The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of ‘shocking’ systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

BackgroundThe use of advance care planning and advance decisions for psychiatric care is growing. However, there is limited guidance on clinical management when a patient presents with suicidal behaviour and an advance decision and no systematic reviews of the extant literature.ObjectivesTo synthesise existing literature on the management of advance decisions and suicidal behaviour.DesignA systematic search of seven bibliographic databases was conducted to identify studies relating to advance decisions and suicidal behaviour. Studies on terminal illness or end-of-life care were excluded to focus on the use of advance decisions in the context of suicidal behaviour. A textual synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach.ResultsOverall 634 articles were identified, of which 35 were retained for full text screening. Fifteen relevant articles were identified following screening. Those articles pertained to actual clinical cases or fictional scenarios. Clinical practice and rationale for management decisions varied. Five themes were identified: (1) tension between patient autonomy and protecting a vulnerable person, (2) appropriateness of advance decisions for suicidal behaviour, (3) uncertainty about the application of legislation, (4) the length of time needed to consider all the evidence versus rapid decision-making for treatment and (5) importance of seeking support and sharing decision-making.ConclusionsAdvance decisions present particular challenges for clinicians when associated with suicidal behaviour. Recommendations for practice and supervision for clinicians may help to reduce the variation in clinical practice.

<p>Convicted of rape, Mr B was sent to Broadmoor. His psychiatrist diagnosed bipolar affective disorder and wanted, if necessary, to compulsorily treat him with anti-psychotic medication. In his professional opinion, Mr B lacked insight into his condition and lacked the capacity to refuse the treatment. Baroness Hale once remarked that “psychiatry is not an exact science”. If there was ever a case to confirm that view, this is it.</p>

This paper considers when the State must take positive steps to protect the right to life of a suicidal patient. Using recent developments across the Council of Europe which challenge the traditional 'ugly Samaritan' approach of many common law systems, it contends that whenever and wherever public authorities know or ought to know of a real and immediate risk to the life of an identifiable person, they must take reasonable precautions to minimise it. Even J. S. Mill's approach to liberty, it is suggested, would tolerate this limited degree of State interference. However, notions of autonomy and dignity, the unpredictability of human behaviour, and the need to avoid unduly burdening the State must influence what it means to act reasonably.

Both the Mental Health Act 1983 and the Mental Capacity Act 2005 authorise the treatment and detention of the mentally ill. Their interface is often clear cut. After all, the 1983 Act formally sanctions and safeguards compulsion where it is necessary to protect patients or others. Individuals can only be detained for psychiatric, not physical, health purposes. 2 And such detention can only take place in hospital. In contrast, the informality of the 2005 Act defends actions taken in the best interests of those unable to decide for themselves. Compulsory treatment and detention of those with capacity cannot be sanctioned. Nor can those lacking capacity be treated or detained for the protection of others. In the wake of the Article 5 violations denounced in HL v United Kingdom, 3 to bridge the colloquial 'Bournewood gap' the Mental Health Act 2007 appended Schedules A1 and 1A to the 2005 Act. Since their coming into force in April 2009, the deprivation of liberty safeguards ('DoLS') have sought to prevent the arbitrary detention of adults in (only) hospitals 4 and care homes. 5 Those under 18 are not covered. 6 Nor does the scheme apply to deprivations occurring in a carer's, or someone's own, home. Supported accommodation 7 and conveyance to a care home or hospital also fall outside its ambit. 8 Where best interests necessitate the detention in hospital of someone with mental disorder, but they lack the capacity to make the relevant decisions, either statute could be invoked. Schedule 1A therefore purports to differentiate the two regimes by describing five situations in which a person