Abstract
Szmukler, Daw and Dawson have produced a detailed and carefully worded proposal for a new approach fusing mental health and capacity legislation. In practice their proposal abolishes separate mental health legislation. It aims to ensure that compulsory care for the mentally ill is provided, when needed, according to the same principles as in severe disabling physical disorders (e.g. toxic confusion states, acute head injury, dementia). Their proposal derives from two strongly held and clearly presented principles – respect for the autonomy of the psychiatric patient and removal of what they consider the stigmatising discrimination between mental and physical illness. Capacity becomes the threshold for considering any compulsory detention or treatment.
Highlights
Szmukler, Daw and Dawson have produced a detailed and carefully worded proposal for a new approach fusing mental health and capacity legislation
It will be clear that I do not believe that mental illnesses are ‘ social constructs’ but have a consistency and reality beyond our diagnostic manuals and legal definitions
It is the nature of mental illnesses and their treatments that shape mental health legislation: not mental health legislation that shapes mental health practice
Summary
Mental illness is different and ignoring its differences profits nobody Tom Burns[1]. It starts with an introduction outlining the principles behind the proposed ‘fusion’ legislation and an overview of its practice. This is followed by an extensive preliminary draft of their model statute in eight parts. Gaining any understanding of the principles of the Act is usually through exposure to where it restricts their clinical decisions Such learning is via simple, practical requirements such as confirming ‘treatability’ or ‘danger to others’ in the detention of specific individuals. Where I describe ‘what psychiatrists do’ it is based on my direct experience of practice in the UK and in a range of international jurisdictions where I have worked alongside colleagues These include various European countries, the USA, New Zealand and Australia and in India and Hong Kong – in no way a scientific sample. It is the nature of mental illnesses and their treatments that shape mental health legislation: not mental health legislation that shapes mental health practice (other than at the edges)
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