Public policy and mental health legislation should be reconsidered

BMJ 1999;318:1354 ( 15 May )

Letters

Public policy and mental health legislation should be reconsidered

The first 150 words of the full text of this article appear below.

EDITOR $---$ Eastman's discussion of the Fallon inquiry into the personality disorder unit at Ashworth high security hospital identifiesthe dangers for psychiatric practice inherent in public policyin the United Kingdom.¹ We have proposed that mental healthlegislation should be viewed in a radically new light, separatinginterventions aimed at treating people in their own best interestswho (because of mental incapacity) are unable to take treatmentdecisions for themselves from interventions aimed at promotingthe safety of the public.²

Interventions aimed at treating people in their own best interests, but not those aimed at promoting the safety of the public,can be ethically justified on paternalistic grounds. Most violentacts are committed by people who are not mentally ill. Psychiatristscan advise the courts about the presence of mental illness, itsprognosis, and appropriate treatment. The evidence base for thisadvice is strongest for psychotic disorders and weakest . . . [Full text of this article]