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SIDMA as a Criterion for Psychiatric Compulsion: An Analysis of Compulsory Treatment Orders in Scotland

Martin, Wayne and Brown, Miriam and Hartvigsson, Thomas and Lyons, Donny and MacLeod, Callum and Morgan, Graham and Schölin, Lisa and Taylor, Kathleen and Chopra, Arun (2021) 'SIDMA as a Criterion for Psychiatric Compulsion: An Analysis of Compulsory Treatment Orders in Scotland.' International Journal of Law and Psychiatry, 78. ISSN 0160-2527

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Scottish mental health legislation includes a unique criterion for the use of compulsion in the delivery of mental health care and treatment. Under the Mental Health (Care and Treatment Act) (Scotland) Act 2003, patients must exhibit ‘significantly impaired decision-making ability’ (SIDMA) in order to be eligible for psychiatric detention or involuntary psychiatric treatment outside the forensic context. The SIDMA requirement represents a distinctive strategy in ongoing international efforts to rethink the conditions under which psychiatric compulsion is permissible. We reconstruct the history of the Scottish SIDMA requirement, analyse its differences from so-called ‘fusion law,’ and then examine how the SIDMA standard actually functions in practice. We analyse 100 reports that accompany applications for Compulsory Treatment Orders (CTOs). Based on this analysis, we provide a profile of the patient population that is found to exhibit SIDMA, identify the grounds upon which SIDMA is attributed to individual patients, and offer an assessment of the quality of the documentation of SIDMA. We demonstrate that there are systemic areas of poor practice in the reporting of SIDMA, with only 12% of CTOs satisfying the minimum standard of formal completeness endorsed by the Mental Welfare Commission. We consider what lessons might be drawn both for the ongoing review of mental health legislation in Scotland, and for law reform initiatives in other jurisdictions.

Item Type: Article
Uncontrolled Keywords: Psychiatric compulsion, Impaired decision making, Mental health legislation, Capacity, Scotland, Insight
Divisions: Faculty of Humanities > Philosophy and Art History, School of
Depositing User: Elements
Date Deposited: 26 Aug 2021 12:57
Last Modified: 26 Aug 2021 12:57

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