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How to keep up with the Mental Health Act
M. S. Humphreys, J. P. Kenney-Herbert and R. V. Cope
APT 2000, 6:407-411.
Access the most recent version at DOI: 10.1192/apt.6.6.407
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Advances
Treatment
(2000),
Keeping up with the Mental Health
Act in Psychiatric
APT (2000),
vol. 6, p.
407 vol. 6, pp. 407–413
How to keep up
with the Mental Health Act
M. S. Humphreys, J. P. Kenney-Herbert & R. V. Cope
In recent years there has been a marked increase in
the proportion of individuals with mental disorders
detained in hospital involuntarily, compared to
those admitted on an informal basis (Wall et al, 1999).
There is also growing concern about legally
incompetent patients being treated under the
doctrine of necessity (Eastman & Peay, 1998). The
rise in the numbers of detained patients may have
come about for a variety of reasons. Suggested
possible contributory factors include a reduction in
psychiatric hospital beds; the move towards
community care and the consequent tendency to
maintain patients at home for longer; increasing
comorbidity and more severely disturbed behaviour
on hospital wards; and a greater number of individuals transferred to hospital care from the criminal
justice system (Mental Health Act Commission,
1999). Statutory mental health legislation in the UK
has remained essentially unchanged, in some cases,
for nearly 15 years. There have been additions and
amendments during that period, as well as new law.
For instance, the Mental Health (Patients in the
Community) Act 1995, dealing with the care and
treatment of people with mental disorders, and the
Criminal Evidence (Amendment) Act 1994, covering
specific issues to do with certain groups of those
suffering from psychiatric disorders. Despite this
there is clear evidence from recent research from
various parts of the UK that medical practitioners,
most particularly psychiatrists, and even those using
the Mental Health Act on a day-to-day basis, do not
necessarily possess a detailed knowledge of the law.
Among a random sample of Section 12(2) approved
medical practitioners in the West Midlands, none of
those interviewed was able to define the term mental
disorder as used in the Act, and only just over onethird correctly identified the four legal categories of
mental illness, mental impairment, severe mental
impairment and psychopathic disorder (Bhatti et al,
1999). In similar studies undertaken in Scotland,
only one in 10 of a national sample of consultant
psychiatrists was able to give the statutory definition
of the term mental disorder (Humphreys, 1998) and
among a similar non-consultant sample only 28%
were able to give the correct title and year of the
Mental Health (Scotland) Act 1984 (Humphreys,
1997). It would seem important, therefore, that
psychiatrists do not become complacent about their
knowledge and use of the Act, even though there
has been considerable debate around the issue of
how much expertise and precise factual knowledge
of specific legislation is actually required.
Why should psychiatrists know and understand
the law as it relates to the care of individuals with
mental disorders? The question might be more
appropriately posed the other way round, namely,
why should they not know the law? For some
people suffering from certain forms of mental
disorder, involuntary detention and compulsory
treatment are major and important means of access
to the care that they require. The law also serves to
protect the rights of those made subject to formal
measures, as well as clinicians and others involved
in their treatment. It might be argued that knowledge
of the Mental Health Act and its proper use is as
fundamental to many branches of psychiatry as the
correct understanding and appropriate initiation of
physical investigations, therapies or practical
Martin Humphreys is Senior Lecturer in Forensic Psychiatry in the University of Birmingham and Honorary Consultant Forensic
Psychiatrist at the Reaside Clinic (Birmingham Great Park, Birmingham B45 9BE). He has a particular research interest in
mental health law and statutory follow-up of mentally disorderd offenders, as well as the clinical care and treatment of female
prisoners. Jeremy Kenney-Herbert is Consultant Forensic Psychiatrist at the Reaside Clinic, and Honorary Senior Clinical
Lecturer, University of Birmingham. His research interests include mental health law and service delivery. Rosemarie Cope is
Consultant Forensic Psychiatrist and Clinical Director of the Reaside Clinic, and Honorary Senior Lecturer, University of
Birmingham. Her research interests include ethnic issues in forensic psychiatry.
APT (2000), vol. 6, p. 408
procedures in any other branch of medicine. In one
very widely publicised case of homicide, committed
by a detained patient with mental illness, misunderstanding and lack of knowledge of mental health
legislation played a part in the circumstances
leading to the death of a member of staff (BlomCooper et al, 1995). A young man with a schizophrenic illness, who was subject to Section 3 of the
Mental Health Act 1983 (a substantive treatment
order), was being granted leave from the hospital
where he was a patient by members of nursing staff,
with no reference to the responsible medical officer.
