The 1959 Mental Health Act marked a transition from the “legalism” of the 1890 Lunacy Act, with its 19th century libertarian concerns, to a welfare statute in which decisions about involuntary treatment for mental disorders became primarily a matter for doctors.1 In the Mental Health Act 1983 a revived form of legalism set some limits to medical discretion. Now a white paper, Reforming the Mental Health Act, promises a new epoch, one where “concerns of risk will always take precedence, but care and treatment provided under formal powers should otherwise reflect the best interests of the patient.”2 The foreword to a preview of the “biggest shake up in mental health legislation for four decades” is signed by both the health and the home secretaries, and half the paper is devoted to “high risk patients.” Perceived failures in community care are the main drivers.