Background Choice enables patient autonomy and independence, and equalises power dynamics between service users and healthcare professionals. However, preserving choice in mental health settings is difficult, as restrictions enforced by the Mental Health Act can inhibit patient decisions and create disempowerment.

Aim To assess service users’ level of perceived choice across six domains based on Maslow’s hierarchy of needs.

Methods The setting was a residential home for people with severe mental health conditions. A ten-point questionnaire using a Likert-type scale was developed to rate the residents’ level of choice across six domains of care, including food, sleep, friendship and activities.

Findings Patients perceived they had the greatest amount of choice in personal expression through clothes and friendship. Interventions were put in place for the lowest scoring domains: food and sleep. Post-intervention follow-up showed a significant increase in the perception of choice in the food domain and a less significant increase in the sleep domain.

Conclusion Patients’ perceptions of choice are dependent on the relationship they have with a staff member or how valued they feel. This study highlights the importance of understanding patients’ views and opinions on all aspects of their care.