substituted decision-making wherever possible.