A patient has committed suicide. You are his/her doctor. You're faced with the emotional impact this has on yourself, your colleagues, the patient's family and your other patients. You must report the suicide to your hospital authority and to the coroner (or procurator fiscal in Scotland). If you're very unlucky, you may be the focus of media attention. You have the prospect of a coroner's (or fatal accident) inquiry, a hospital inquiry and perhaps copycat suicides or para-suicides among your other patients. What are your obligations, where do you turn for help and can anything positive come from the experience?

While attending a rancorous and ill-tempered meeting of the Hackney Community Health Council in 1985 it was brought home to me that psychiatry was different from other branches of medicine. Not in the sense that it was the only one that dealt with intangibles, we all know that X-rays, scans and the like are far less precise than their purveyors let on. But it seemed that the mental health professionals and the groups that represented the clients, relatives and users of the service couldn't agree on a single thing, not even whether people were ill in the first place. It was difficult to imagine, say, the British Diabetic Association and a group of Endocrine Clinic staff knocking verbal lumps out of each other in this way even though diabetes and schizophrenia have a good deal in common.

There has been considerable debate in the UK in recent years about the propriety of using various forms of ‘involuntary out-patient treatment’ for some individuals with serious mental illness (Eastman, 1995; Dyre, 1998; Burns, 1999; Moncrieff & Smyth, 1999; Sugarman, 1999). While most jurisdictions in the US have statutes that support involuntary out-patient treatment (Torrey & Kaplan, 1995), its use remains controversial (Slobogin, 1994; Diamond, 1995; Torrey, 1997). Involuntary outpatient treatment was originally proposed as a solution to the ‘revolving door syndrome’ (Geller, 1996). It has also been recognised, however, that it may provide a solution to the clinical and ethical dilemmas of allowing individuals who are incapable of making treatment decisions to discontinue treatment, with predictable deterioration to the point where they may harm themselves or others (Geller, 1990). This paper provides a review of controlled studies that have examined whether involuntary treatment in the community is effective.