A model project for promoting decision-making and expression of intention of persons with mental disorders related to hospitalization was conducted and advocator guidelines were proposed, under the initiative of the Japan Psychiatric Hospitals Association using the 2015 Health, Labor and Welfare Science Research Grant for comprehensive welfare promotion for persons with disabilities. Nowadays, the expression "advocate" is used instead of "advocator" because of valuing the protection of patients' rights. Currently, in non-psychiatric general hospitals, medical staff usually assist inpatients in decision-making. In order to introduce effective advocacy in psychiatric hospitals, well-balanced procedures are necessary, including prioritizing patients' will, after the medical staff fully understand the medical condition, respecting intentions of the patients' family members, and considering the maximum benefits for patients.
 In Goryokai Medical Corporation, an ethics conference is held based on four principles of medical ethics (autonomy, non-maleficence, beneficence, and justice), proposed by T. M. Beauchamp and J. F. Childress in their textbook titled "Principles of Biomedical Ethics," so that medical professions can adequately discuss ethical issues. Medical staff sometimes face a dilemma between support for patients' decision-making and actual treatment, as allowing non-voluntary inpatients to express their thoughts is considered to be disadvantageous, which is caused by a poor understanding of mental illness. In this article, efforts by the Goryokai Medical Corporation that led to support for patients' decision-making and advocacy are introduced and the necessity of well-balanced procedures is discussed.
 Author's abstract