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Comparison of mental health legislation for involuntary treatments across the Commonwealth


In order to inform law reform, a method was developed for comparing the legal criteria for involuntary admission and treatment against current consensus guidelines, and used to analyze mental health legislation in Commonwealth countries.


World Health Organization (WHO) and Council of Europe (CoE) guidance on the desirable components of mental health legislation were used to develop standards for criteria for involuntary admission and treatment. The standards include the presence of appeal or review procedures, conditions included/excluded under the remit of the law, and thresholds for risk and incapacity that would legitimize involuntary treatment. Mental Health Acts from a range of high and low resource Commonwealth jurisdictions were rated against the criteria. Instances where current law falls short of the guidelines were noted, as were examples of good practice that could be used as models for law reform.


The analysis included 32 Acts from Asia, Africa, Australasia, the Caribbean, Europe and North America, enacted between 1895 and the present decade. Of these, 13 excluded intellectual disability as a reason for involuntary treatment, 11 excluded substance misuse, and 3 excluded types of personality disorder. The number of Acts meeting standards set by the WHO and CoE were: review procedures (WHO) 0, (CoE) 23; diagnostic threshold (WHO & CoE) 13, incapacity threshold (WHO) 10, (CoE) 32; risk threshold for detention (WHO) 21, (CoE) 18; risk threshold for treatment (WHO) 8, (CoE) 17.


Within the Commonwealth, there is considerable variation in the criteria used for involuntary admission and treatment. Widespread deviation from consensus guidelines raises the possibility that involuntary admission and treatment may be used inappropriately. The adoption of new laws based on existing legislation which meets these standards could reduce this risk.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fistein, E., Holland, T. & Clare, I. Comparison of mental health legislation for involuntary treatments across the Commonwealth. BMC Psychiatry 7 (Suppl 1), S43 (2007).

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  • World Health Organization
  • Personality Disorder
  • Intellectual Disability
  • Consensus Guideline
  • Substance Misuse