On one of these occasions he purchased a knife and
on returning he killed an occupational therapist. In
the ensuing inquiry it was clear that failure to use
the proper provision for leave from hospital under
Section 17 of the Mental Health Act 1983 had
obviously been a significant factor.
The law is one area where psychiatrists may be
cross-examined, most frequently at the time of a
mental health review tribunal, but sometimes in
court. It is necessary to have a clear understanding
and knowledge of original grounds for detention,
whether they are still fulfilled, what issues the
tribunal might be required to address and the
questions they or the patient’s legal representative
might ask. All of this requires knowledge of the
relevant Act . There is reason then for psychiatrists
to know the law. Understanding can only come with
use, but familiarity should not be allowed to breed
contempt.
Royal College of Psychiatrists’
training pack
In 1997, the Royal College of Psychiatrists produced
a training pack entitled Using the Mental Health Act.
A Training Resource for Doctors. In the introductory
notes it states that “a working knowledge of the
Mental Health Act ... is vital to enable psychiatrists
to function effectively in today’s mental health
services”. The pack contains comprehensive
summary information about use of the various parts
of the Mental Health Act, including the detention
and care of formal patients, consent to treatment,
mental health review tribunals, the Care Programme
Approach (CPA) and risk assessment. It encompasses both statutory legislation and, where relevant,
case law, as well as clinically important associated
areas. It also gives guidance on some relevant areas
of the Police and Criminal Evidence Act 1984, and
the Sex Offenders Act 1997. It has a glossary and a
quiz on the Mental Health Act 1983. In addition,
there is a training video, which includes simulated
Humphreys et al/Browne
mental health assessments with associated comments
and questions at various intervals and time for
discussion. The pack includes details of how to plan
a training session using the video, summaries of the
case scenarios and a set of overhead projector slides
to be used in seminar teaching. It is an invaluable
educational tool.
The National Confidential Inquiry into Suicide
and Homicide by People with Mental Illness
(1999) has emphasised the importance of training
in use of the Mental Health Act in relation to the
reduction of suicide, self-harm and homicide by
people with mental disorders. In producing its
training pack, the Royal College of Psychiatrists
has acknowledged public interest in the difficulties
of the management of people with mental disorders
and the need to improve professionals’ knowledge
and understanding of mental health legislation.
Although it may be difficult to establish an evidence
base for the use of the Mental Health Act, doctors
who are engaged in psychiatric practice and the care
of patients with mental disorders should have an
understanding of the theoretical basis of mental
health legislation, a firm grounding in sound
clinical practice in relation to compulsory
detention and treatment and knowledge of the
associated ethical issues.
Literature
Although there is no substitute for reference to the
Act itself, there is a wide variety of literature available that addresses both the theoretical and practical
aspects of mental health law (Box 1). Books range
from those specifically about the Mental Health Act,
including guides (Bluglass, 1983), those based
around theory and practice in mental health law
(Blackie & Patrick, 1990; Hoggett, 1990; Jones, 1999)
and comprehensive and ongoing review (Gostin,
1986). In addition, there have been a number of
handbooks produced by pharmaceutical companies
(Bethlem and Maudsley NHS Trust, 1983; Schering
Healthcare, 1983, 1984). In some texts there are useful
and easily understood summary tables of statutory
powers and procedures in relation to the care of
individuals with mental disorders, which are a
helpful and quick guide to various sections and
parts of the Mental Health Act 1983, as well as the
Mental Health (Scotland) Act 1984 and the Mental
Health (Northern Ireland) Order 1986 (Briscoe et al,
1993; Cope, 1995). More recently, work has been
published that has sought to approach the issue of
review and reform of current mental health
legislation from a variety of different standpoints
(Eastman & Peay, 1999). This has succeeded in
Keeping up with the Mental Health Act
APT (2000), vol. 6, p. 409
Box 1 Literature sources on the Mental
Health Act
Box 2 Other sources of information on the
Mental Health Act
Relevant Mental Health Act
Associated code of practice
Books, including practical guides, theoretical
analysis and ongoing review
Pharmaceutical company handbooks
General journals – uncommon
Specialist journals (e.g. Psychiatric Bulletin)
Department of Health systematic review
of research relating to the Mental Health
Act 1983
The internet
Mental Health Act Commission, Mental
Welfare Commission, etc.
