Discriminatory practices and barriers to care are increasingly recognised as a significant challenge for mental healthcare institutions. Yet, little research has considered what measures people with experience of using mental health services and mental healthcare service providers recommend to implement anti-discrimination within mental healthcare.

This study aims to explore the perspectives and recommendations of marginalised people with experience of using mental health services, mental healthcare service providers and psychosocial counsellors, to inform more equitable mental healthcare.

Between May 2022 and June 2023, we conducted 17 semi-structured qualitative interviews and 2 focus groups with psychosocial counsellors, people with experience of using mental health services and mental healthcare service providers. Data analysis followed structuring qualitative content analysis, combined with participatory methods.

Study participants recommended interpersonal, organisational and structural measures to address mental healthcare inequities. On an interpersonal level, they emphasised providers’ behaviour and attitudes toward discrimination. Organisationally, they called for a comprehensive intersectional care framework, fostering inclusive therapy environments, increasing staff diversity and implementing continuous anti-discrimination training. Structurally, they advocated for discrimination-critical therapy materials, revised curricula and removing barriers to medical education and healthcare.

The study yielded suggestions for anti-discriminatory, critical consciousness-based and inclusive practices on the interpersonal, organisational and structural levels of mental healthcare. It offers important insights for research devoted to implementing and evaluating such measures.

Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.

This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders’ views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom.

Comparisons between the empirical findings were drawn using a structured expert consensus process.

Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission duration, improvement of the therapeutic relationship, involvement of persons of trust, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals’ confidence, and relief for proxy decision-makers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce resources, disappointment due to noncompliance, and outdated content. Stakeholders tended to focus on practical challenges and did not often raise fundamental ethical concerns.

Stakeholders tend to see the implementation of SBDs as ethically desirable, provided that the associated challenges are addressed.