When Mind’s chief executive Sarah Hughes said the mental-health charity sector had sometimes “softened the truth” about the relationship between serious mental illness and violence, the interesting question was what happens next. A letter to the Guardian from Prof John F Morgan — a consultant psychiatrist in Harrogate, former chair of the Royal College of Psychiatrists group concerned with risk, and a witness to the Nottingham inquiry — is a first answer, and it is more specific than the original admission.
Morgan’s contribution is to name the institutional history behind the silence. Mind grew out of the National Association for Mental Health, where psychiatrists and other professionals played an important part; from the 1970s it increasingly defined itself as an independent campaigning organisation and, at times, “a vigorous critic of psychiatric practice and authority.” The reluctance to talk about risk, in other words, was not only a general fear of stigma. It arrived with a decades-long stance toward the profession.
Two propositions, held at once
The clinical framing he offers is deliberately plain. Psychiatrists have long had to hold two claims together: the overwhelming majority of people with mental illness are not violent and should not be stigmatised as though they were; and some severe mental disorders — “particularly when accompanied by factors such as substance misuse, disengagement from treatment or a previous history of violence” — can materially raise risk. “Acknowledging the second proposition does not contradict the first.”
He is explicit that he has seen what the failure to say this plainly costs. Avoiding the subject for fear of stigma, he writes, “can itself have consequences for patients, families and the wider public.” The protections he names are unglamorous and mostly budgetary: properly resourced services, continuity of care, assertive follow-up, thoughtful risk assessment — measures he describes as protecting patients as well as others.
The timing is not incidental. The admission that prompted the letter came as the public inquiry into the Nottingham attacks closed, and Hughes made it while naming the fear that keeps charities quiet: that candour about risk gets read as an invitation to coercion, pushing policy back toward a more restrictive system. That fear is not irrational, and the letter does not dissolve it — it argues instead that the trade-off has been drawn in the wrong place.
Morgan’s ask is that this not become another round of psychiatry versus its critics. He wants clinicians, patients and campaigning organisations to “recover a more mature position: opposing stigma while being equally willing to speak honestly about risk.” Whether that position holds up in the areas where it is actually contested — detention thresholds, community treatment orders, how much follow-up a depleted service can promise — is the part the letter leaves open.