Personality Disorder in Mental Health Law and Criminal Law

This chapter considers how mental health law and criminal law deal with people with personality disorder, with a focus on England and Wales. It explores the evolving psychiatric understandings of personality disorder and the persistent stigma that surrounds the diagnosis despite recent efforts to reduce it. It then evaluates the concept of ‘treatability’ in the former Mental Health Act 1983 and its replacement, ‘appropriate medical treatment’, and considers recent reform proposals from the 2018 Independet Review of the Mental Health Act 1983 and the 2021 White Paper Reforming the Mental Health Act. Finally, it explores the intersections between mental health law, criminal law and human rights law and issues surrounding capacity and consent to treatment. It concludes that, despite efforts to move towards person-centred and rights-respecting mental health care, legal reforms are hampered by risk aversion within government towards people with mental disorders who offend. In this context, people diagnosed with personality disorders seem to get a ‘raw deal’ (Pickard, 2015, p. 16). They often find themselves excluded both from legal protections from punishment accorded to people with mental disorders under criminal law and from legal protections from coercion accorded to people with no mental disorder under mental health law.