Abstract
Aims and MethodA postal audit of practice in the South-East Thames Region of England before and after the Bournewood judgements.ResultsThere was a trebling in the rate of admission under section of elderly incapacitated patients occurred prior to the Houseof Lords' ruling. By the time of the ruling many consultants had not changed their practice. There is now, however, no impact of the ruling upon clinical practice. The majority of consultants remain concerned about the lack of safeguards for mentally incapacitated elders at the present time.Clinical ImplicationsAlthough the Bournewood judgement was expected by some to have a permanent impact upon the management of the mentally incapacitated this has not happened. There is a need for effective and resource efficient safeguards for the mentally incapacitated to be developed.
Highlights
The Bournewood judgement was expected by some to have a permanent impact upon the management of the mentally incapacitated this has not happened.There is a need for effective and resource efficient safeguards for the mentally incapacitated to be developed
Over half of the consultants felt that their practice had changed as a result of the Bournewood judgement, but only a minority felt that the judgement still affected their practice
The data collected via Mental Health Act administrators show that the rate of detention was slow to increase following the Court of Appeal (COA) judgement and this fits with the need to plan implementation of the COA judgement and the working groups which were established to do this at local level
Summary
There was a trebling in the rate of admission under section of elderly incapacitated patients occurred prior to the House of Lords' ruling. Lord Goff pointed out that the Court of Appeal's judgement suggested that`there will be an additional 22 000 patients detained on any one day, plus an additional 48 000 admissions per year under the Act'' This compared with a figure of 11 000 detained under the Act at any one time prior to the COA judgement. The judgement was unanimously overturned, Lord Steyn (House of Lords, 1998) believed that the result was`an indefensible gap in our mental health law'' He said`the general effect of the decision of the House of Lords is to leave the compliant incapacitated patients without the safeguards enshrined in the Act of 1983'' and lamented the fact that`the common law principle of necessity contains none of the safeguards of the Act of 1983''. Census data on admissions of patients over the age of 65 years as well as patients detained at any one time were collected
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