I enjoyed the article by Dawson & Szmukler (Reference Dawson and Szmukler2006) because I like to keep up to date with legal and ethical issues in mental health. However, their claim for equivalence between mental and physical diseases sits uneasily with scientific papers published in the Journal. Shaw et al (Reference Shaw, Hunt and Flynn2006) found that schizophrenia had a prevalence of 5% in perpetrators of homicide, compared with 1% in the general population. I would love to see comparable figures for the prevalence of hypertension, multiple sclerosis, leprosy etc., but meanwhile we have a problem. The Ritchie report on the inquiry into the care of Christopher Clunis reveals capacity's dark side by showing how psychiatrists repeatedly brought a patient to the point at which he could make his own decisions, then left him to fend for himself (Reference Ritchie, Dick and LinghamRitchie et al, 1994). Perhaps the best way for services to reduce the stigma and discrimination associated with psychiatric illness is to reduce the 5% figure? Somehow, I cannot see capacity-based legislation playing a lead role in achieving that objective.
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