Government departments
NHS trusts
Continuing professional development
highlighting many of the areas that will require
attention when new legislation is drafted.
Amendments to the existing law and new legislation are generally subject to review and assessment
in academic and peer-reviewed professional
publications. There are a small number of specialist
journals now dealing with the subject of mental
health law and associated issues, which include
sections on the Mental Health Act, analysis of
relevant cases where these might have an impact on
the care of people with mental disorders and
associated issues. The Department of Health has
recently published a systematic review of research
on the Mental Health Act 1983 (Wall et al, 1999).
Code of practice
The appropriate government department produces
a code of practice to accompany the relevant Mental
Health Act for all UK jurisdictions. This is intended
as a guide and reference source for medical
practitioners and others involved in the care and
treatment of people with mental disorders. It
supplements the legislation itself and also gives
guidance in related areas, such as those concerned
with patients presenting particular management
problems, the possible need for physical restraint,
the use of locked and secure areas and seclusion, as
well as psychological treatments and a broad outline
of procedures for dealing with complaints.
The internet
There are many other sources of information available on mental health law (Box 2), including the
internet. Sites exist for the UK and further afield.
These include the Royal College of Psychiatrists, the
Department of Health, the Home Office and others.
They provide up-to-date information on publications,
case law, research, the current review process and
associated discussion documents. A search on
‘mental health law’ is likely to yield several hundred
possible sites.
Statutory independent bodies
The Mental Health Act Commission (MHAC) and
the Mental Welfare Commission for Scotland intermittently publish guidelines on various aspects of
the law and its interface with psychiatry, including
the operation of the appropriate Mental Health Act.
They also address wider issues, including the interpretation of terms and aspects of the Code of Practice
(e.g. MHAC Practice Note 3: “Section 5(2) of the 1983
Mental Health Act and transfers”; MHAC Practice
Note 4: “Section 17 of the Mental Health Act”). These
bodies also produce regular reports that include
figures for the use of the relevant Act.
Government departments
The Home Office issues circulars in relation to a
wide variety of legal provisions, some of which affect
the care of those with mental illness. These are not
confined to mental health legislation specifically,
but may include other statutory law that may
affect, for instance, mentally disordered offenders
(Criminal Evidence (Amendment) Act 1997). The
Home Office Statistical Bulletin not infrequently
includes data that relate to patients detained under
Part III of the Mental Health Act.
The Department of Health publishes annual
statistics on the use of the Mental Health Act and
raises topical issues on those of particular concern.
A recent example is guidance issued relating to visits
by children to patients in psychiatric hospitals.
Case law
Case law may be important in the interpretation of
statutory legislation, and mental health law is no
APT (2000), vol. 6, p. 410
exception. In particularly important cases, such as
R v. Bournewood Community and Mental Health
NHS Trust ex part L, information and analysis will
be readily available. On other occasions a more
careful search of specialist journals, or reference to
other sources, may be necessary.
NHS trusts
Mental health trusts are required to circulate
guidelines and policy documents relating to new
provision and the use of current mental health
legislation.
They engage the services of solicitors in order
to have access to legal advice on a wide range of
matters. Comment and advice should be available
from them on issues relating to the use of the
Mental Health Act and allied legislation. They
should be able to provide an opinion on most areas,
particularly those where case law has influenced
practice or where statutory provision has been
interpreted or clarified in a particular way. They are
not only a source of direct information, but can act
as a means of access to specialist law journals and
other legal practitioners with particular expertise in
specific areas.
Continuing professional
development
Continuing professional development in mental
health law and the use of the Mental Health Act is
available through a range of different postgraduate
educational opportunities. These vary from locally
organised academic programmes including clinical
case conferences, through legal briefings, to sessions
or study days designed specifically to address
Mental Health Act matters and whole-day or
residential courses run by specialist consultancies
or organisations with a particular remit to teach
mental health law and related issues. The British
Association of Mental Health and Law has recently
been founded and held its first annual meeting in
Nottingham in October 1999.
