A new mental health (and public protection) act

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7277.2 (Published 06 January 2001) Cite this as: BMJ 2001;322:2

Risk wins in the balance between providing care and controlling risk

  1. George Szmukler, joint medical director
  1. South London and Maudsley NHS Trust, Maudsley Hospital, London SE5 8AZ

    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.


    We will see big changes. A simpler template for “formal assessment” followed by a care and treatment order, applicable in both civil and criminal justice settings, is described. Everyone, including patients and carers, should find it easier to understand. The definition of mental disorder is very broad—”any disability or disorder of mind or brain, whether permanent or temporary, which results in an impairment or disturbance of mental functioning.” Personality disorder is clearly included. The criteria for a …

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