‘Self-binding
directives’ or ‘Ulysses contracts’ are preferences laid out in advance by
service users, which draw on ‘expertise through experience’, and instruct
clinicians to overrule treatment refusal during future severe episodes of
illness. They are promoted as having the potential to increase autonomy for
individuals with severe episodic mental illness. I will start with a broad
introduction to ‘self-binding directives’ (SBDs)– what they are, the potential
pros and cons. I will then explore in more depth the qualitative data from a
large survey our group conducted with Bipolar UK, where service users provided
reasons for endorsing or rejecting this intervention. The survey
responses indicate strong support for SBDs – prior to this survey there had
been no substantial investigation of service user views about this
intervention, despite the centrality of lived experience. At the same
time, the responses also provide some very interesting insights into how
participants’ views about their illness and its management might relate to
debates surrounding notions such as risk, illness, insight, and decision-making
capacity. For a good introduction to SBDs, you can listen to our BBC Radio 4
documentary, ‘Bound to the Mast’, available as a podcast at BBC
Radio 4 - Bound to the Mast.
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