Most patients with bipolar disorder endorse the use of self-binding directives, signed when they are in remission, to allow psychiatrists to overrule their objections to treatment during severe episodes, a survey shows.

And to the surprise of the UK researchers, the main reason given by patients for being in favour of the so-called Ulysses contracts is not that they fear harm to themselves or others, but that they don’t trust their ill selves to make wise decisions.

The findings fly in the face of the view of the United Nations’ Committee on the Rights of Persons with Disabilities that psychiatric use of capacity assessment and involuntary treatment are violations of fundamental human rights, the authors say.

Invitations to participate in the online survey were emailed to more than 20,000 people on the mailing list of UK charity, Bipolar UK, in October 2017.