This article describes the literature specific to partnership working across the National Health Service, social services and voluntary and community sector in order to summarise the potential advantages and challenges of partnerships. We explore the meaning of partnership working and review the policy developments and investment initiatives underpinning the Government's emphasis on partnership working between statutory services and the voluntary and community sector. A number of barriers hinder effective partnership working and we examine some possible solutions to overcome these. We then address the key issues influencing the approach to increasing the voluntary sector's participation in partnership activities within mental health services and provide brief examples of good practice. Finally, we discuss practical issues relevant to planning partnerships and the role consultant psychiatrists can play in initiating and developing partnership working between the voluntary sector and statutory mental health services.

There has been a series of judgments in recent years emanating from the Court of Protection in England and Wales involving sexual relations. One such judgment is unique in that it is the first time the court has assessed capacity in the sexual practice of autoerotic asphyxiation in a person with a diagnosis of autism spectrum disorder. This article reviews the judgment and specifically the key section of the Mental Capacity Act 2005, section 27, which applies to capacity decisions in the context of family relationships, including sexual relationships. The practice of autoerotic asphyxia can be a complex and emotive subject and dangerous to individuals undertaking it. The judgment provides guidance and a framework for applying the Act to assess the capacity of someone practising autoerotic asphyxia that can be used in clinical practice for people with any mental disorder.

Measuring outcomes is becoming an increasingly standard (and highly complex) part of what mental health services are expected to do. Practising psychiatrists will need to have a good understanding of approaches to outcome measurement: used well, they have the potential to amplify the patient voice, promote good-quality services and facilitate research. We discuss what constitutes an outcome measure, the different ways that such measures can be obtained and the mechanisms for assessing the quality and appropriateness of an outcome measure. We outline the rapidly evolving research and policy context regarding outcome measurement, with particular reference to the UK's National Health Service. We also consider the potential pitfalls to outcome measurement, such as added clinical burden, inappropriate incentivisation of behaviour and incorrect interpretation of results. We discuss ways that such difficulties can be avoided or their effects mitigated.

This article aims to provide a practical overview concentrating on civil legal aspects of psychiatric care for the elderly. We limit ourselves to English law (which also has jurisdiction in Wales; Scottish and Northern Irish law may be similar, but not identical). Civil law can, in turn, be divided into statute law (legislation provided by Parliament) and common law (the UK, unlike some European countries, has a strong tradition of law based on previous rulings by judges).

The article briefly describes the structure of the civil courts in England and Wales and explains how laws are drafted. This information is used as a basis for understanding the rule of precedent: how earlier court decisions may be binding in later cases. The article explains what law reports are, how cases are reported in the legal literature and how they may be located and cited. A number of key cases are summarised to illustrate the process of judicial reasoning and to show how case law contributes to psychiatric practice and defines the legal structure of medical work. A list of useful legal websites is given.

The professional regulatory cases of the psychiatrist Dr Richard Pool and the neuropathologist Dr Waney Squier have given rise to concerns among expert psychiatric witnesses, and indeed medical experts in general. Here we restate the law on expert evidence with particular reference to the judgment of the Supreme Court in the case of Kennedy v Cordia. We emphasise that Pool does not change the law regarding ‘what is expertise’; in particular, the case does not establish restrictive, status-based tests governing the admissibility of expert evidence such as according to whether an expert psychiatric witness has undergone higher training, is on the specialist register as a specialist in a particular field or is a consultant. Rather, expertise continues to be legally defined in terms of a combination of qualification, knowledge and experience. Crucially, the test of medical expertise in legal proceedings is a legal test and not one determined within a medical paradigm.

The United Nations' 1959 Declaration of the Rights of the Child states that ‘the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth’. In the UK, children and young people are afforded protection by two important pieces of legislation: the UN Convention on the Rights of the Child and the Human Rights Act 1998. There have been plentiful and varied challenges involving children and young people, in particular under Article 8 of the Human Rights Act. This review of Article 8 cases demonstrates both its use and key principles underpinning its use.

UK law on assisted suicide and euthanasia is very clear: it is unlawful. However, there have been successive proposals for changes to legislation in this area (in England and Scotland) and a series of individual challenges to current legislation in the courts. This article does not seek to debate the profound ethical arguments that surround this emotive subject, but instead to portray how the law, through court judgment and legislative proposals, has wrestled with opposing views, particularly over the past decade or so, as the impact of the Human Rights Act has presented unique challenges. Some of our closest European neighbours have diverse legislation that could influence our own legislature, and, from across the Atlantic, the Oregon Death with Dignity Act is being mirrored in proposals to change the law in the UK.

Liaison and diversion services are concerned with ensuring that individuals with mental health problems and related vulnerabilities who come into contact with the criminal justice system receive appropriate support and treatment. In the past 15 years there have been significant changes in policy, legislation and the broader landscape in community, custodial and hospital settings which have shaped these services. The Bradley Report, published in 2009, represents an important landmark in this field. Bradley made 82 recommendations, from interventions to improve identification of mental illness and vulnerable individuals at risk of offending to effecting speedier transfers of mentally disordered prisoners to hospital. Some progress has been made in achieving these recommendations, and further investment is promised, but at present only half of England is covered by liaison and diversion services.

Assisting another person's suicide is a criminal offence in England and Wales, although the offence is rare and the law allows for charges not to be brought where there has been no criminal intent. Campaigners for ‘assisted dying’ want something else – a law licensing assisted suicide in advance for certain groups of people in certain circumstances. The present law has been challenged in the courts, hitherto unsuccessfully, as incompatible with article 8 of the European Convention on Human Rights. The Supreme Court has taken the view that, given its social policy implications, this is a matter that Parliament is better placed to consider than the courts.

