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Anti-therapeutic community mental health law

BMJ 1995; 310 doi: (Published 29 April 1995) Cite this as: BMJ 1995;310:1081
  1. Nigel Eastman
  1. Head Section of Forensic Psychiatry, St George's Hospital Medical School, London SW17 0RE

    Rules cannot substitute for resources

    The government's Mental Health (Patients in the Community) Bill is apparently designed to prevent mentally disordered patients in the community from harming themselves and others. It is one of the measures announced in the government's 10 point plan,1 which preceded the Ritchie report on the care and treatment of Christopher Clunis.2 (Is this a case of designing new bolts on the stable door before the carpenter has advised?) Like supervision registers,3 the bill purports to offer greater control of patients in the community. Again like registers, it will largely fail to do so because it is both clinically unworkable and medicolegally flawed.

    The bill allows a power of aftercare under supervision in respect of a patient who (at the time that the order is made) is an inpatient detained for treatment (or is already in the community but still formally detained) and who would represent “a substantial risk of serious harm” to his or her own safety or health, or to the safety of others, or would be at risk of being “seriously exploited,” if he or she did not receive aftercare services on leaving hospital. But the medical recommendations must also state: “his being subject to aftercare under supervision …

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