Mental health and incapacity legislation.

I enjoyed the article by Dawson & Szmukler (2006) 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 (2006) 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 (Ritchie 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 capacitybased legislation playing a lead role in achieving that objective.