Sir, – Mary Donnelly's article "Reform of mental health law should put patient's voice to the fore" (Opinion & Analysis, July 17th) makes some important points and calls for the enactment of the Mental Health (Amendment ) Bill 2017, so as to ensure consistency between the Mental Health Act 2001 and the Assisted Decision-making (Capacity) Act 2015.
Prof Donnelly refers to the need to remove the principle of the best interest of the patient, which is in the 2001 Act, as it has been interpreted by the courts in a paternalistic manner and has left little “space for the patient’s own views and preferences”.
As a mental health professional working with patients with severe and ensuring mental illness for over 20 years, I think there will always be a need for a balance to be struck between the rights of patients and the protection of their health and safety and the safety of others.
Insight is key in decision-making and those with a serious mental illness like psychosis can at times lack insight.
We live in a risk-averse culture, and while Prof Donnelly may want to bring to an end the “outdated attitude that the doctor knows best”, the reality is that many patients who do not accept the recommendations of their treating team can be discharged from that mental health service and can subsequently be vulnerable to even greater risk. – Yours, etc,
FRANK BROWNE,
Templeogue,
Dublin 16.