Quiet revolution in Scotland.

Change is part of life. Some changes are much discussed or even feared, with predictions that they will bring an end to the world as we know it. They seldom do. Contrary to these generalizations, however, there have been two major changes in Scotland in the past couple of years, arriving at the same time only by chance, as they are not linked in any way. They are both likely to have significant effects on our society. However, public reaction, so far, has been slight. The first change, confused in the minds of some as being a form of independence, which it is not, is the establishment of a devolved Scottish parliament whose arrival was greeted with nationalistic pride and emotion. The second was the adoption of the European Convention on Human Rights, largely unnoticed by the public. Both these changes have had, even at this early stage, effects on the work of forensic psychiatrists in Scotland, and this report highlights some of these effects. The Scottish parliament was established in 1999, sitting in Edinburgh and broadly dealing with Scottish matters, through the devolution of power from Westminster, with the latter still controlling national policy and all international matters. If the boundaries between what is devolved to the new parliament and what is not seem blurred, it is because they are. As far as mental health matters are concerned, both countries are completely revising the mental health law, and we have been following with interest, and with some anxiety, the proposals from Westminster for major changes to the role of secure psychiatric services for mentally disordered offenders in England and Wales. Our parliament has produced very different legislative proposals for us. They are less extreme and were produced from a comprehensive consultation exercise, with the responses of interested groups being invited during the drafting of the proposals and, whenever possible, incorporated at that stage. This is easier to do in a small country of only five million people. The legislation, which is currently being drafted, may, however, not include some of the more attractive parts of the proposals, and we are beginning to wonder what form the final version will take. For example, in the original proposals, patients detained in a hospital would have the right to appeal for transfer to less secure conditions. Government in Scotland has been alarmed at this because of concerns about possible costs. Our services have tiered levels of security, with many patients starting their period of treatment at the most secure level and progressing thereafter. Perhaps surprisingly, it is at the lower levels of security that facilities are lacking, and our government’s reluctance about this provision is disappointing. Unrelated to this review of legislation is the very first legislation to appear from the new parliament, the Mental Health (Public Safety and Appeals) (Scotland) Act, 1999. This has recently been discussed by Crichton et al. The background to this short piece of legislation was the case of Noel Ruddle, who, in Glasgow in 1992, after being charged with murder, was convicted of the lesser crime of culpable homicide, the charge having been reduced on the grounds of diminished responsibility. He was indefinitely committed to the State Hospital, Carstairs—Scotland’s only maximum security hospital. He showed features of psychotic mental illness at the time of his committal, but these symptoms soon resolved, and the diagnosis became one of psychopathic personality disorder. In due course, he appealed against his continued detention. After lengthy and detailed expert evidence, the judge, who has sole discretion in these cases, decided that although Noel Ruddle had psychopathic personality disorder, he was receiving no treatment, and no treatment was Dr. Baird is a Consultant Forensic Psychiatrist at Leverndale Hospital and Visiting Psychiatrist to Barlinnie Prison, Glasgow, Scotland, UK. Address correspondence to: John A. Baird, MD, Leverndale Hospital, 510 Crookston Road, Glasgow G53 7TU, Scotland, UK. E-mail: [email protected]