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.

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.