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EDITORIALS: Paul E Mullen Dangerous people with severe personality disorder BMJ 1999; 319: 1146-1147 [Full text]

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Dealing with Dangerous people-Law or Psychiatry

Brian Boettcher   (29 October 1999)

Dangerous people with severe personality disorder

David Church   (8 May 2000)

Dealing with Dangerous people-Law or Psychiatry 29 October 1999
Brian Boettcher, Consultant Psychiatrist Shelton Hospital, Shrewsbury Send response to journal: Re: Dealing with Dangerous people-Law or Psychiatry	Dear sir, There has been dismay by some psychiatrists in UK at the attempt to medicalise this very prickly problem. A plebisite at the summer meeting of the Royal College of Psychiatrists held in Birmingham and the message was that most psychiatrists do not see Personality Disorder as in their remit. These rare non-patients with dangerous and severe psersonality disorder are the provence of the Criminal Justice System. The dialogue, that is the Law, should be between the Criminal Justice System and society , not psychiatry. The Law simply seems unable, in most countries, to come to terms with indeterminate sentences just as it struggles with War, Terrorism, and internet crime. I agree with Professor Mullen that we should not allow ourselves to become responsible for solving these problems. We may be able to contribute to the dialogue like any other person in society but that is all.
Dangerous people with severe personality disorder 8 May 2000
David Church Send response to journal: Re: Dangerous people with severe personality disorder	In an editorial in the 30th October, 1999, Journal (BMJ 1999, 319, 1146-7, "Dangerous people with severe personality disorder : British proposals for managing them are glaringly wrong - and unethical"), Professor Mullen, from a foreign country, makes criticisms of the proposals withwhich I cannot agree. The Home Office paper proposed to involve specialist medical opinion in the management of people likely to harm others, which Prof Mullen criticised as being too much of a public order, rather than healthcare , role. I disagree. I feel it is essential Doctors are involved, to ensure subjects of this proposed legislation are offered every opportunity for medical help and treatment when possible, and not detained on the basis of lay opinion when they may be suffering from some treatable organic problem. On the count of it not being ethical for doctors to be involved, I have to counter that it cannot be ethical for doctors to stand by and remain uninvolved in either scenario : innocent ill persons being detained without treatment, or dangerous persons being allowed to injure, or kill others. Doctors also have a responsibility to the personality disordered to prevent them offending where possible, to avoid the stress to themselves that occurs when a mentally disordered person harms another. Primary Prevention is better than secondary prevention when possible - remember John Snow and the Broad Street Pump : did the local people have greater right to use the pump, and thereby kill themselves, than Dr Snow had to remove it ? Society is entitled to decide how it will manage anti-social behaviour, and will detain these people if it wants. I do not consider it right that we should deny medical care to the detained people. At the same time, I would consider it unethical to deny the community at large the right to protection from harm caused by those who are personality disordered or otherwise antisocial. Current systems are failing - we need something better. Until Prof Mullen comes up with a better, workable, and affordable, system, we must work with the proposals of the Home Office as being the best we have got to work with.