ABSTRACT

This essay examines the contradictory philosophies and policies at play in the system of care of mentally disordered people, and the impact of the case law of the European Court of Human Rights on that system. It argues that a convergence is taking place between the values and legal structures of the hospital system on the one hand and the penal system on the other, a convergence with profound implications for the citizenship rights of mentally disordered people, and the nature of the doctor/patient relationship. The essay traces how pursuit by the Government of radical risk management policies within the constraints of European Convention case law has affected and will continue to affect the legal framework of compulsory care for mentally disordered people, how it has altered the balance between therapy, retribution, and social defence, and, finally, how it has affected the nature of the relationship between clinicians and patients.