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New measures announced for detaining psychiatric patients

John Warden, parliamentary correspondent, BMJ

A form of preventive detention for people with social psychopathic disorders is to be introduced in England and Wales, the home secretary, Jack Straw, told parliament on Monday.

The new legal powers would apply whether or not someone was before the courts for an offence, if it could be established that the individual had a recognised severe personality disorder and was a grave risk to the public.

Mr Straw said that depriving individuals of their liberty in such circumstances is a very serious step but that the key aim is to protect the public while meeting the health needs of individuals.

He will join with the health secretary, Frank Dobson, to publish a consultative document this spring. They are also working on plans for closer integration of the prison medical service and the NHS. The opposition parties broadly welcomed the change, though with reservations about civil liberties.

The announcement also reopens the dispute between Mr Straw and the psychiatric profession last autumn, when, after a murder conviction, he criticised psychiatrists for a reluctance to treat unstable offenders. He accused psychiatrists of interpreting the law too narrowly by taking on only patients they regard as treatable (BMJ 1988;317:1270).

This week Mr Straw admitted that there was an "intellectual failure" within the mental health acts, which allow compulsory detention only if the condition is treatable. In his view, however, people should not be written off as untreatable. They might be untreatable in the eyes of a particular group of psychiatrists but treatable by clinical psychologists, Mr Straw said.
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BMJ 1998 317: 1270. [Extract] [Full Text] [PDF]