Psychiatric Injustice? The Therapeutic Presumption of Behaviour Management in Mental Health Law Kirsty Keywood Senior Lecturer in Law University of Manchester Introduction There are a great many people with mental health problems receiving treatments that are aimed primarily at managing aggressive or challenging behaviours by means of sedation, seclusion or restraint. The management of these behaviours is frequently justified under Part IV of the Mental Health Act 1983, which permits treatments - without consent if necessary - for a person’s mental disorder. Alternatively, the behaviours have been managed at common law on the basis that the patient is incapable of giving a legally effective consent to behaviour management and the interventions are considered to be in the person’s best interests. This article considers the management of difficult behaviours in adults with mental health problems. This issue is particularly timely as there have been a considerable number of legal challenges in this area in recent years. This article reviews the practical contexts in which behaviour management, which here covers sedation, seclusion and restraint, is used with adults with mental health problems and explores the legal justifications for these interventions. Although the justification for the management of challenging behaviours is frequently asserted (or, more likely, presumed) to be therapeutic, a review of the research literature and recent case law casts doubt on the credibility of this therapeutic justification. The legal justifications for intervention Mental Health Act 1983 The Mental Health Act 1983 authorises the treatment of mental disorder for those people with mental health problems who are detained under the Act. In order for such interventions to be lawful, they must by given under the direction of the patient’s responsible medical officer and constitute treatment for the patient’s disorder (section 63). Where the behaviour management is taking place more than three months since treatment was first given under the Act and is administered in the form of medication, additional safeguards (consisting of patient consent or approval by a second opinion appointed doctor) must be complied with (section 58). Although the legislation refers to ‘treatment’ for mental disorder, the courts have adopted a sufficiently broad interpretation of treatment to embrace acts and interventions that are ‘ancillary’ to the primary therapeutic objective (B v Croydon District Health Authority, 1995).