Letter: A treatment order that could mean a family's safety

Sir: Your report of the substantial award by the Criminal Injuries Compensation Board to the mother of a schizophrenic who attacked her (27 January) is opportune. The case of Jonathan Morrell (now a patient in Rampton Special Hospital under the Mental Health Act 1983) sits directly alongside the case of Ben Silcock, who apparently suffered from a mental illness and jumped into the lion enclosure in London Zoo.

The Silcock case gave rise to comment by the Secretary of State for Health, Virginia Bottomley, regarding the possible need for amendment of the Mental Health Act 1983 towards the provision of some form of coercive treatment in the community. The Royal College of Psychiatrists has recently published a paper in favour of introduction of a 'Community Supervision Order' under the Act. Such an order would aim to provide a degree of coercion of seriously mentally ill patients to continue medication when not in hospital, thereby avoiding recurring relapses and readmissions.

Although it may be that some patients fail to receive treatment in the community as a result of their own reticence, it is also clear that infringement of civil rights could become an (apparently) necessary corollary of lack of adequate community psychiatric resources. Substantial patient support is often a sufficient, and indeed better, basis for encouraging mentally ill patients to continue medication than is compulsion through legislation.

Further, where a patient is recognised to be violent, or otherwise difficult, the issue is often not one of 'the refusing patient' but of 'the refusing doctor'. Hence, forensic psychiatry as a sub-speciality deals with patients whom general psychiatrists commonly reject, even though they are seriously mentally ill. Provision of compulsory community treatment would not reverse this tendency within general psychiatric services.

What is needed is substantial community psychiatric resources with recognition that behaviourally disordered patients warrant care as much as do patients at risk of harming only themselves.

Yours faithfully,

NIGEL EASTMAN

Head and Senior Lecturer

Section of Forensic Psychiatry

St George's Hospital

Medical School

London, SW17