Approval procedures for medical
practitioners under the Mental
Health Act
For England and Wales there are Department of
Health guidelines on the procedures for the approval
and reapproval of medical practitioners under
Section 12(2) of the Mental Health Act 1983. These
courses, which are now organised in all regions of
England, constitute an important opportunity to
Humphreys et al/Browne
obtain initial and refresher training in the use and
operation of the Mental Health Act. They are not
confined to those seeking approval or reapproval at
any particular time. Their content and length varies
considerably across the country, but they are the
responsibility of the appropriate Section 12(2)
approval panel.
Research
With a major review of mental health legislation
likely throughout the whole of the UK, there has
been an increasing interest in research into many
different aspects of the law and its impact on the
care and treatment of people with mental disorders.
As part of a major programme of research into the
operation of the Mental Health Act 1983, the
Department of Health has recently published a
systematic review of research relating to it (Wall et
al, 1999). This is an important source of information
for those seeking an evidence base for their practice
in relation to use of the legislation. It provides a
comprehensive picture of available findings on both
practical and theoretical matters pertaining to the
Act, as well as an analysis of trends in its use over
recent years. It includes reference to review and
commentary but concentrates on the detail of datacontaining papers, giving a resumé of each. It also
identifies a number of important areas where no
research has yet been undertaken. Although its
usefulness may be limited with the advent of new
legislation, it still gives invaluable pointers to
sources of information about good practice and the
starting points for future research.
Conclusion
The Mental Health Act 1983 bestows upon medical
practitioners the power to override the basic
autonomy of individuals with mental disorders in
certain circumstances. The onus is upon the medical
practitioner to maintain an adequate and up-to-date
knowledge of the relevant legislation, its underlying
principles and best practice in its use and interpretation. Such understanding will protect the rights of
those with mental disorders, as well as, in certain
circumstances, increasing the efficacy of psychiatric
intervention. Review of current legislation is
underway in the UK and reform will follow. With
new law it will be particularly important for
psychiatrists to remain well informed in this area.
There is a wide variety of readily available sources
of information already and a growing interest,
particularly in the area of research.
Keeping up with the Mental Health Act
References
Bethlem and Maudsley NHS Trust (1983) Mental Health Act
1983 Guidelines. London: Bethlem and Maudsley NHS
Trust.
Bhatti, V., Kenney-Herbert, J., Cope, R., et al (1999)
Knowledge of current mental health legislation among
medical practitioners approved under Section 12(2) of
the Mental Health Act 1983 in the West Midlands. Health
Trends, 30, 106–108.
Blackie, J. & Patrick, H. (1990) Mental Health. A Guide to the
Law in Scotland. Edinburgh: Butterworths.
Blom-Cooper, L., Hally, H. & Murphy, E. (1995) The Falling
Shadow: One Patient’s Mental Health Care 1978–1993.
London: Duckworth.
Bluglass, R. (1983) A Guide to the Mental Health Act 1983.
Edinburgh: Churchill Livingstone.
Briscoe, O., Carson, D., d’Orban, P., et al (1993) The law,
adult mental disorder and the psychiatrist in England
and Wales. In Forensic Psychiatry. Clinical, Legal and Ethical
Issues (eds J. Gunn & P. J. Taylor), pp. 21–117. Oxford:
Butterworth Heinemann.
Cope, R. (1995) Mental health legislation. In Seminars in
Practical Forensic Psychiatry (eds D. Chiswick & R. Cope),
pp. 272–309. London: Gaskell.
Department of Health & Welsh Office (1999) Code of Practice.
Mental Health Act 1983. London: Stationery Office.
Eastman, N. & Peay, J. (1998) Bournewood: an indefensible
gap in mental health law. British Medical Journal, 317, 94–95.
APT (2000), vol. 6, p. 411
––– & Peay, J. (1999) Law Without Enforcement. Integrating
Mental Health and Justice. Oxford: Hart Publishing.
Gostin, L. (1986) Mental Health Services – Law and Practice.
London: Shaw and Sons.
Hoggett, B. (1990) Mental Health Law. London: Sweet &
Maxwell.
Humphreys, M. S. (1997) Non-consultant psychiatrists’
knowledge of emergency detention procedures in Scotland.
A national survey. Psychiatric Bulletin, 21, 631–635.
––– (1998) Consultant psychiatrists’ knowledge of mental
health legislation in Scotland. Medicine, Science and the Law,
38, 237–241.
Jones, R. M. (1999) Mental Health Act Manual. London: Sweet
& Maxwell.
Mental Health Act Commission (1999) The Mental Health
Act Commission Eighth Biennial Report 1997–1999. London:
Stationery Office.
