What question did this study set out to answer?

To explore the experience of a bipolar disorder patient using a self-binding directive for future treatment.

February 5, 2026Open Access

Ulysses looks back: a case report on the experience of using a mental health self-binding directive

Key Points

To explore the experience of a bipolar disorder patient using a self-binding directive for future treatment.
Presented a case report of a service user with bipolar disorder employing a self-binding directive.
Conducted a systematic review comparing this case's findings with existing literature on self-binding directives.
The service user's experience supports the feasibility and ethical justification of self-binding directives.
Insights from the case challenge criticisms of autonomy, implementation, and potential harms associated with self-binding directives.

Abstract

Abstract A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter ‘bipolar’) who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.

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