We are grateful to Dr Watt for his thoughtful response. He makes the very point that we raised in our editorial; namely that applying Montgomery in practice raises interesting questions for different psychiatrists working in different settings. One of us is a consultant in forensic child and adolescent mental health services so recognises the issues Dr Watts describes; another is a consultant in long-term secure care where patients and professionals may have different value perspectives on risk.

We therefore entirely concur that more debate and discussion about the Montgomery judgment is needed; and we hoped our editorial would stimulate this kind of debate. We especially hope that the Montgomery judgment will encourage psychiatrists in all settings to think about how best to establish dialogue with patients about treatment that allows exploration of different values from the both the patients’ and the professionals’ perspective. It is this emphasis on exploration of what is important to all parties in terms of treatment experience and outcome (not just risk) that makes Montgomery such an interesting case for psychiatrists.