National Confidential Inquiry into Suicide and Homicide by
People with Mental Ilness (1999) Safer Services. London:
Department of Health.
Royal College of Psychiatrists (1997) Using the Mental Health
Act. A Training Resource for Doctors. London: Royal College
of Psychiatrists.
Schering Healthcare (1983) A Guide to the Mental Health Act
1983 and Allied Legislation. Burgess Hill, Sussex: Schering
Healthcare.
––– (1984) A Guide to Parts of the Mental Health (Scotland) Act
1984 and Allied Legislation. Burgess Hill, Sussex: Schering
Healthcare.
Wall, S., Churchill, R., Hotopf, M., et al, (1999) A Systematic
Review of Research Relating to the Mental Health Act 1983.
London: Department of Health.
Commentary
Fred Browne
Although practitioners will be most familiar with
the mental health legislation in their own jurisdiction, there can also be value in studying other
legal frameworks. I give here a perspective from
Northern Ireland.
The central piece of mental health legislation in
Northern Ireland is the Mental Health (Northern
Ireland) Order 1986 (hereafter, the Order). The Order
has been closely modelled on the Mental Health Act
1983 of England and Wales and the Mental Health
(Scotland) Act 1984. However, the Order has unique
and distinctive features that differentiate it from the
mental health legislation in England, Scotland and
Wales. The Order is also substantially different from
the Republic of Ireland’s Mental Treatment Act 1945.
Particularly at the present time, when reform of
mental health legislation is being considered, it is
important to be aware of these differences between
the different jurisdictions and to assess their
advantages and disadvantages.
Features of the Mental Health
(Northern Ireland) Order 1986
It is not possible in a short article such as this to list
all of the different features of the Order, but the
following are among the more notable.
Fred Browne is a Consultant Forensic Psychiatrist at the Knockbracken Healthcare Park, Belfast BT8 8BH. His research interests
include mental health legislation and service development.
APT (2000), vol. 6, p. 412
Definition of ‘mental illness’
The Order’s definition of ‘mental illness’ is believed
to be the first in UK legislation. It reads:
“’Mental illness’means a state of mind which affects
a person’s thinking, perceiving, emotion or judgement
to the extent that he requires care or medical treatment
in his own interests or the interest of other persons.”
Unfortunately, the definition is circular and of
limited value to those seeking guidance on
whether an individual’s mental disorder is of a
nature and severity to warrant exercise of the
powers of the Order (such as detention in hospital
or the making of a guardianship order). However,
this criticism illustrates the difficulty in providing
a simple and practical definition of mental illness.
Exclusion of personality disorder
as sole grounds for detention
The Order does not recognise a separate category of
psychopathic disorder and does not allow for the
detention and treatment of persons diagnosed with
a psychopathic disorder, regardless of whether they
are considered amenable to treatment. (People may,
of course, be detained and treated under the provisions
of the Order when personality disorder coexists with
mental illness or severe mental impairment.) In the
Brian Doherty inquiry, Fenton et al (1995) recommended that the Order be amended to make it similar to
the Mental Health Act 1983, so that certain people
with severe personality disorder could be detained.
However, the majority of psychiatrists in Northern
Ireland appear to favour the current arrangement.
Stringent criteria for admission
and detention
Patients are generally detained under the Order
when they suffer from mental illness or severe
mental impairment and when “the failure to detain
a patient or the discharge of a patient would create
a substantial likelihood of serious physical harm”.
In determining this issue, the Order requires
evidence of one or more of the following:
(a) that the patient has inflicted, or threatened or
attempted to inflict, serious physical harm on
himself/herself; or
(b) that the patient’s judgement is so affected
that he/she is, or would soon be, unable to
protect himself/herself against serious
physical harm and that reasonable provision
for his/her protection is not available in the
community; or
Humphreys et al/Browne
(c) that the patient has behaved violently towards
other persons; or
(d) that the patient has behaved such that other
persons were placed in reasonable fear of
serious physical harm to themselves.
Thus, detention in hospital requires specific
evidence about the nature of the harm that the patient
has caused or may cause to self or others.
Unitary admission system
The Order provides for a period of assessment in
hospital lasting up to 14 days, followed by detention
for treatment, which lasts for 6 months in the first
instance. Patients are admitted to hospital following
a medical recommendation (usually completed by
the patient’s general practitioner) and by an
application completed either by a nearest relative or
by an approved social worker.
