Examining the Ethics of Informed Consent in Housing Services Models for Homeless Adults with Dual Diagnosis

The process of informed consent within mental health treatment and services has been controversial. There has often been a tension between the autonomy and preferences of the consumer and the clinical judgment of the practitioner on what is in the best (mental health) interest of the client, and whether the consumer has the decisional capacity to make an informed choice about treatment and/or services. The ethics underlying the informed consent process becomes further complicated when looking at mental health treatment that is coupled with social services, such as the case with housing programs for homeless adults with serious mental illness. As such, this paper examines the process of informed consent – focusing specifically on the elements of competence and voluntariness - within two different models of housing services – housing first (HF) and treatment-contingent housing (TCH)– to highlight how these models either facilitate or present a barrier to voluntariness in treatment decisions based on their implicit assumptions of client capacity. Implications for increasing consumer choice in deciding on the receipt or refusal of such services are discussed.