SIDMA as a criterion for psychiatric compulsion: An analysis of compulsory treatment orders in Scotland

Wayne Martin,Miriam Brown,Thomas Hartvigsson,Donny Lyons,Callum Macleod,Graham Morgan,Lisa Schölin,Kathleen Taylor,Arun Chopra

doi:10.1016/j.ijlp.2021.101736

Wayne Martin, Miriam Brown + Show 7 more

Open Access

https://doi.org/10.1016/j.ijlp.2021.101736

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Abstract

Scottish mental health legislation includes a unique criterion for the use of compulsion in the delivery of mental health care and treatment. Under the Mental Health (Care and Treatment) (Scotland) Act, 2003, patients must exhibit ‘significantly impaired decision-making ability’ (SIDMA) in order to be eligible for psychiatric detention or involuntary psychiatric treatment outside the forensic context. The SIDMA requirement represents a distinctive strategy in ongoing international efforts to rethink the conditions under which psychiatric compulsion is permissible. We reconstruct the history of the Scottish SIDMA requirement, analyse its differences from so-called ‘fusion law,’ and then examine how the SIDMA standard actually functions in practice. We analyse 100 reports that accompany applications for Compulsory Treatment Orders (CTOs). Based on this analysis, we provide a profile of the patient population that is found to exhibit SIDMA, identify the grounds upon which SIDMA is attributed to individual patients, and offer an assessment of the quality of the documentation of SIDMA. We demonstrate that there are systemic areas of poor practice in the reporting of SIDMA, with only 12% of CTOs satisfying the minimum standard of formal completeness endorsed by the Mental Welfare Commission. We consider what lessons might be drawn both for the ongoing review of mental health legislation in Scotland, and for law reform initiatives in other jurisdictions.

Highlights

We are living through a period of intensive reassessment of the legal standards and mechanisms used to authorise involuntary medical treatment, in the context of mental illness or impaired ca pacity
The Millan Report did not itself use the term ‘significantly impaired decision-making ability’ (SIDMA),’ but it proposed that compulsion be used in the delivery of mental health care outside forensic contexts only if: as a consequence of the person's mental disorder, the person's judgement is impaired to a nature or degree which would justify compulsory measures. (Millan, 63)
Results a) The Assessors: The majority of the 100 mental health reports were completed by an Approved Medical Practitioner (AMP) (87%), with a minority completed by General Practitioner (GP) (13%)

Summary

Introduction

We are living through a period of intensive reassessment of the legal standards and mechanisms used to authorise involuntary medical treatment, in the context of mental illness or impaired ca pacity. In the Mental Health (Care and Treatment) (Scotland) Act, 2003 (hereafter: the Act), SIDMA plays a role in several provisions regarding the exercise of coercive power in the context of mental disorder, including (but not limited to): the criteria for emergency detention in hospital The Millan Report did not itself use the term ‘SIDMA,’ but it proposed that compulsion be used in the delivery of mental health care outside forensic contexts only if: as a consequence of the person's mental disorder, the person's judgement is impaired to a nature or degree which would justify compulsory measures. The Millan Committee proposed that this new criterion should function as an additional prerequisite for compulsion – over and above the re quirements that are familiar from earlier legislation and other jurisdic tions: the presence of mental disorder of a nature or degree that requires treatment, risk of harm to the patient or to other persons

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