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Final orders at the last chance saloon?
  1. Harvey Wickham
  1. South London and Maudsley NHS Foundation Trust, London, UK
  1. Correspondence to harvey.wickham{at}

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In 2017, the prime minister announced the first independent review of the Mental Health Act 1983 since its reform in 2007. Last December, shrouded by Brexit, the report was published—Modernising the Mental Health Act, 2018.1

The origins of our mental health legislation, ‘protecting him and of the safety of his neighbours’, stem back to ancient Greece and Rome.2–4 Our story, however, maybe best started two decades ago, in the heady-days of 1998, when the freshly elected New Labour government published ‘Mental Health Policy: safe, sound and supportive’.5 Though patients’ rights were weighed, high-profile homicides had tipped the balance towards public protection, with the killing of Jonathan Zito in 1992 leading to calls for enforceable community treatment.6 Though the argued draconian nature of the draft Bill forced many concessions, arguably the highest-profile change, Community Treatment Orders (CTOs), received Royal Assent within the 2007 Act.7 The Department of Health had explained its intention was not to increase compulsion, but rather 10% of …

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  • Competing interests None declared. Disclosure of conflicts of interest form(s) are published online as supplementary files.

  • Provenance and peer review Commissioned; externally peer reviewed.