27 January 2000

Dear Prof Appleby

Thank you for your response to my letter. I must say I am unsure why your thinking I feel strongly about this issue means you do not want to debate it with me. I was not expecting a long discussion - merely a justification for your statement that community treatment orders would reduce suicide and homicide. Nor did I suggest that the order of reduction in deaths you are suggesting is negligible. I too wish to reduce suicides and homicides by mentally ill people. The point I making is that in fact community treatment orders may increase suicide and homicide. Your not offering any evidence to refute my suggestion does not make your claim seem valid.

In fact I think you did not mean to say that community treatment orders would reduce suicide and homicide. You were trying to make some attempt to quantify what the reduction would be if they did. The fact is that you were merely describing the number of people in your sample with a diagnosis of schizophrenia or affective disorder who in their last admission had to be detained under the Mental Health Act and were non-compliant or did not attend prior to suicide or homicide. You concede that community treatment orders would not have necessarily made them compliant or attend and that if they had complied or attended that they would not still have committed suicide or homicide. The figure you quote is, therefore, a maximum for the assumptions on which it is made. However, community treatment orders could increase, not decrease, suicide and homicide not just in the subgroup you identify for purposes of calculating a figure but also in other subgroups and for people who may not have even been included in your sample.

It is clear that you are making an assumption that community treatment orders will reduce suicide and homicide. Having made this assumption you seek to substantiate it by calculating figures which seem to give a respectability to your assumption. Nonetheless it is an assumption and cannot be justified by pseudo-evidence.

I presume you will not anwer this letter. I am therefore asking John Hutton to seek some justification from you for the statement he has quoted. As I said in my first letter to you I am posting this correspondence on the web at http://www.critpsynet.freeuk.com/reform.htm, as there is a need for public justification of your view. Even if you will not respond to me or the minister, I think you do have a responsibility to clarify or retract your statement.

Best wishes

Yours sincerely


D B Double

Consultant Psychiatrist