From paternalism to self-determination: international experience of supported decision-making by people with psychiatric disorders

Context and relevance. The outdated and persistent notion that individuals with psychiatric diagnoses are incapable of making their own decisions infringes upon their right to self-determination. Currently, several countries have transitioned to the Supported Decision-Making Model (SDMM), which ensures respect for the will, equality, and integration of these citizens into society. Objective. To facilitate the development and implementation of a national SDMM within Moscow’s social services, an analysis and systematization of international experience in applying SDMM was conducted. Hypothesis. A successful transition to SDMM depends on a complex interplay of psychological, social, and systemic factors, and requires addressing a number of specific challenges when developing national guidelines. Methods and materials. A comprehensive review of scientific literature and reports from international organizations published between 2010 and 2025 was conducted using thematic and conceptual analysis of open-source materials. The search was performed using the keywords: “supported decision-making”, “psychiatric disorders”. Results. The systematization of SDMM allows for the classification of sources based on the degree of formalization (legal institutions, social and therapeutic practices), the focus of support (cognitive, communicative, social), and the level of involvement (individual and team). Key factors for successful model implementation were identified: long-term trusting relationships and effective communication with supporters, accessibility of information crucial for decision-making, proactive planning of actions, and independence of support institutions from state structures. The main challenges in implementing SDMM were outlined, including risks of supporter dominance, institutional inertia of the medical model, entrenched social stereotypes, and difficulties in balancing client self-determination with risk protection. Conclusions. The success of SDMM development and functioning depends on non-legal factors and systemic conditions. The obtained data can serve as a basis for developing and implementing a national model that considers international experience and identified challenges.

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