This literature review on choice in mental health was commissioned by the Department of Health in July 2005 and submitted to the Department in January 2006. The main part of the review looked at the English language literature on choice in mental health over the past five years. It aimed to identify in particular what tools there are to help people make meaningful choices; what media are effective in facilitating decision-making; and to what extent methods such as advance directives might be used. The review also included a consultation exercise and an overview of how choice is reflected in national policy and guidance in four other countries.
Mental health service users' ability to make choices may be constrained by their own limitations (lack of knowledge, information, capacity), others' shortcomings (lack of appropriate and available services, staff unreceptive to the principle of user choice, restrictive referral processes), and by legal constraints imposed on those who are subject to compulsion under the Mental Health Act 1983. How service users make and communicate their choices also needs to be considered; there may be particular problems for people with learning difficulties, those with some form of mental impairment, those with communication difficulties due to auditory or visual impairment, people who communicate non-verbally, and those for whom English is not their first language. In addition, the choices of carers may be at odds with what service users would choose for themselves.