Subjects, methods, and results

A 1 in 4 random sample of Edinburgh general practitioners (n = 70) was selected. Eight declined to take part and we could not contact 12 others. The 50 who were interviewed represented a wide range of age and seniority. Nineteen had had some experience in psychiatry. Questions were asked only about matters considered essential to lawful emergency detention.

Table 1 gives the results. Forty two believed that the emergency order was intended to be the mainstay of compulsory care. Although most were aware that standard documentation was not necessary, none was able to describe all the statutory requirements for emergency detention. Asked if any conditions were specifically precluded from being sole grounds for detention 10 said intellectual impairment, eight psychopathic or antisocial personality, and 13 intoxication with drugs or alcohol.

Comment

We interviewed 18.3% of general practitioners in the area, from practices responsible for more than 300 000 patients. Those with a particular interest in mental illness were equally likely to have been included in the sample, and it is unlikely that the non-participants represented a group with particular knowledge of the law; indeed our initial approach may have discouraged those with more limited understanding from taking part. Of concern is the possibility that others might have been sufficiently indifferent to decline interview.2

We asked about the law, rather than actual procedure in an emergency. Some doctors did state that before using compulsory powers they would always seek specialist advice, but in practice, given urgent circumstances, there may be less time for thought than during our interviews.

The results were disquieting. Our interviewees were uncertain about terminology and generally unable to define basic statutory requirements. Many doctors believed incorrectly that the presence of certain disorders precluded detention and that treatment could be enforced under the emergency provision.

These are not isolated findings, though previous studies have concerned the knowledge of psychiatrists.3 Medical practitioners base decisions about compulsory hospitalisation on a “needs” rather than a “rights” orientated approach, acting in the patients' best interest and often within the confines of the law.4 Nevertheless, lack of knowledge about statutory provision may lead to loss of the right to treatment for some or infringement of civil liberties for others in an area of the law where these are least well protected.

Most of the doctors interviewed estimated that they used the emergency powers of detention about once a year and then only after exhaustive attempts to do otherwise. Nevertheless, a fifth had detained three or more patients in the previous 12 months, and general practitioners initiated 86 urgent compulsory admissions to hospital in Edinburgh during the 10 month study period.

It is difficult to identify how this sample might differ from doctors working in other parts of Scotland or further afield. Some priority should be given to the issue of mental health law in continuing professional development for all those who might use compulsory measures, particularly in a jurisdiction where the initial decision to deprive an individual of his or her liberty may be in the hands of a single practitioner. Other findings suggest that there are no grounds for complacency elsewhere.5

We thank all those general practitioners who so generously gave us their time to be interviewed for this study.