Doctor's notes

· The government has just delivered its response to the recommendations made by the joint parliamentary committee on the draft mental health bill which was published in September last year. The joint committee received 450 written submissions and oral evidence from 124 witnesses, but it appears that the bill, even having had some concessions made to it, is still causing huge concern.

So why exactly have a vast number of mental health organisations - from service user and service provider charities to the Royal Colleges of Psychiatry and Nursing - all expressed reservations, many of them grave? As Dr Tony Zigmond, vice president of the Royal College of Psychiatrists, says: "It is sad that the government still fails to understand that it is unethical to force treatment on people who are well enough to make their treatment decisions. It is a bad law when it requires doctors and nurses to detain people in hospital, even if the patient cannot be treated."

In a nutshell, this seems to be the most significant and distressing outcome of what the bill will mean. Firstly, competent people should always be able to decide and make their own choices about their health. We accept this when we are dealing with physical health. If I performed surgery on someone without having their consent, it would be rightly termed assault. If someone doesn't want a smear test, I am bound to discuss the pros and cons of this with my patient, to ensure that it is an informed choice, and to accept whatever decision she makes. So why do we not aspire to the same standards in mental health?

With information properly explained and with support, people are able to make reasonable choices, just as it should happen in any other area of healthcare. After all, it is fundamentally important that people are able to make an informed and honest choice about treatments. If you aren't able to do this when you are well or well enough to make your own decisions, how can you have faith in the system to treat you when you are not well enough to make your own choices? A fairer system could be used - in Scotland, the new Mental Health Act allows for compulsory treatment only if the person is so ill that their judgment is seriously impaired.

This bill has the potential to adversely change the relationship between patients and their healthcare team, and no wonder that so many people are concerned by it. Patients need to know that their doctors and nurses are going to act without their consent or against their will only in the most extreme and the rarest of occasions.

· Were ancient wisdom, folklore and your mother right all along? Fish has long been recommended as "brain food". But what's the proof? Stories over the weekend reveal that the interim analysis - results analysed while research is ongoing - of one study is, so far, apparently "very impressive" in improving pre-school children's behaviour and learning skills. It's important to be clear that interim analysis of studies doesn't always reflect how the study is going to turn out. There are many instances where strong initial results level out over the duration of the study, and aren't, in the end, as positive as they first seemed.

This particular study, being run in Durham (details at, may need to be done on a larger scale and analysed together with other work being done in the area before a definite conclusion can be reached. That may seem unduly pessimistic, but it's important to evaluate the evidence carefully if we are going to recommend something widely - even something "natural". It's still important that we should still be as certain as we can reasonably be that fish oils are effective and safe in this age group, and I look forward to seeing the full results when they are available.

One wonders what other old wives' tales could be ripe for investigation. Do carrots really give you good night vision? (Unlikely: a study in the Australian and New Zealand Journal of Ophthalmology found that women who said they ate a lot of carrots also said that their night vision was poor - but rather than carrots being the cause of poor vision, they suggest that "it is probable that people attributing poor driving ability to their vision may be eating more carrots in the hope of reversing this decline".) What else? Will eating crusts of bread give you curly hair? (Unsurprisingly, no studies on that.) But what about milk being good for children's bones? There's an interesting paper in the journal Pediatrics that effectively blows away a few cobwebs: "Scant evidence supports nutrition guidelines focused specifically on increasing milk or other dairy product intake for promoting child and adolescent bone mineralisation." In other words, there isn't a great deal of proof that getting children to drink more milk will make their bones any stronger.

· The writer is a GP in Glasgow

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