Psychologists and compulsion

Until recently, psychologists have not been directly involved in imposing compulsory mental health care. In England and Wales, the amendments to the Mental Health Act in 2007 brought a significant change in the form of the new role of 'responsible clinician'. The 'responsible clinician' replaces the old role of 'responsible medical officer' and is the person responsible for a person's care while detained under the Mental Health Act. Clinical Psychologists as well as psychiatrists can now be 'responsible clinicians'. This is a profound change in our potential role within mental health care (although, of course, it will apply to those of us who adopt this responsibility). Indeed, the psychologist David Smail has said: 'what makes [psychologists] different from other professions in the field is . .. [that we] . .. can't lock them up; we can't drug them or stun them with electricity; we can't take their children away from them. The only power we have is the power of persuasion and this ... more or less forces us into an attitude of respect towards our clients'.12 Clearly, this relationship between clinical psychologists and their clients could be threatened by compulsion. But, in my opinion, what makes psychologists different from other professions is not only a historical absence of formal power but also a markedly different framework of knowledge and skills. The argument made in this book is that a different, new psychosocial model of care is required. Although I am well aware of the potential dangers, I am also of the opinion that this different approach to care planning should be available - should particularly be available - to people in the most acute need. In time, I believe it should be routine for the 'responsible clinician' to be a psychologist or social worker.

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