Decisions and Dilemmas: Working with Mental Health Law J. Peay Oxford: Hart Publishing, 2003, £21.95, 217 pp., ISBN: 1841133434

At a time when a great deal concerning mental health law, ethics and practice is in the ‘melting pot’, this book makes a highly-distinctive and welcome contribution to the debate taking place. The author needs no introduction to most readers of this journal, since she has, over the years, made a distinguished contribution to mental health literature. Most notable of her contributions has been her research into Mental Health Review Tribunal decision-making processes (Peay, 1989) and her edited volume Inquiries After Homicide (Peay, 1996). The work reviewed here reports on an empirical study of the decision-making processes engaged in by psychiatrists (often in their responsible medical officer capacity), approved social workers and Second Opinion Appointed Doctors (SOADs) in connection with the admission, treatment, detention and discharge of detained patients under the Mental Health Act 1983.

A short review cannot do justice to the rich (and sometimes disquieting) material contained in Peay's careful critical analysis. Her ‘ subjects’ consisted of 106 participants; 52 psychiatrists from the Faculty of General and Community Psychiatry Division of the College, 14 SOADs and 40 approved social workers. ‘The study examined whether, given identical case materials, individual and paired decision-makers reached similar decisions about the application or non-application of the law, and, more critically, whatever the nature of the decisions made, how these decisions were justified by the parties making them’ (p. x). Peay's intention (having stated ‘that this is an odd book… having neither the methodological rigour of a research report, nor the analytical rigour of a scholarly text)’ was to attempt to recapture the sense of ‘anxiety, excitement, curiosity and discovery experienced by those participating in the research’ (p. xi).

Three ‘manufactured’ cases and accompanying videos formed the basis of the research material. These concerned Mr Draper, ‘A Case For Admission’; Mr Wright, ‘A Case For Discharge’; and Hazel Robinson, ‘A Case For Compulsory Treatment’. The manner in which the mental health professionals in her sample reached their decisions is described in meticulous and fascinating detail. Significantly, one of the major findings concerned the confusion demonstrated by a number of the professionals about the correct application of the law. Another major finding was the role played by what Peay describes as a ‘cautionary’ approach to decision-making. Perhaps one of the most important points made by Peay in her concluding chapter is that ‘the research findings should not be judged merely by the nature of the decisions made, but, as importantly, if not more importantly by the reasons the practitioners gave for these decisions’. In her Foreword to the book, Lady Justice Hale (who will be known to many readers in her former academic role as Brenda Hoggett), describes the book as ‘fascinating’, a statement which I echo wholeheartedly. I think this book is a ‘must’ for all who are thoughtful about the compulsory powers afforded in the current mental health legislation.