O-16 Implementing a capacity-based mental health law in Bermuda: International lessons and Caribbean implications

Methods: This comparative policy analysis used document review and synthesis of international experience. We analysed the Bermuda Mental Health Act 1968, its 2019 amendments and the 2021 Mental Health Code of Practice to describe the current legal framework. Regional legislative developments in Barbados, The Bahamas, Guyana and the Cayman Islands were reviewed using publicly available documents. We then synthesised studies from Norway and Queensland, Australia, where capacity-based mental health laws have been introduced, to identify key implementation challenges, system preconditions and governance arrangements.

Results: Bermuda’s current legislation remains diagnosisand risk-based, with capacity principles operating through a Code of Practice rather than primary law. International evidence shows that capacity-based reforms can enhance patient autonomy and shared decision-making but may not reduce coercion when introduced alongside reduced inpatient capacity, limited voluntary services and inadequate training in decision-making capacity. Five priority domains for implementation in Bermuda were identified: embedding capacity principles in statute; systematic training in capacity and risk assessment for a broad health workforce; expansion of community-based and after-hours services; stronger roles, safeguards and supports for families, next-of-kin and independent advocates; and coordinated macro-meso-micro governance to align law, policy and frontline practice.

Conclusion: Introducing a capacity-based mental health law in Bermuda appears feasible and could modernise mental health governance in line with human rights obligations, but its benefits will depend on investment in community services, workforce development and regional learning to avoid unintended increases in family burden and involuntary care.