Support persons as procedural safeguards in involuntary psychiatric care

Abstract

Ensuring effective access to justice for persons with psychosocial disabilities in psychiatric hospitals remains a critical challenge in some European countries. While the Convention on the Rights of Persons with Disabilities (CRPD) requires States Parties to provide procedural accommodations and support in exercising legal capacity, hospital-based involuntary treatment settings present systemic barriers to participation, complaint mechanisms, and judicial review. This paper examines the role of support persons as an emerging form of procedural safeguard in involuntary psychiatric care, with a comparative focus on four jurisdictions: the Netherlands (patiëntenvertrouwenspersoon), Sweden (Personligt Ombud Skåne), Austria (Patientenanwaltschaft), and Czechia (důvěrník). Drawing on legal analysis and qualitative interviews with psychiatrists, advocates, lawyers, and peer workers, the paper explores the legal basis, institutional design, and practical functioning of supportperson mechanisms. It identifies key factors shaping their effectiveness, including independence from service providers, clarity of mandate, professional acceptance, and the ability to assist with complaints and judicial proceedings. While the Dutch and Austrian models represent institutionalized and rightsoriented advocacy structures, the Swedish model offers strong community-based support but limited reach inside hospital settings. By contrast, the Czech důvěrník model remains comparatively weak and inconsistently implemented, illustrating the risks of nominal safeguards without operational support or awareness. Support persons can enhance procedural fairness, empower individuals, and operationalize CRPD obligations, but they are not a substitute for broader reforms toward non-coercive mental health care. The paper argues that effective support systems require statutory guarantees, resourcing, and integration into complaints and review procedures. Recommendations are offered for strengthening support-person models within European mental health systems to enable genuine access to justice and equal recognition before the law.