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Analysis

Mentally disordered or lacking capacity? Lessons for management of serious deliberate self harm

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4489 (Published 07 September 2010) Cite this as: BMJ 2010;341:c4489

Rapid Response:

Re:The balancing act?

Dear Editor

I would like to commend the authors for this article, it is
sensitively pitched with sound advice. This is especially true around
basing the approach on supporting decision making.

Truly exploring capacity, whether as part of a Mental Health Act
assessment or under the Mental Capacity Act, is an extremely complex
process in these cases. Acts of violence to self or others, have enormous
meaning and to understand them can take a lot of time and patience, in my
experience best measured in weeks and months, rather than hours. Not
possible when quick intervention is required.

The simplest advice I could give when struggling with a patient in
this situation is that I would suggest the clinician ask themselves this
question. If this person truly wants to die why have they involved me in
this? The vast majority of people that commit suicide, plan and carry out
these acts in secret.

Competing interests: No competing interests

24 September 2010
Oliver Dale
Consultant Psychiatrist
WLMHT