Should people with mental illness be able to commit themselves to future involuntary treatment?

Yes—Tania Gergel and Allen Frances

Many people with severe episodic mental illness, such as bipolar disorder, know from past experience that their illness may well expose them to risk during future severe episodes in a way that they won’t be able to control at that point. They may also recognise the likelihood that they’ll resist treatment during such episodes—even though this is when treatment is most desperately needed.

These people understand, when they’re well, the potentially catastrophic consequences of remaining untreated, even including risk to their lives given the high risk of suicide, particularly during the most severe depressive or “mixed” episodes of bipolar disorder. A self-binding directive (SBD) could provide them with a greater degree of control and safety for their future, by allowing those who wish to do so to explain how illness and risk manifest for them and to request treatment during the most severe phases of illness, even if they don’t consent when a future episode occurs.