Psychiatry and the law

The law in most developed countries provides for the compulsory admission and/or treatment of mentally disordered persons for their own protection and/or the protection of others and for mitigation in the case of mentally disordered individuals who commit a criminal offence. In England and Wales the Act of Parliament that is crucially involved is the Mental Health Act 1983, although a new Act is about to go through parliament. The Mental Health (Scotland) Act 1984 and the Mental Health (Northern Ireland) Order 1986 contain clauses broadly similar to those in England and Wales.

Apart from one provision of the National Assistance Act 1948, the Mental Health Act 1983 is the only method whereby individuals can legally be deprived of their liberty without having committed a crime or being suspected of committing a crime. It is, therefore, necessary that doctors understand the seriousness of their responsibility and the details of the legislation.

There are three conditions that need to be met before an appropriate compulsory section form is signed. The patient must be:

suffering from a defined mental disorder
at risk to his/her and/or other people's health or safety
unwilling to accept hospitalization voluntarily.

The reasons why there is no alternative approach to the treatment suggested for the patient should be outlined. Sexual deviance or alcohol/drug dependence are not defined mental disorders, but otherwise the definition of mental disorder is broad. Any registered medical practitioner may sign a medical recommendation under the Act, but the added signature of a specialist psychiatrist is needed for compulsory orders lasting for more than 72 hours. Unless the patient is already in hospital, the nearest relative or an approved mental health social worker is also required to sign the application form.

Physicians are likely to be involved in sections 5(2) and 2. It should be remembered that a section does not give a doctor the right to treat a physical disease, although it could be argued that a section would apply if the physical disease was causing the mental disorder (e.g. delirium). This has never been legally tested.

Although much of the process of detention against one's will is formalized, there is no liability for a doctor who acts in good faith with a patient's best interests at heart. Clearly written medical notes, accepted forms of treatment and common sense remain the basis of good practice.