Mental health law and incapacity: The role of the Clinical Psychologist

Abstract

From an academic clinical psychological perspective, mental health problems are seen as existing on a number of continua with normal functioning, rather than being explicable in terms of categorical diagnoses. Clinical Psychologists use clinical case formulations in their professional practice and are critical of the validity and utility of diagnosis. Psychologists also see mental health problems as stemming from disturbances in psychological processes. In turn, these processes may be disrupted by a variety of causes – biological, social and psychological. Nevertheless, we see disturbance or impairment of such psychological processes as the central issue in mental ill health.

Mental health legislation should therefore reflect these perspectives in terms of the criteria for compulsory treatment and in terms of the procedures and practices governing care.

To an extent this is welcome in the Government’s current proposals for mental health legislative reform. A basis of compulsion based on criteria rather than diagnosis is proposed, as are care plans rather than diagnosis and treatment. Clinical psychology, however, would go further. Since there seem to be differences between ‘well’ and ‘ill’ in terms only of the degree and nature of the disturbance of psychological process and the impact on functioning, this speaks to the nature of
‘unsoundness of mind’. Clinical psychologists contend that it follows that mental health legislation is appropriate and necessary only if people are impaired in their judgement to the extent of being unable to make valid decisions for themselves.
It has been proposed that Clinical Psychologists could act as ‘clinical supervisors’ (the term which is to replace ‘responsible medical officers’). If, indeed, mental ill health is the disturbance of complex, inter-related psychological processes, it makes perfect sense to employ psychologists to coordinate care and decision-making. Clinical psychologists are ready to take their place as partners with lawyers and psychiatrists.