Psychiatry RSS feed: Current Issue. Psychiatry is a review journal presenting current knowledge and practice of psychiatric conditions, treatments and outcome in a structured three-year "curriculum". With guidance from highly regarded editorial board members and chapter editors, and contributions from leading experts in all key psychiatric specialties, our aim is to describe accepted principles and practice, and to indicate recent advances that will improve the understanding of mental healthcare and the care of patients. Psychiatry provides information for basic and higher specialist trainees, consultant psychiatrists and specialists in psychological medicine, GPs with a special interest in mental health, psychiatric nurses and other mental health professionals. Editorial Office Vicky Chapman Managing Editor Medicine Publishing The Boulevard Langford Lane Kidlington, Oxford OX5 1GB, UK. psychiatry@medicinepublishing.co.uk http://www.psychiatryjournal.co.uk/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Psychiatry1476-1793812December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.psychiatryjournal.co.uk/article/PIIS1476179309002304/abstract?rss=yesContents10.1016/S1476-1793(09)00230-4Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1OFCOFChttp://www.psychiatryjournal.co.uk/article/PIIS1476179309002328/abstract?rss=yesEditorial Board10.1016/S1476-1793(09)00232-8Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1iihttp://www.psychiatryjournal.co.uk/article/PIIS1476179309002109/abstract?rss=yesAfter almost a decade of debate, sometimes acrimonious, the Mental Health Act 1983 was amended to create the Mental Health Act (MHA) 2007. The recommendations of the Richardson Committee (1999), set up by the government to ‘scope’ the changes that would ‘modernise’ mental health law by taking account of changes in practice, particularly its community focus, were mostly rejected. What started as a call for a ‘root and branch’ reform ended as a set of amendments, some of which sit uncomfortably with the 1983 Act, and with the Mental Capacity Act (MCA) 2005, passed a little earlier. This was the best the government could achieve in the face of vigorous opposition to two Mental Health Bills (2002 and 2004) from an unprecedented alliance of almost every stakeholder group involved in mental health care. Major criticisms concerned the government's emphasis on public protection ahead of patients' health interests, and its continued rejection – despite repeated recommendations from the Mental Health Alliance, experts in the field, a joint committee of parliament set up to scrutinise the 2004 Bill, and the House of Lords when the amendment bill was debated – that there should be an ‘impaired decision making’ (or capacity criterion) for involuntary treatment. ‘Capacity’ and the risk posed by persons with mental disorder are both reviewed in this chapter of Psychiatry.The changing legal landscape governing mental health practiceGeorge Szmukler, Gareth S. Owen10.1016/j.mppsy.2009.09.011Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Introduction463464http://www.psychiatryjournal.co.uk/article/PIIS1476179309002043/abstract?rss=yesAbstract: The Mental Capacity Act 2005 has put the assessment of mental capacity for decision-making at the forefront of psychiatric practice. This capacity is commonly linked within philosophy to (personal) autonomy, that is, to the idea, or ideal, of self-government. However, philosophers disagree deeply about what constitutes autonomy. This contribution brings out how the competing conceptions of autonomy would play out in psychiatric practice, taking anorexia nervosa as a test case.Personal autonomy and mental capacityFabian Freyenhagen10.1016/j.mppsy.2009.09.005Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Philosophy465467http://www.psychiatryjournal.co.uk/article/PIIS1476179309002018/abstract?rss=yesAbstract: The question of definition of mental disorder and the related question of its boundaries have been, and remain, of crucial importance in many contexts. Two approaches were evident from the beginnings of modern psychiatry approximately 100 years ago: the medical and the psychological models, differing in several critical respects, particularly on whether or not psychiatric conditions are meaningful and understandable, and the related question of whether or not the abnormal is clearly differentiated from the normal. A third approach, the sociological, emphasized the strong connexion between so-called mental disorder and social deviance, and appeared forcefully in the 1960s as critiques of mainstream psychiatry. These controversial issues remain alive, sharpened by major changes since the 1960s, particularly the development of medications for common mental health problems and the development of care in the community for severe mental health problems.What is mental disorder?Derek Bolton10.1016/j.mppsy.2009.09.002Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Philosophy468470http://www.psychiatryjournal.co.uk/article/PIIS1476179309002031/abstract?rss=yesAbstract: Truth-telling has been part of one of the great bioethical shifts of the 20th century, from medical paternalism to respect for patient autonomy. Some argue that there are psychiatric cases where truth-telling is less necessary, however. The three standard justifications for medical deception – that the truth can be anti-therapeutic, that patients don't want to know the truth, and that telling the truth is ultimately impossible – seem to be more compelling in psychiatry, and there are additional justifications that apply when psychiatric patients lack the capacity to make their own decisions. Here, I consider those justifications, and argue that truth-telling is paramount even in psychiatry.Truth-telling in psychiatryRichard A.A. Kanaan10.1016/j.mppsy.2009.09.004Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Philosophy471472http://www.psychiatryjournal.co.uk/article/PIIS147617930900202X/abstract?rss=yesAbstract: Despite our intuitions, there is no generally agreed definition of criminal responsibility. Here, the relevant English legal background, the mental condition defences, and the main philosophical theories of criminal responsibility are reviewed. The latter are the choice and capacity theories, character theory, agency theory, social theory, and the definitional theory. The psychiatric defences of insanity and diminished responsibility are considered in respect of each of these theories. Although criminal responsibility does not have any explicit role in English criminal law, it does pervade the system, and the problem with the lack of any generally agreed approach is perhaps most starkly exposed when the mental condition defences are contested in court.Criminal responsibilitySimon Wilson10.1016/j.mppsy.2009.09.003Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Philosophy473475http://www.psychiatryjournal.co.uk/article/PIIS1476179309002067/abstract?rss=yesAbstract: Mental capacity is a difficult yet fundamental concept that is becoming more influential in psychiatric practice. Assessment of mental capacity for research purposes has proven possible but empirical research into this area is relatively new. I report on empirical studies that have assessed the reliability of capacity assessments and the associations with psychopathology. Such information can help to guide decision-making both at a clinician–patient level and also at a policy level. The decision-making at issue is some of the most fundamental we face in medicine.Mental capacity and psychopathologyGareth S. Owen10.1016/j.mppsy.2009.09.007Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Capacity and vulnerability476477http://www.psychiatryjournal.co.uk/article/PIIS147617930900189X/abstract?rss=yesAbstract: The Mental Health Act (1983) and the Mental Capacity Act (2005) (both amended by the Mental Health Act (2007)) together provide a comprehensive framework for the care and treatment of people with a mental disorder in England and Wales. The Mental Health Act relates solely to the treatment of mental disorders whilst the Mental Capacity Act has much wider applicability to decisions surrounding treatment and care where a person lacks capacity. Psychiatrists require a good working knowledge of relevant mental health and mental capacity legislation whatever jurisdiction they work in: here, key legal issues for England and Wales are briefly reviewed.The Mental Health Act and the Mental Capacity Act: untangling the relationshipDaniel P. Herlihy, Frank Holloway10.1016/j.mppsy.2009.09.001Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Capacity and vulnerability478480http://www.psychiatryjournal.co.uk/article/PIIS147617930900216X/abstract?rss=yesAbstract: The Mental Capacity Act 2005 provides the legal framework within which we must now make decisions for adults who lack capacity to make decisions for themselves. It lays out a statutory test of capacity. If the person lacks capacity, it requires us to make decisions in their ‘best interests’, which means that a range of relevant factors must be considered and weighed up to come to a conclusion as to what is best for the person. The framework allows for others to be consulted and the previously known views of the person themselves to be considered. It also provides protection from liability for routine acts of care or treatment, providing that it can be demonstrated that the acts are in the person's best interests. It will require a change in the way that decisions are made and documented.Best interestsTheresa Joyce10.1016/j.mppsy.2009.09.014Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Capacity and vulnerability481483http://www.psychiatryjournal.co.uk/article/PIIS1476179309002092/abstract?rss=yesAbstract: Policies and procedures for ‘adult safeguarding’ aim to protect adults against the harm posed to them by other individuals. In England, safeguarding adults from abuse is a public duty, and psychiatrists have an important role to play in upholding this duty through their involvement in this process. Here, we outline ethical, legal and