Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-12-01T04:32:00.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental Health Act reform: treatment of dangerous and severe personality disorder

Published online by Cambridge University Press:  02 January 2018

Prabhat Mahapatra
Prabhat Mahapatra*
Affiliation:
Care Principles, Dover Road, Barham, Canterbury CT4 6PW
Rights & Permissions [Opens in a new window]

Abstract

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.
Type
The Columns
Information
Psychiatric Bulletin , Volume 25 , Issue 12 , December 2001 , pp. 486
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2001. The Royal College of Psychiatrists

Sir: Chiswick (Psychiatric Bulletin, August 2001, 25, 282-283) has captured the essence of the proposed Mental Health Act reforms with regard to dangerous and severe personality disorder (DSPD).

The existing Mental Health Act always gave clinicians the power to detain patients with psychopathic disorder in a hospital for treatment if the patient was thought to present risks to others. Treatment of patients with psychopathic disorder is stressful because of the difficulties in treating them, the resources they take up, the strong countertransference reactions these patients evoke and the staff burnout that they cause. Therefore, understandably, clinicians resort to a narrow interpretation of the ‘treatability test’.

In the proposed reforms, the emphasis is on the fact that this group of patients needs treatment and that the interpretation of the treatability test needs to be a broad one.

The main arguments put forward by clinicians against the proposals are that (a) patients who are not treatable should not be detained and (b) it is unethical to detain patients for public protection alone.

Taking the first argument about treatability of psychopathy, there is a lot of evidence in the literature that psychopathy can be a difficult condition to treat, but not entirely untreatable.

As to whether it is unethical to detain patients when they pose a risk to others, it can be argued that because of the high probability of their offending, patients with DSPD run a high risk of being imprisoned and being the victims of retaliation by others and therefore detention in hospital prevents offending behaviour and protects them from the consequences thereof.

If we as clinicians refuse to treat people who are clearly unwell and distressed, we would be failing in our duty of care and pushing these vulnerable patients into the criminal justice system.

Since it seems inevitable that the proposals will become law, we should be fighting for more resources to be able to deliver the services this group of patients need.

Submit a response

eLetters

No eLetters have been published for this article.