Achieving social justice for psychiatric survivors: capabilities and advance consent to mental health treatment

Furgalska, Magdalena Wanda (2023). Achieving social justice for psychiatric survivors: capabilities and advance consent to mental health treatment. University of Birmingham. Ph.D.

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Abstract

This thesis uses a socio-legal methodology to investigate the desirability of advance consent to mental health treatment. Advance consent to mental health treatment is an anticipatory directive whereby a mentally ill patient may self-bind to future treatment in specific circumstances. Currently, there is no such provision available in English law. To assess the desirability of advance consent, this thesis asks the following questions: 1) To what extent would advance consent to mental health treatment be able to minimise coercion in the experiences of treatment? 2) What role, if any, should the mental capacity assessment play in facilitating a legal framework for advance consent? 3) Which capabilities are valued by psychiatric survivors, and to what extent can advance consent translate into securing those? 4) What are the sources of injustice experienced by psychiatric survivors, and what challenges/barriers do they pose for advance consent? These questions are grounded in original empirical data based on 21 interviews with 12 psychiatric survivors using narrative and photo- elicitation methods. These methods are considered novel for the socio-legal inquiry into mental health law. Thus, this thesis suggests a new methodological approach for studying lived experience of mental health law in everyday life. This socio-legal analysis is driven by the capabilities approach developed primarily by Martha Nussbaum and Amartya Sen.

I argue that social justice is best understood through capabilities and practical alternatives to what is currently experienced as injustice in people’s lives. I suggest advance consent can aid the individual experience or achievement of social justice by supporting capabilities necessary for bodily integrity, health, emotions and safety, making it a desirable mechanism. This is the first study to use the capabilities approach to conceptualise lived experiences of mental health and treatment to provide a new contribution to existing debates on advance consent. In my investigation, I find that coercion, insufficient information, insight, stigma and mental capacity are experienced as injustice. I argue that legally binding, voluntary, informed, sufficiently safeguarded, and carefully implemented advance consent can minimise these experiences of injustice. Using empirical data alongside the capabilities framework enables a more holistic and practical consideration of the value of advance consent in everyday life and in relation to social justice.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):