The team behind the SALUS project in Bochum is exploring ways to empower people with mental illnesses to make their own decisions. Advance directives are an effective tool.
Advance directives for people with physical disabilities are widespread in Germany, but their counterparts for mental illnesses are far less common. In a research project, scholars at Ruhr University Bochum collaborated with various stakeholders to develop a template for a psychiatric advance directive and published it in November 2025 as a freely accessible resource through Psychiatrie-Verlag, along with a guide for drafting the advance directive. The template places particular emphasis on enabling people with mental illnesses to exercise self-determination. It is available for download on the publisher’s website.
The team led by Anne-Sophie Gaillard and Dr. Matthé Scholten developed the advance directive template as part of the SALUS project, which is funded by the Federal Ministry of Education and Research. It is the only existing template in Germany that was developed with the active involvement of both affected individuals and other key stakeholders.
Greater autonomy through advance directives
In a psychiatric advance directive, people can specify—while they are still capable of giving consent—which treatments they want and which they do not want during a mental health crisis. “Psychiatric advance directives promote self-determination for people with mental illness,” says Matthé Scholten. “Studies also show that they can significantly reduce the rate of involuntary psychiatric hospitalizations.
As part of the SALUS project, the Bochum team has been conducting research since 2018 on, among other things, the advantages and disadvantages of psychiatric advance directives. The researchers concluded that the advantages clearly outweigh the disadvantages.
“Many people with mental illness want to make end-of-life plans. Doing so gives you a sense of peace of mind,” confirms Iris, who herself has a mental illness and has been deeply involved in developing the now-published document for over two years.
Scientific findings have been incorporated into the draft
The material now available was developed by the team at the Bochum Institute for Ethics and History of Medicine in close collaboration with several affected individuals and their relatives, mental health professionals, and legal experts. The guide explains in simple terms when and for whom a psychiatric advance directive is appropriate, how it can be drafted, and offers tips on storage, updating, and revocation. The guide also provides information on what to consider when assessing the person’s capacity to consent.
“I was able to bring a different perspective to the project,” says Iris. “Even though mental illness is very personal and I obviously can’t speak for everyone affected, I was able to describe, for example, how certain situations feel,” she adds. She also helped make the template easy for laypeople to understand.
She has nothing but positive things to say about her close collaboration with the researchers. “I attended all of the research team’s meetings and gained a great insight into how research works,” says Iris. “Now I feel a sense of pride that I was able to contribute to something that will hopefully help many people.”
Original publications
Anne-Sophie Gaillard, Esther Braun, Iris Haferkemper, Jonas Karneboge, Julia Haberstroh, Tanja Henking, Jakov Gather, Matthé Scholten: Self-Determination in Times of Crisis – A Guide to Drafting and Implementing Psychiatric Advance Directives, Psychiatrie Verlag, 2025, DOI: 10.1486/9783966053488
Anne-Sophie Gaillard, Jakov Gather, Iris Haferkemper, Jochen Vollmann, Sarah Potthoff, Matthé Scholten, Esther Braun: A Template for a Psychiatric Advance Directive: Co-development and Qualitative Evaluation with Key Stakeholders, in: International Journal of Law and Psychiatry, 2025, DOI:
https://doi.org/10.1016/j.ijlp.2025.102135
Press Contact
Dr. Matthé Scholten
Institute for Medical Ethics and History of Medicine
School of Medicine
Ruhr University Bochum
Phone: +49 234 32 28628
Email: matthe.scholten@ruhr-uni-bochum.de
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