Clear policies regarding sexual expression, sexual behaviour and related decision-making assist in ensuring that the rights of people with mental disorder or intellectual disability are upheld, and that staff know how to react to situations consistently and lawfully without interfering on the basis of their own moral judgements or personal beliefs. Sensitive and holistic planning of care that complies with domestic law, international human rights law and statutory guidance is necessary to complement such policies. Non-intimate physical contact, masturbation, sexual relationships, contraception, sterilisation and vasectomy, pregnancy, termination of pregnancy, sexual dysfunction, parenthood, marriage and civil partnership, divorce, prostitution, pornography, and sex aids and toys are all matters that may properly be part of care planning.

The Human Rights Act 1998 was introduced into UK law in 2000. It must be considered in all clinical cases, including mental health review tribunals. The number of mental health cases brought to the European Court of Human Rights that breach Article 3 has been very few. However, Article 3 will need to be considered in the clinical setting in complaints arising from conditions of detention, seclusion, control and restraint. This article analyses the case law, illustrating its evolution and also demonstrating the fundamental and core concepts that underpin the Act that can be used in clinical practice.

Clinical decision-making in psychiatry is affected by many factors, including how best to reduce risks of harm while promoting autonomy and personal recovery. This article proposes guidance for clinical decision-making that is consistent with civil liability law. It emphasises collaboration, clarification of the available information and communication of decisions as a basis for recovery-oriented risk management.

This brief article reflects on the relationship between psychiatrists and pharmaceutical companies (pharma), which continues to generate debate and concerns. We suggest that psychiatrists should consider both the biomedical ethical principles and how values guide actions and clinical decision-making in their dealings with pharma. In addition, the Royal College of Psychiatrists should err towards eschewing influences that might be regarded by others as distorting its position, and individual psychiatrists should declare interests that others might regard as competing/conflicting in order to maintain the trust of patients and the public.

Alcohol is the most commonly used recreational drug in the world and the third leading cause of preventable death. Alcohol consumption and alcohol problems have increased steadily over the past six decades. Methods likely to reduce alcohol problems (e.g. minimum pricing, restricting licensing hours and increasing the availability of alcohol treatment) tend not to be supported by the drinks industry. Methods favoured by the industry (e.g. public education, industry self-regulation and product warning labelling) are less effective or do not work. The recent history of alcohol policy clearly demonstrates how the financial power of industry can influence governments and undermine effective public health measures, for instance by lobbying, political donations, confusion marketing and creating fnancial vested interests by grants from industry-sponsored 'social aspect organisations'.

Balancing risk and safety in long-term care settings can be challenging while providing and respecting patients’/residents’ needs and rights in terms of sexual expression. We look at factors affecting the expression of sexuality, including staff attitudes and reactions, and the lack of policies governing sexuality. We review the various statute and case law, other legislative and quasi-legal provisions governing sexuality and sexual expression. Finally, we consider the need for clear policies and training for both staff and family members.

Clinicians should be aware of the inherent jurisdiction of the High Court in providing a ‘safety net’ to protect ‘vulnerable’ adults who are not within the scope of the Mental Capacity Act 2005 (MCA) or the Mental Health Act (MHA) 1983. Many situations in which the inherent jurisdiction has been deployed have been to safeguard vulnerable adults where there is abuse, coercion or undue influence, but the person does not lack decision-making capacity under the MCA. We explain the nature of the inherent jurisdiction, including descriptions of concepts surrounding ‘vulnerability’; as an intervention of last resort, we consider what statutory alternatives may exist, including safeguarding law under the Care Act 2014; we discuss decision-making capacity in relation to contact with others and, using real cases, the types of order that may be made under the court's inherent jurisdiction. It is important to be mindful that although there may be a legal remedy to safeguard this ‘vulnerable but capacitous’ group, there is a delicate and challenging balance between protecting those at risk and respecting their autonomy.

Religious laws do not usually forbid the use of psychotropic medication, but many do forbid the consumption of animal-based derivatives of bovine and/or porcine origin (e.g. gelatin and stearic acid) such as are found in many medications. Demonstrating awareness of this, combined with a genuine concern about how it affects the patient, may strengthen the doctor—patient relationship and avoid non-adherence. In this article, we outline dietary requirements of key religions and belief systems that may have a bearing when prescribing medication containing animal-based ingredients. We identify common psychotropics that contain animal-based derivatives and suggest alternative prescribing options and approaches to dealing with sensitive ethical issues.

Although psychiatrists in England and Wales are generally familiar with the Mental Health Act 1983 and the Mental Capacity Act 2005, there is a body of law that is available to assist patients in the community with which they are generally less familiar. There are two main reasons for this. The first is that it is a rather confused amalgam of different statutes and case law affecting each other in ways that are less than clear. The other is that the care programme approach (CPA) was meant to cut through all this and make care provision straightforward. In fact, the latter has never been the case and community care law has always sat uneasily alongside the CPA, but in October 2008 the CPA was withdrawn from some patients with mental health problems. This article explains what is meant by community care law and how psychiatrists can use it to help their patients.

The motor vehicle on the road has a history of only just over 100 years. It is a major form of personal and public transport, but is also associated with hazards and risks. Many more people are killed on the roads each year in Britain than are the victims of homicide. General and forensic pyschiatric evaluation of offenders charged with or convicted of motoring offences is, however, infrequent, despite the presence of mental health problems in some of them. I describe psychiatric, criminological and legal factors associated with driving of motor vehicles, as many psychiatric patients have driving licences and have access to a vehicle or, indeed, may decide to drive unlicensed.