Psychiatric injustice? The therapeutic presumption of behaviour management in mental health law

There are a great many people with mental health problems receiving treatments that are aimed primarily at managing aggressive or challenging behaviours by means of sedation, seclusion or restraint. The management of these behaviours is frequently justified under Part IV of the Mental Health Act 1983, which permits treatments ‐ without consent if necessary ‐ for a person's mental disorder. Alternatively, the behaviours have been managed at common law on the basis that the patient is incapable of giving a legally effective consent to behaviour management and the interventions are considered to be in the person's best interests. This article considers the management of difficult behaviours in adults with mental health problems. This issue is particularly timely as there have been a considerable number of legal challenges in this area in recent years. This article reviews the practical contexts in which behaviour management, which here covers sedation, seclusion and restraint, is used with adults with mental health problems and explores the legal justifications for these interventions. Although the justification for the management of challenging behaviours is frequently asserted (or, more likely, presumed) to be therapeutic, a review of the research literature and recent case law casts doubt on the credibility of this therapeutic justification.