Regular review of patients
by consultants
The Order ensures that a doctor assesses the patient
immediately after admission to hospital and, if the
admitting doctor is not a consultant, the patient is
seen by a consultant within 48 hours of admission.
If the patient is further detained, he/she will be seen
again by a consultant within the first and second 7day periods of the admission and at other specified
intervals thereafter.
Non-discrimination against
detained patients
Article 10 of the Order states that detention for
assessment (for up to 2 weeks) need not be revealed
under certain circumstances, for example, this
information need not be declared to employers.
Managers’ hearings
There are no routine managers’ hearings, and the
Mental Health Review Tribunal hears appeals
against detention.
Patients involved in criminal
proceedings
The Order requires that, when a hospital order is
being made, the court must receive evidence from
two medical practitioners, one of whom must be Part
Keeping up with the Mental Health Act
II approved (in practice, a consultant) and give oral
evidence. The receiving trust must be given an
opportunity to make representation to the court, but
the ultimate decision about the making of a hospital
order lies with the court.
Sources of information
The main sources of information on mental health
legislation in Northern Ireland are the Order itself
and a Guide and Code of Practice (Department of
Health and Social Services, 1986, 1992). A booklet
entitled A Practical Guide to the Mental Health (NI)
Order 1986 has been produced by Conway et al
(1986). Some psychiatric text books also contain
information on the Order (e.g. Gunn & Taylor, 1993;
Chiswick & Cope, 1995; Johnstone et al, 1998).
Information on the use of the Order can be obtained
from regular reports published by the Mental Health
Commission. It should be noted that the Order has
been amended by subsequent legislation, such as
the Criminal Justice (NI) Order 1996. Practice has
also been influenced by guidance from the Department of Health and Social Services (see, in particular,
Department of Health and Social Services, 1996).
Induction and regular refresher training in the
use of the Order was recommended in the Brian
Doherty inquiry (Fenton et al, 1995). Unfortunately,
this recommendation does not appear to have been
implemented throughout the Province of Northern
Ireland, and training in this important area remains
patchy.
Research and the future
Little research has been carried out into the Order.
This is perhaps related to the small size of the
APT (2000), vol. 6, p. 413
Province and the underdevelopment of forensic psychiatry. It seems a shame that we may be embarking
upon changing our mental health legislation without
studying our existing provisions in detail. In
addition to studying the Order itself there may be
important lessons to be learnt from comparisons
between the different laws and practices within the
different jurisdictions in the UK and Ireland.
Perhaps also there is a need for harmonisation
between jurisdictions. For example, at present we
have provision for the transfer of detained patients
between England, Scotland, Wales and Northern
Ireland. However, we do not have reciprocal
legislation that allows for transfer of detained
patients across the UK’s only land-based border –
that between Northern Ireland and the Republic of
Ireland. Considering that the Royal College of
Psychiatrists represents psychiatrists from all these
jurisdictions, perhaps we should pay more attention
to the differences in our mental health laws and the
relationships between them.
References
Chiswick, D. & Cope, R. (eds) (1995) Seminars in Practical
Forensic Psychiatry. London: Gaskell.
Conway, N., Henry, P. & McCloskey, G. (1986) A Practical
Guide to the Mental Health Order (N. I.) 1986. Londonderry:
Western Area College of Nursing.
Department of Health and Social Services (1986) The Mental
Health (Northern Ireland) Order 1986: A Guide. Belfast:
DHSS.
––– (1992) Mental Health (Northern Ireland) Order 1986: Code
of Practice. Belfast: HMSO.
––– (1996) The Discharge from Hospital (or Prison) and the
Continuing Care in the Community of Mentally Disordered
People who are Thought Could Represent a Future Risk to
Themselves or Others. Belfast: Department of Health and
Social Services.
Fenton,G., Deane, E., Herron, S., et al (1995) The Brian Doherty
Inquiry. Derry: Western Health and Social Services Board.
Gunn, J. & Taylor, P. J. (eds) (1993) Forensic Psychiatry. Clinical,
Legal and Ethical Issues. Oxford: Butterworth Heinemann.
Johnstone, E. C., Freeman, C. P. L. & Zealley, A. K. (eds)
(1998) Companion to Psychiatric Studies (6th edn).
Edinburgh: Churchill Livingstone.