Understanding Treatment Without Consent: An Analysis of the Work of the Mental Health Act Commission. By Ian Shaw, Hugh Middleton & Jeffrey Cohen. Ashgate. 2007. £50.00 (hb). 138pp. ISBN 9780754618867

There are eleven biennial reports from the Mental Health Act Commission (MHAC), each longer than the previous one, running to many thousands of pages. Is there any more to say about treatment without consent and the work of the MHAC?

All responsible medical officers and many other psychiatrists whose practice involves treating detained patients, will have come across the MHAC. Some view Commission visits to hospitals as an essential safeguard for patients and a means to improve patient care. Others think that the Commission is an irrelevance whose sole purpose appears, at times, to be complaining that a particular form isn't completed to the Commission's satisfaction. This book describes how the Commission carries out its tasks and the sort of information it collects. But it also goes further. As one reads about the history of the Commission and its predecessor organisations and ponders the type of information collected (both on hospital visits and in relation to requests for second opinion appointed doctors) and, more interestingly, the way it is interpreted in this book, one may gain some insight into how the Commission perceives mental health services and patient detention. The review, by a previous MHAC policy officer, of reform of the Mental Health Act (now rather dated) and of the MHAC itself (through the Health and Social Care Bill), furthers the impression of a Commission with a particular way of seeing the world.

The book also includes a paper on ‘treatability’ of individuals with psychopathic disorder. Although it doesn't really fit in with the rest of the book, some readers may consider it the most thought-provoking chapter.

However careful one is to think about the impact of detention and use of the Mental Health Act, one of the rewards of working as a Mental Health Act commissioner is gaining a greater understanding of how others, particularly patients, view detention under the Act. This is reflected in the tone of much of what is written. For those who wish to understand better what the MHAC does this book is worth reading.