Realising the Convention on the Rights of Persons With Disabilities With Mental Health Advance Directives

All countries that have signed the United Nations Convention on the Rights of Persons with Disabilities (CRPD) have obligations to align their national laws and policies with it. According to the General Comment on Article 12 prepared by the CRPD Committee, this entails operationalising systems and practices that support, rather than substitute, decision-making. The CPRD Committee has identified Mental Health Advance Directives (MHADs) as one mechanism to operationalise supported decision-making, and many jurisdictions have incorporated them into newly reformed mental health legislation. The purpose of this systematic scoping review was to assess whether any MHADs currently under investigation conform to the specifications outlined in the General Comment on Article 12 regarding advance directives. The results indicated that no MHAD under investigation in the international literature meets the specifications of the General Comment on Article 12 for advance directives. MHADs are an essential tool to ensure the human rights of people who experience psychosocial disability are protected in line with the requirements of the CRPD. Although there are projects examining the effectiveness of MHADs, none of these MHADs fulfil the specifications of the General Comment on Article 12. This raises questions for both policymakers and clinicians who will implement these MHADs, particularly as they feature in newly reformed legislation. Researchers should consider the implications of the CRPD Committee guidance when evaluating the effectiveness of MHADs, including whether their jurisdiction aligns with the requirements for tools that facilitate supported decision-making.