The British Journal of Psychiatry (2006) 189: 564. doi: 10.1192/bjp.189.6.564a
© 2006 The Royal College of Psychiatrists
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Correspondence

Mental health and incapacity legislation

A. Adeshina

Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust, Oxford, UK

A. Sule

Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust, Oxford, UK

Correspondence: Email: Akeem.Sule{at}obmh.nhs.uk

EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL

Dawson & Szmukler (2006) raised a number of interesting points but assumed that general medical patients who lack capacity and object to medical intervention have as serious consequences for their actions as those that refuse psychiatric care. However, we believe that for psychiatric patients objection to intervention could increase risks to self and others. This justifies involuntary treatment under the Mental Health Act 1983. Studies have shown that mental disorder is a risk factor for violent offending in the community (Monahan et al, 2001).

Earlier intervention in mental disorders as a result of using ‘incapacity criteria’ will not confer any advantage, as the Mental Health Act 1983 already makes provision for such early intervention (allowing detention on the basis of the nature or degree of the disorder). Nature in this context represents the pattern of the disorder, allowing for earlier application of the Act.

Finally, we believe that returning patients who have mental disorder and capacity to prison because they refuse hospital treatment is wrong. The prison health services are at best basic (Wilson, 2004). It seems unethical to return vulnerable patients to an environment which can exacerbate their mental disorder and even increase their risk of suicide (Shaw et al, 2004).

REFERENCES

  1. Monahan, J., Steadman, H., Silver, E., et al (2001) Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. New York: Oxford University Press.
  2. Shaw, J., Baker, D., Hunt, I. M., et al (2004) Suicide by prisoners: national clinical survey. British Journal of Psychiatry, 184, 263 –267.[Abstract/Free Full Text]
  3. Wilson, S., (2004) The principle of equivalence and the future of mental health care in prisons. British Journal of Psychiatry, 184, 5 –7.[Free Full Text]




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