History of Psychosurgery in The United Kingdom - Legislation

Legislation

By the early 1980s the number of psychosurgical operations carried out annually in the United Kingdom had fallen to fewer than 70. Most of them were stereotactic subcaudate tractotomies performed at the Geoffrey Knight psychosurgical unit at the Brook Hospital, London. The Mental Health Act 1983 (which covers England and Wales) classified psychosurgery as a treatment that could only be carried out with a patient’s consent. Under section 57 of the Act, which applies to both detained and informal patients, a panel of three people appointed by the Mental Health Act Commission has to establish that the patient is consenting. Then the psychiatrist on the panel authorises the operation if it is likely to alleviate or prevent deterioration in the patient’s condition. In Scotland, under section 234 of the Mental Health (Care and Treatment) (Scotland) Act 2003, psychosurgery can only be carried out on consenting patients if a panel from the Mental Welfare Commission confirms that the patient’s consent is valid and that the operation is in their best interests. It may also be carried out on incapable patients, as long as they are not objecting, with Court of Session approval. Since the law came into force, no non-consenting patients have undergone psychosurgery.

Since the introduction of the Mental Health Act 1983 no more than 28 psychosurgical operations have been carried out in the United Kingdom in any year. No operations were performed in England between 1999 and 2009; Frenchay Hospital, Bristol, performed one anterior cingulotomy in 2010. A few stereotactic anterior capsulotomies are performed every year at the University of Wales Hospital, Cardiff. Stereotactic anterior cingulotomies are performed at the Dundee Royal Infirmary in collaboration with the psychiatric unit at Ninewells Hospital in Dundee, Scotland. The Cardiff and Dundee units introduced psychosurgery programmes in the early 1990s and have used psychosurgery in the treatment of depression, obsessive-compulsive disorder and anxiety.

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