Earlier this year in a BBC Radio 4 programme Tania Gergel documented her treatment for bipolar. In this blog, she describes how she has used ‘self-binding directives’ to manage the risks associated with these treatments.

Shortly after I moved into the field of mental health ethics and law about twelve years ago, I found my work focusing on one particular area – mental health advance directives or ‘advance choice documents’, as they will soon be known within the upcoming revisions to the Mental Health Act in England and Wales.

Research and practice in this area had been dominated by the idea that advance choice documents could provide a way for people with severe mental illness to avoid hospitalisation and involuntary treatment. But it soon became evident that, in fact, many people might also want to harness the power of advance decision-making to do the opposite – to ensure that they received treatment, even if against their will, during future episodes of illness when they knew from past experience, they would resist.