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Least restrictive alternative – advance statements and the new mental health legislation

  • J. M. Atkinson and H. C. Garner (a1)
Extract

Proposals for new mental health legislation make the case for using the ‘least restrictive alternative’ (Scottish Executive, 2001) and the ‘least restrictive environment’ (Department of Health & Home Office, 2000) as guiding principles in deciding the management and treatment of the patient. This appears to be the case made for introducing compulsory treatment in the community. The patient living in the community, while maintained on medication, rather than the hospital would appear to be defined as on the ‘least restrictive alternative’. This, however, takes only a limited approach to what is ‘restrictive’, which should be interpreted more widely, including the patient's view as well as that of clinicians and policy makers. Thus, a patient may see it as less restrictive during an acute phase to be in hospital and not on medication, than in the community but on medication. It is likely, given our knowledge of patients' attitudes to medication (Eastwood & Pugh, 1997), that many patients will prefer to be on oral medication rather than depot, which they see as less restrictive.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Department of Health & Home Office (2000) Reforming the Mental Health Act. London: Department of Health & Home Office.
Eastwood, N. & Pugh, R. (1997) Long-term medication in depot clinics and patients' rights: an issue for assertive outreach. Psychiatric Bulletin, 21, 273275.
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R. v. Camden and Islington Health Authority ex parte K (2001) Commentary: mental health: health and social services authorities'duties to provide after care needed to implement tribunal discharge decision. Medical Law Review, 9, 180184.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
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Least restrictive alternative – advance statements and the new mental health legislation

  • J. M. Atkinson and H. C. Garner (a1)
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