13 January 2000
Dear Professor Appleby
Thank you for your letter clarifying the basis for your evidence about the value of community treatment orders. Although you may have been trying to say that community treatment orders would have little preventive effect on suicide and homicide, this is not what is being quoted by government.
As you know John Geddes has criticised your work for making recommendations beyond the evidence. I know from your e-letter in response that nonetheless you think there is some logic to your conclusions. I am afraid I have not completely read Safer Services. How many of the inpatient deaths were of patients detained under the Mental Health Act? What proportion of these deaths could have been prevented if they had not been admitted to hospital? Indeed, what proportion of the deaths of all inpatients would not have occurred if they were not admitted to hospital? The number of people who commit suicide as inpatients is significant as a proportion of all suicides. What is wrong with the logic that the number of people admitted to hospital should therefore be reduced? It is no different from the argument you use in reverse about the value of community treatment orders. In fact, what evidence do you have that the implementation of community treatment orders would not increase suicide and homicide, rather than reduce it?
I shall look forward to your reply. I have taken the liberty of posting our correspondence on the Critical Psychiatry Network website.
D B Double