Men in White Coats

Cover
Men in White Coats
Copyright
Contents
Introduction
	Involuntary treatment
	Justifying compulsion
	Questioning the orthodoxy
	Discrimination
	A solution
	Treatment pressures and ‘coercion’
	A few explanations
	The title of this book
	How the book is structured
Part I The problem
	1 A practice with a very long history
		Reasons for detention: ‘plus ça change’
		The routine, accepted criteria: ‘mental disorder’ and ‘risk of harm’
		Do two centuries of no change mean no change is required?
		A better explanation for the lack of change
		The ‘shadow of coercion’
		References
	2 Some troubling observations about involuntary treatment
		Disturbing statistics on variation by place and time
		An unfortunate history of abuse, misuse, or mistreatment
			Psychiatry as an instrument to control threats to the social order
			Mistreatment due to misplaced therapeutic confidence
		Race, ethnicity, minority status, and involuntary treatment
		References
	3 The conventional grounds for involuntary treatment are highly problematic
		Human rights conventions and mental disorder
		What is a ‘mental disorder’?
			‘Disorder’ and ‘values’
		Risk: the grave limitations of its assessment
			What goes into creating a sound risk assessment?
			The lure of narrative versus statistical reality
			How the statistics of risk assessment unfold
			Predicting perpetrators of a homicide
			Some ‘costs’ of an unwarranted risk emphasis
		References
	4 Challenges to the orthodoxy
		‘Informed consent’ and ‘capacity’
		A brief history of informed consent
			Disclosure
			Decision-​making ‘capacity’ or ‘competence’
			A codification of case law
			Decision-​making capacity and psychiatry
		Extending involuntary treatment into the community
		References
	5 How mental health law discriminates against persons with mental illness
		Two entirely different sets of rules governing involuntary treatment
			Capacity and best interests
		How does mental health legislation discriminate?
			A fundamental failure to respect autonomy
			The protection of others criterion: an unconcern for fairness
		Some facts about violence and mental illness
		The anomalous position of mental illness
		References
Part II A solution
	6 A law that does not discriminate against people with mental illness
		A single, generic law: the ‘fusion’ proposal
		Key provisions of the ‘fusion’ proposal
			The principles
			Scope of the law and definitions of ‘capacity’ and ‘best interests’
		Involuntary treatment
		Offenders with an impairment of mental functioning
		‘Deprivation of liberty’: ‘a gilded cage is still a cage’
			Deprivation of liberty and the Fusion Law
		Summary of the proposal
		References
	7 On being able to make decisions and making decisions for others
		An expanded notion of ‘decision-​making capability’
			Beyond a ‘cognitive’ or ‘procedural’ view
		Decision-​making capability and the role of ‘interpretation’
			‘Principle of Charity’
		Interpretation in practice
		‘Understandability’
		Values can change
		Rethinking ‘best interests’ in the light of interpretation
		Problematic situations
		Relevance to coercive interventions
		References
	8 A new United Nations ‘disability’ convention: ‘respect for rights, will and preferences’
		A ‘paradigm shift’
		What the Convention says
		An ‘authoritative’ interpretation of a key issue
		How can the challenge be met?
		‘Respect for rights, will and preferences’
			‘Interpretation’ and ‘will and preferences’
		Discrimination—​direct and indirect
		The Convention and the criminal justice system
		Supported decision-​making
		Decision-​making capability is not an all-​or-​none phenomenon
		The Convention and the Fusion Law proposal
		References
Part III ‘Coercion’ viewed more broadly
	9 Treatment pressures and ‘coercion’
		A spectrum of ‘treatment pressures’
			1	 Persuasion
			2 Interpersonal leverage
			3 Inducements (or offers)
			4 Threats
			5 Compulsion
		‘Subjective’ versus ‘objective’ accounts of coercion
		Exploitation and ‘unwelcome predictions’
		‘Inducements’ in the context of health care
		‘Threats’ in the context of health care
			Conditional treatment in the community
			Conditional treatment in hospital
		Justifying treatment pressures and coercion
		References
	10 Can we reduce the need for coercive interventions?
		Having a ‘voice’ and ‘procedural justice’
		‘Advance statements’ and ‘psychiatric advance directives’
			Crisis cards
			Joint crisis plans
			Psychiatric advance directives
		Reducing coercive measures on hospital wards
		References
Part IV How practice would change
	11 ‘Mental disorder’ and public protection
		Protection, preventive detention, and treatment
			Preventive detention for infectious disease and discrimination
		Protection from dangerous people with a ‘mental disorder’
			How the Fusion Law would deal with such cases
			‘Fitness to plead’ and ‘not guilty by reason of insanity’
		‘Mad’ versus ‘bad’
			‘Psychopathy’ under the Fusion Law proposal
		Involuntary treatment and addictions
		References
	12 Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’
		Emergencies
		General hospitals
		‘Fluctuating capacity’
		Involuntary outpatient treatment (or community treatment orders)
		Advance statements and directives
			Why have advance statements been ignored in mental illness?
			Benefits and drawbacks
			When, if ever, should an advance directive be overridden?
		References
PART V The future
	13 Where does this take us?
		Change is now essential
		Conflicting social policies, but some positive signs
		References
Index