At a conference organised by the Law Society, Mental Health Act Commission, and Institute of Psychiatry possible reform of mental health legislation in England and Wales was discussed. It was concluded that radical legal reform was required, and that the law should be designed specifically for provision of care in both hospital and the community. Reform should be based on principle rather than pragmatism, particularly the principle of reciprocity - patients' civil liberties may not be removed for the purposes of treatment if resources for that treatment are inadequate. Protection of society from nuisance or even violence is insufficient reason for detention. Legal provision for compulsion of patients, whether in hospital or the community, must be matched by specific rights to treatment.

Mental health law removes from some psychiatric patients civil liberties otherwise inherent in our legal system. Through both statute and common law it balances a patient's right to autonomy with doctors' duty of care by reference to the health and safety of the patient. It also balances the civil rights of individual patients against the right of society to protection. Does current law correctly strike these various balances? The conference The Mental Health Act 1983: Time for Change? organised by the Law Society, Mental Health Act Commission, and Institute of Psychiatry (London, November 1993) offered a major review of aspects of mental health legislation in England and Wales on the tenth anniversary of the act. John Bowis, minister of state, Department of Health, opened the conference by asking whether changes in the organisation of mental health care have created the need for a radical review of the act or whether only fine tuning is necessary. I comment on some of the opinions voiced at the conference.