Dangerousness and mental health policy.

Mental health policy development in the UK has become increasingly dominated by the assumed need to prevent violence and alleviate public concerns about the dangers of the mentally ill living in the community. Risk management has become the expected focus of contemporary mental health services, and responsibility has increasingly been devolved to individual service professionals when systems fail to prevent violence. This paper analyses the development of mental health legislation and its impact on services users and mental health professionals at the micro level of service delivery. Historical precedence, media influence and public opinion are explored, and the reification of risk is questioned in practical and ethical terms. The government's newest proposals for compulsory treatment in the community are discussed in terms of practical efficacy and therapeutic impact. Dangerousness is far from being an objectively observable phenomenon arising from clinical pathology, but is a formulation of what is partially knowable through social analysis and unknowable by virtue of its situation in individual psychic motivation. Risk assessment can therefore never be completely accurate, and the solution of a 'better safe than sorry' approach to mental health policy is ethically and pragmatically flawed.

Moral perspectives on the prevention of suicide in mental health settings.

The response to suicidal clients is a recurrent and deep ethical problem in mental health practice. Rational suicide is rarely considered in relation to psychological suffering and is generally only discussed within the literature in connection with terminal illness. Focusing on a case example derived from a composite of patient experiences, this paper considers the premise that suicidal ideation may not be an irrational belief arising from mental disorder and analyses the ethical aspects of nursing care through the competing moral frameworks of the care-based and principle-based approaches to nursing ethics. We conclude that when the client is not capable of autonomous decision making, the two approaches lead to the same response. But when the client is capable of autonomous decision making, the two approaches lead to different responses. Specifically, from the care-based perspective, intervention to prevent suicide is easier to justify and helps formulate a nursing response, which promotes hope through the engagement.