Psychological models, human rights, and compulsory community mental health care

Planned changes to the 1983 Mental Health Act announced by the United Kingdom Department of Health include the controversial proposal: "to introduce supervised treatment in the community for suitable patients following an initial period of detention and treatment in hospital". This provision is widespread, and more formal, in other English-speaking jurisdictions. This paper discusses the idea of compulsory psychiatric treatment in the community from a psychological perspective. The 'mediating psychological processes model' of mental disorder [1], proposes that biological and environmental factors, together with a person's personal experiences, lead to mental disorder through their conjoint effects on psychological processes. In this approach, disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. Kinderman [1] briefly outlined some of the implications of such a model for health service policy and for research. Kinderman and Tai [2] extended this discussion to clinical practice. An application of this psychological model and human rights considerations to coercive treatments in mental healthcare suggest that proposed 'supervised community treatment orders' are valuable, lawful, and compatible with the European Convention on Human Rights if certain specific conditions are met. Proposals for 'supervised community treatment orders' should be supported, but with the provisos that: the powers of the Mental Health Act are limited as in Scotland, to persons whose "ability to make decisions about the provision of [care] is significantly impaired", that each order is time-limited and subject to review by a properly constituted Tribunal, and that the use of such orders should represent a benefit to people in terms of more appropriate treatment, or be a least restrictive alternative, or better preserve the person's private and family life.