A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter ‘bipolar’) who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.

Capacity has become a prominent theme in the literature on nongovernmental organizations (NGOs) in the last few decades, due in part to the increasingly global role these organizations play in development. We analyze data obtained from a national sample of local and international NGOs operating in Cambodia, documenting capacity differences between these two groups as well as highlighting overall levels of capacity in the sector. The analysis covers a number of different organizational dimensions that have been associated with capacity, including structural characteristics and concrete management practices. Results suggest that international NGOs generally have greater capacity, but overall levels of capacity are relatively low for a variety of measures. We conclude with an exploratory cluster analysis that identifies four distinctive groups of NGOs based on capacity, providing additional insights into diversity within the sector. These findings will be useful for comparative NGO research and for capacity-building programs, in addition to helping establish an agenda for future research to monitor progress.

There is potential for nonprofit organizations to increase effectiveness by mobilizing social media to help achieve goals. However, the sector is only just becoming aware of the possibilities for social media and lags behind other sectors in its use. We report a New Zealand initiative to enhance the capability of nonprofit organizations through action research that has implications for nonprofit organizations elsewhere. Borrowing from resource mobilization theory, we introduce the concept of resource mobilization chains to explain the requirements for and obstacles to taking advantage of social media. A survey and two in-depth case studies found that nonprofit organizations demonstrated extremely limited familiarity with and use of social media. Participants were enthusiastic about the potential of mobilizing social media to achieve organizational goals, but struggled to take concrete steps to implement their aspirations. Lack of resources was a key obstacle identified in both survey and case study research.

This article examines civil society strengthening experience in Indonesia to illuminate issues, challenges, and lessons for non-governmental organization (NGO) capacity building and international donor-supported democratic reform. The authors conceive of capacity as a function of contextual factors, and internal factors associated with an individual NGO or a network of NGOs. Contextual factors that need to be taken into account in Indonesia include weak reform implementation, state distrust of NGOs, and backsliding on some basic freedoms. Among the important internal features of NGOs in democracy promotion are overreliance on confrontational advocacy strategies, shallow organizational capacity, inability to cooperate to leverage impact, limited outreach to indigenous constituencies and sustainability problems. Indonesia’s democracy-promotion NGO coalitions have largely operated as instruments of donor-supported reforms. As they seek to become socially embedded actors pursuing indigenous agendas, they face the need to confront the various expectations of their stakeholders regarding their roles and legitimacy, develop flexibility to respond to new engagements with government and with citizens, and address their internal capacity gaps. Three cases are presented that illustrate both the problems and the encouraging progress with government–NGO collaborations in democratic governance.

Research on nonprofit advocacy in non-Western settings is still rather limited. In this article, we address this limitation by examining the advocacy practices of nonprofit charitable organizations in Singapore, a non-liberal democratic city-state in Southeast Asia with a history of colonial rule. We ask the following questions: What are the key environmental and organizational factors that influence the scope and intensity of advocacy activities of nonprofit organizations? In particular, what is the effect of the political context on the advocacy strategies and tactics among these organizations? To answer these questions, we present a three-factor explanatory model of nonprofit advocacy incorporating cause, capacity, and context. The research methodology entails a survey of nonprofit executives from a random sample of Singapore human and social service organizations. Our findings shed light on how the various aspects of the political context—perceived opportunities and threats from government intervention and dependence on government funding—shape nonprofit advocacy in a non-Western setting.

Two years on from the implementation of the Assisted Decision-Making (Capacity) Act (ADMCA) 2015, significant legal uncertainty persists in Ireland’s acute hospitals for the care of people who lack capacity to consent to treatment. Consultation-liaison psychiatrists must navigate a legal landscape where clear lacunae have emerged in the regulation of frequently encountered clinical scenarios. We identify three of these – eating disorders requiring refeeding, refusal of life-saving treatment, and unsafe discharges – where neither the ADMCA nor the Mental Health Act 2001 provide legal authority to intervene. In such cases, the Inherent Jurisdiction of the High Court has become the default mechanism for authorising treatment or deprivation of liberty, raising serious concerns about proportionality, clinical delays and uncertainty, cost, and consistency. We also consider a fourth category of patients who require immediate life-saving treatment, and the legal status of Advance Healthcare Directives in this context. Many of the patients who fall into these categories will have an established or suspected mental illness requiring the clinical input of a consultation-liaison psychiatry team.

We contrast Ireland’s evolving capacity legislation with developments in England and Wales. Reflecting on these comparisons, we consider the proposed Protection of Liberty Safeguards may provide some clarification but also contain potential risks of becoming unwieldy and bureaucratic and still fail to provide a workable statutory basis for authorising medical treatment in acute hospital settings. A proportionate, patient-centred, and clinically usable legal framework remains urgently needed.

This review article explores the legislative differences across Canadian jurisdictions with respect to involuntary admission and treatment pending appeal. Some jurisdictions restrict involuntary admission for mental illness to when there is a risk for serious bodily harm or physical impairment. However, the majority of jurisdictions recognize non-bodily harms or substantial mental or physical deterioration as grounds for involuntary admission when other criteria are met. Once a person is involuntarily admitted, jurisdictions differ on how treatment is authorized and whether treatment can commence while a person contests a finding of incapacity to treatment to the courts. Some jurisdictions permit treatment pending appeal while others do not. This article compares Canadian jurisdictions’ mental health legislation and addresses discrepancies through the lens of the Canadian Charter of Rights and Freedoms and the Canada Health Act.