Book Review
Mental Health Law
Decisions and Dilemmas: Working With Mental Health Law. Jill Peay. Portland (OR): Hart Publishing; 2003. 217 p. US $40.00.
Reviewer
rating*: Very Good
Review by: Leo Uzych, JD, MPH
Wallingford, Pennsylvania
Painstaking dissection and examination, by nonlawyers, of the corpus of mental health law decision making is the central attraction of this terse volume. The author, Jill Peay, is a reader in the Department of Law at the London School of Economics and Political Science. Peay has crafted a somewhat unconventional text characterized by a varied structure. The empirical heart of the book is a study methodically examining the terrain of nonlawyer, duodisciplinary decision making by psychiatrists and social workers (with specialized training in mental health) pursuant to the 1983 Mental Health Act (the principal statutory edifice governing the treatment of mentally ill persons in England and Wales). Analytic material comprises the remainder of the structurally bifurcated textual content.
Peay’s overarching purpose is to identify the gamut of strategies employed by participating nonlawyer mental health practitioners, with respect to resolving hypothetical cases and addressing particular scenarios. In the process, she seeks to expose the clinical, legal, and ethical quandaries potentially posed by common dilemmas encountered in real-life mental health practice. Although the pages of the text savour strongly and unmistakably of UK-rooted law, the empirical and analytic material presented should nonetheless enthrall those nonlawyers in Canada and elsewhere who are professionally tethered in some capacity to the realm of mental health law and suffering from trepidations and uncertainties as to how to properly discharge their attendant responsibilities.
The 106 psychiatrists and social workers participating in the study were required to make individual and paired decisions concerning 3 common scenarios: the possible compulsory hospital admission of a patient, the possible discharge of a long-stay patient subject to compulsory hospital detention, and the possible imposition of compulsory treatment. For this purpose, 3 well-conceived hypothetical cases were created. These salutary and vital elements make up the first 3 chapters of the book.
The multipronged format employed with respect to the respective hypothetical cases warrants brief attention. Data, such as the case histories made available to study participants, are replicated. Additionally, Peay succinctly analyzes the issues raised by the hypothetical cases. She summarizes the decisions reached by study participants and scrutinizes the reasons underpinning those decisions. Critically and importantly, she proffers a workaday discussion of unearthed clinical, legal, and ethical problems.
Peay follows the case studies with several analytically laden chapters. In Chapter 4, for instance, she reviews the research moorings of mental health law decision making. Although her review principally reflects a UK-based perspective, Peay’s musings nonetheless likely shed extensive light on how nonlawyer mental health practitioners can carefully fit their professional decisions into the pertinent legal framework. The legal and policy context of mental health decision making, encompassing attendant tensions and the unfolding process of mental health law reform, especially in regard to England and Wales, is the subject of another chapter.
This is a sobering book, albeit a highly instructive one. Exercising intellectual muscle, Peay reveals considerable insight and information and provides a realistic, unalloyed view of how nonlawyer mental health practitioners actually make decisions that involve applications of mental health law. Prospective readers should be mindful, however, that efforts to reform mental health law are probably Sisyphean, nor is any respite likely for conscientious nonlawyer mental health practitioners endeavouring to disentangle the knotty concerns entwining law and mental health and to competently fulfill their legally imposed responsibilities.
Peay’s very good book is finely tailored to fit mental health professionals working in the realm of law and mental health. It should also nourish the intellectual appetites of social workers, lawyers, policy-makers, and others who wish to imbibe knowledge germane to the growth and development of skills relevant to examining mental health law issues.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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