Independence, Risk and Compulsion: Conflicts In Mental Health Policy

During the second half of the 20th century the mental hospital population in England and Wales has fallen by some two-thirds. This dramatic shift in mental health policy has been based, in part, upon a policy assumption concerning the therapeutic benefits of hospital discharge for mental patients. This view derives from an acknowledgement of the potentially negative impact of institutional life and, conversely, a recognition of the beneficial effect of a return to independent living in the community. Yet, in recent years, concern has grown about the risks posed to the health and safety of patients and to the safety of other members of the community as a result of hospital discharge. In turn this has led to a policy shift in favour of increasing use of compulsory community powers. This article identifies the tensions in policy that exist between the goal of independence, the recognition of risk and the implementation of compulsory community powers, and seeks to provide an assessment of the extent to which they can be reconciled.