Sir: The proposals to reform the Mental Health Act can only lead to a massive increase in the number of individuals compulsorily detained. It is difficult to underestimate the impact that the ludicrously broad definition of mental disorder (without the exclusions in the 1983 Act); the replacement of the ‘treatability’ clause with a requirement that treatment need only control the behavioural manifestations of the disorder; and the low threshold for compulsion (a 'significant risk) (Department of Health, 2000) will have upon already overstretched services. Psychiatric services will find their beds filled by anybody deemed to be a risk to the public who can be squeezed into an ICD-10 or DSM—IV diagnosis; that is, pretty much the entire prison population and many others besides.

There is a fine line between a relatively minor offence and an offence “from which the victim would find it hard to recover” (Department of Health, 2000), such as section 18 on wounding. Those who routinely deal with offenders are aware that the outcome often has more to do with chance and degree of intoxication than any easily distinguishable psychopathological features.

Although there has always been debate within the profession regarding the management of personality disorders, it is generally accepted that psychological treatments cannot be delivered without the motivation and cooperation of the patient. The Government propose to replace the ‘lottery’ of treatability with the certainty of ‘preventative detention’, regardless of the impact this is likely to have on services and patients. All this because of an unsafe conviction.

Anybody for another Fallon Inquiry?