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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0665

The Rooman paradox: When autonomy can become lifelong detention under the Mental Capacity Act (Northern Ireland) 2016

THE ROOMAN PARADOX: WHERE AUTONOMY COULD BECOME A LIFE SENTENCE UNDER THE MENTAL CAPACITY ACT (NORTHERN IRELAND) 2016

Since approximately 76% of patients in secure forensic psychiatric settings retain the capacity to consent to or refuse treatment, fusion legislation that treats capacity as an absolute threshold may lead to indefinite detention without treatment, thereby undermining its legal basis.

The study aims to assess the applicability of the Mental Capacity Act (Northern Ireland) 2016 (MCA) in forensic psychiatry against the requirements of Article 5(1)(e) of the European Convention on Human Rights (ECHR). The methodology combines qualitative legal-doctrinal analysis, a comparative assessment of the detention and treatment provisions of the MCA (NI) 2016 against Article 5 ECHR standards, and prevalence modelling synthesising rates of decision-making capacity in secure psychiatric settings. The sources examined include the MCA (NI) 2016 (Part 10: Criminal Justice), the Mental Health (Northern Ireland) Order 1986, the European Court of Human Rights Grand Chamber judgment in Rooman v. Belgium (2019), and cross-sectional literature on the prevalence of decision-making capacity in secure forensic hospital populations (e.g. Dornan et al., 2015). The findings indicate that approximately 76% of patients in secure forensic psychiatric settings retain the functional capacity to consent to or refuse psychotropic treatment; a patient with capacity subject to a Public Protection Order (PPO) may lawfully refuse the necessary treatment programme, and without effective treatment to alleviate symptoms or reduce dangerousness, hospitalisation becomes preventive warehousing. Under the Rooman criterion, detention without a therapeutic purpose loses its legal basis, meaning that a provision designed to safeguard autonomy may result in indefinite and unlawful deprivation of liberty. The author argues that the unresolved tension between public safety, the obligation to provide treatment, and an absolute capacity threshold explains why Part 10 has not become operational and why reliance continues on the updated draft Code of Practice for the 1986 Order; without targeted legislative reform, fusion legislation risks remaining a dual-track rather than a unified framework.

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