social issues raised by current procedures for adult safeguarding in England and consider proposals for policy reform alongside parallel developments in the law in Scotland. Addressing these issues adequately involves (a) clarifying who will require the support of safeguarding services, (b) defining the nature of the putative harm they face, (c) determining which interventions are justifiable, and (d) ascertaining the circumstances in which these interventions can be initiated. In line with other recent developments in mental health and mental capacity law, the major challenge facing the development of adult safeguarding policy and practice is to find an appropriate balance between protection and empowerment.The duty to safeguard adults from abuseMichael C. Dunn, Anthony J. Holland, Isabel C.H. Clare10.1016/j.mppsy.2009.09.010Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Capacity and vulnerability484486http://www.psychiatryjournal.co.uk/article/PIIS1476179309002079/abstract?rss=yesAbstract: The Mental Capacity Act Deprivation of Liberty Safeguards have been introduced to provide a framework for people who are, or may become, deprived of their liberty. Here, I describe the background to the legislation and the assessment process that leads to authorisation of deprivation of liberty. I also outline the review and appeal processes and consider some of the challenges that may be associated with implementing the new legislation.Deprivation of libertyRuth Cairns10.1016/j.mppsy.2009.09.008Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Liberty and detention487489http://www.psychiatryjournal.co.uk/article/PIIS1476179309002158/abstract?rss=yesAbstract: The article reviews some of the possible factors, namely the existence of special legal provisions, the facility for compulsory treatment and the role of the media and academic publications, which may contribute to the enhanced perception of risk to others from those with mental disorder and the relative neglect of mentally disordered people as victims of crime.Mental illness, dangerousness and protecting societyJill Peay10.1016/j.mppsy.2009.09.013Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Liberty and detention490492http://www.psychiatryjournal.co.uk/article/PIIS1476179309002080/abstract?rss=yesAbstract: In 2008, Community Treatment Orders (CTOs) became available under the amended Mental Health Act 2007 as a means of supervizing people with severe mental disorders in the community following involuntary hospital stays. The orders were intended to prevent relapse following discharge from hospital by requiring the patient to comply with treatment. Patients can be recalled to hospital should they not comply. The introduction of CTOs has been subject to fierce debate, which is still ongoing. This is, in part, due to a lack of convincing evidence for efficacy. The guidance from the Department of Health and from some NHS Trusts seems to favour CTOs over other means of supporting patients in the community. Early figures indicate that CTOs have already been used extensively, despite a lack of evidence to guide clinical practice. A few teething problems have been identified such as the availability of Second Opinion Appointed Doctors and the ways in which services are organized, which impacts on CTO implementation and continuity of care. Experimental research to identify for whom and in what ways CTOs may have benefits is sorely needed to aid clinical decision making.Community treatment ordersJorun Rugkåsa, Tom Burns10.1016/j.mppsy.2009.09.009Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1Liberty and detention493495http://www.psychiatryjournal.co.uk/article/PIIS1476179309002146/abstract?rss=yesAbstract: The United Nations Convention on the Rights of Persons with Disabilities (CRPD) took effect on 3 May 2008. Here, I survey the content of the CRPD, noting that much of it will buttress existing policy initiatives. It places obligations on states (including the UK) to implement its provisions, which include standard human rights protection, rights to service provision particularly in the community, and protection from exploitation. Amendment of the Mental Health Act 1983 and Mental Capacity Act 2005 will be required to meet these standards. Although some of these changes are consistent with existing policy directions, others on their face provide a direct challenge to how we have thought about mental health law. In particular, the requirement that mental disability can never justify a deprivation of liberty (art 14) directly challenges how mental health law has been conceived in the UK. Compulsory treatment is also likely to be open to challenge, either in whole or in part. Mental health professionals must engage with these new ideas to re-formulate what mental health law is for.The United Nations Convention on the Rights of Persons with Disabilities and the future of mental health lawPeter Bartlett10.1016/j.mppsy.2009.09.012Psychiatry 8, 12 (2009)2009-12-01Psychiatry2009-12-01812S1476-1793(09)X0012-1A human rights perspective496498