The Role of Psychiatric Advance Directives in Addressing Mental Health Disparities in Africa: A Scoping Review

Background: Psychiatric advance directives are essential for upholding human rights, improving access to mental health care, and ultimately achieving universal health coverage. Despite an emerging body of research, there is no prior synthesis that sought to map the evidence on the roles of PADs in addressing mental health disparities in Africa. Methods: A scoping review was conducted according to Arksey and O’Malley’s framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting standards. Results: A total of 27 publications published between 2008 and 2026 met the inclusion criteria. The following thematic domains emerged: (1) mental health disparities associated with advance directives; (2) mental health acts and legislation that do not align with PADs; (3) barriers to implementation of PADs; (4) the need for advance directives to align with African values; (5) recommendations for improvement. Conclusions: There is a paucity of studies that address the role of psychiatric advance directives in addressing mental health disparities in the African region, indicating the main conclusions or interpretations. Evidence from the study remains limited and heterogeneous which calls for more research on this phenomenon.