Compulsory care in the community: a review of the proposals for compulsory supervision and treatment of the mentally ill in the community

This paper reviews developments and proposals in mental health legislation and policies regarding the provision of compulsory supervision and treatment for people with a mental disorder in the community in England and Wales. The current legal framework rests within the Mental Health Act 1983; the Powers of the Criminal Courts Act 1973 (probation order with a condition of treatment) and the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 (supervision and treatment order) . The philosophical and practical issues in compulsory care in the community for people with a mental disorder are examined. The current legal framework for providing compulsory outpatient care in the United States of America, Australia, New Zealand and Hong Kong is noted as background to the introduction to further measures for England and Wales announced by the Department of Health. Proposals from the Royal College of Psychiatrists, the British Medical Association and the Mental Health Act Commission are examined as well as the recommendations from the recent Ritchie Inquiry. The first of the Department of Health proposals — supervised discharge — is currently before Parliament; the second, for supervision registers, has been imposed with very little discussion and is far more contentious. Supervision registers raise ethical, legal, resource and other practical problems which have not been fully acknowledged.