Background/Objectives: Decision making is fundamental to personal autonomy and person-centered, rights-based psychiatric care. This study explored the perceptions and experiences of decision making in psychiatric care from the perspectives of service users, caregivers, and healthcare professionals, identifying contexts that facilitate or hinder these practices. Methods: An exploratory–descriptive qualitative design was applied, using semi-structured interviews with eight service users, six caregivers, and seven healthcare professionals (21 interviews in total). Data were transcribed verbatim and analyzed through inductive content analysis. Results: Four main categories were identified: (1) antecedents for decision making, (2) challenges in decision making, (3) consequences of decision making, and (4) recommendations for improvement. Conclusions: This study provides insight into how decisions in psychiatric care are made in Latvia, highlighting the legal, personal, and institutional factors influencing these processes. Participants offered valuable perspectives, identifying both facilitators and barriers to autonomous decision making, as well as suggesting necessary improvements. The findings suggest the need for legal reform and systemic improvements in practices that favor agency in decision making. Additionally, they underscore the importance of strengthening individual capacities to support meaningful collaboration among service users, caregivers, and healthcare professionals in making healthcare decisions that enhance the quality of care and well-being of people with mental health difficulties.

The paper analyses and compares the available legal frameworks that protect the autonomy and ensure decision-making rights in physical and mental healthcare for persons with mental disabilities in three Baltic countries — Estonia, Latvia and Lithuania. The decision-making rights of persons with mental and psychosocial disabilities are examined in depth, with respect to the principles outlined in the Convention on the Rights of Persons with Disabilities ( CRPD ). The research shows that none of the three Baltic States provide an adequate framework to enable every person with mental health difficulties the ability to exercise autonomous decision-making in healthcare and receive support when needed. There is an urgent need to reform healthcare legislation in all Baltic countries to ensure a paradigm shift towards a human rights-based approach that limits substituted decision-making and enables supported decision-making in healthcare.

As a democratic state, Latvia is responsible for providing human rights-based, modern, respectful and high-quality healthcare for people with mental health conditions. This article outlines the principles of human rights-based mental healthcare and analyses the current legal framework for healthcare in Latvia. An assessment is made of the extent to which Latvian legislation complies with widely recognised human rights principles, particularly those set out in the UN Convention on the Rights of Persons with Disabilities. Recommendations are offered for reforming Latvian health care legislation in the field of mental health care, indicating the rationale and potential benefits of these reforms. It is demonstrated how rights-based solutions can eliminate the discrimination and stigmatisation of people with mental health conditions and ensure the protection and realisation of human rights. Proposals to strengthen the inclusion and participation of individuals in healthcare processes are advanced, alongside their engagement in the organisation and legal regulation of healthcare. The author aims to raise awareness of the importance of protecting the human rights of people with mental health conditions in healthcare, as well as democratic and lawful societies.

This article describes the legal framework for healthcare decision-making in Estonia in cases where an adult has limited capacity. The author analyses the existing regulation of limited capacity in Estonia, its civil consequences and the procedure for appointing a guardian under both substantive and procedural law, subsequently describing the procedures for making health care decisions, including in the field of psychiatry, in cases where a person has limited active capacity, and the legal framework in cases where a person is de facto incapable of making decisions. The author points out that Estonia does not regulate the decision-making of persons who have de facto limited capacity and therefore need assistance in making decisions on various life issues, including health care. Furthermore, the state does not provide solutions for the protection of such persons. The author shows how the existing legal system in Estonia respects international human rights standards for the protection of persons with disabilities, with a particular focus on the standards set out in the UN Convention on the Rights of Persons with Disabilities in general and concerning health care decision-making. The paper is concluded with recommendations for legal and policy reforms needed to ensure the rights of adults with mental disabilities, including intellectual disabilities, to make decisions independently or with support on a range of healthcare issues.

Background/Objectives: Decision-making in mental health care is essential for personal autonomy and a cornerstone of person-centered, rights-based psychiatric care. This study aimed to explore and describe the perceptions and experiences of decision-making in psychiatric care from the perspectives of service users, caregivers, and healthcare professionals. It also examined the decision-making contexts that either facilitate or hinder these practices. Methods: An exploratory-descriptive qualitative design using semi-structured interviews was employed. A total of 21 interviews were conducted with 8 service users, 6 caregivers, and 7 healthcare professionals. The interviews were transcribed verbatim and analyzed using inductive content analysis. Results: Four main categories emerged: (1) Antecedents for decision-making: a) mental healthcare factors, b) service user factors; (2) Challenges in decision-making; (3) Consequences of decision-making: a) benefits, b) risks, c) burden; and (4) Recommendations for better decision-making: a) informational support, b) other help and support. Conclusions: This study highlights the complexity of decision-making in Latvian psychiatric care, as perceived by service users, caregivers, and professionals. All participants identified both benefits and risks in the decision-making process. Factors influencing decision-making stemmed from the mental health system and the service user’s personal circumstances. Systemic improvements, including better informational support and communication, are needed to strengthen decision-making agency in psychiatric care.

This paper examines the legal challenges surrounding the protection of cross-border patients ( CBP s) with acute mental health conditions within the European Union (EU), with a focus on Estonia and Latvia. EU law provides a framework for cross-border healthcare access, but its application in the context of mental health remains underexplored. This study investigates the legal, ethical, and procedural complexities of mental healthcare access for EU citizens traveling within the EU, particularly when acute or emergency mental health issues arise. Through an analysis of legal frameworks, case studies, and data from Estonia and Latvia, the study highlights significant gaps in the implementation of CBP rights in the mental healthcare domain. The paper aims to provide insight into the challenges CBP s face when accessing mental health services across borders and to propose ways to strengthen protections in this under-researched area.