Intended for healthcare professionals


Public health psychiatry or crime prevention?

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:549

Government's proposals emphasise doctors' role as public protectors

  1. Nigel Eastman, Senior lecturer in forensic psychiatry.
  1. St George's Hospital Medical School, London SW17 0RE

    In the wake of the recommendations of the Fallon inquiry into the personality disorder unit at Ashworth Hospital 1 2 the government has now announced its own solution to the problems presented by people with antisocial3 or dissocial4 personality disorder.5 After a joint Home Office and Department of Health review which ran in parallel with the Fallon inquiry it has proposed for consultation new services and law. Although not prescriptive about the detail of its solution, both the government's philosophy and its resolve are clear. In pursuing, above all, public protection, it intends services which essentially hybridise punishment and health care, with law that allows preventive detention of even the unconvicted.

    The uncertain treatability of antisocial personality disorder,6 consequent professional therapeutic ambivalence,7 and inherent uncertainty about the moral status of the condition (whether individuals “suffering” from it are mad or bad)8 combine sensibly to imply a hybrid service solution which is far more radical than that which emerged from the last government's attempt at a similar review.9 Reflecting its close look at various European service models, the present government seems to intend a “third way,” involving establishing new specialist institutions which would be hybrids of prison and hospital and would house only people with severe personality disorder.

    This contrasts with the solution proposed by Fallon …

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