The Routledge Handbook of Mental Health Law begins with a chapter on the history of mental illness describing the emergence of psychiatry as a medical speciality and the establishment of psychiatric hospitals and asylums for the mentally ill. This is followed by a chronological account of the evolution of mental health law from the 13^th century to present day and the use of this legislation to allow for admission and treatment without consent. This historical backdrop is essential in mapping the trajectory of psychiatric services and mental health law to date. It grounds us in the present medicolegal setting so that the reader may critically appraise subsequent chapters which are wide ranging and challenging in their content.

The authors note that this book is particularly relevant in the context of the United Nations Convention on the Rights of Persons with Disabilities 2006 (CRPD) which is now shaping the landscape of mental health law. This book is co-edited by a Professor of Psychiatry and a Professor of Law with expert authors from across the globe. As such the book is not only aimed at those with a mental health background but also students of law, human rights, disability studies, campaigners and law- and policymakers.

Part 2 of the book focusses on European and international standards for deprivation of liberty, the role of the CRPD in modifying accepted approaches to mental health law and the responses of individual jurisdictions to the WHO Quality Rights toolkit. Developments in specific jurisdictions are further explored in Part 6. The section on personality disorders pertains to UK mental health law and therefore is not directly relevant to Irish law. However, the discussion regarding changes in the conceptualisation and treatment of personality disorders and the incongruences between mental health law and criminal law is interesting and arguably a defence of current Irish mental health law. Lastly in Part 3 the role of legal frameworks in preventing abuse and neglect, and the interaction with adult safeguarding is explored.

Part 4 of the book explores the interface between forensic psychiatry and criminal law. This section of the book begins by examining inadequacies and shortcomings of the insanity legislation in England and Wales. It was interesting to read about the changes in the insanity legislation in Norway, highlighting the different approach taken by the Norwegian jurisdiction to the McNaughten rules that we are familiar with in this part of Europe. The author also summarises how Norwegian lawmakers moved the insanity defence from a medical model to a legal model in its new legislation, that was introduced in 2020. Towards the end of the first chapter of Part 4, the author comprehensively presents the uncertainties and complexities that exist within the field of forensic psychiatry. The author empathetically echoes the dilemmas faced by psychiatrists who deal with medicolegal matters, including insanity, fitness to stand trial and legal responsibility. The author highlights the difficulties faced by forensic psychiatrists in marrying the subjective aspects of psychiatry with the more concrete criminal law, leaving psychiatric experts vulnerably exposed in courts.

In the chapter that looks at mental capacity in forensic psychiatry, the authors helpfully summarise the key themes of civil mental health legislation across Europe and touch on the issue of capacity to consent to treatment and research. These matters apply to all fields of psychiatry and certainly are not restricted to forensic psychiatry. The authors then continue to explore the issues of mental capacity and fitness to stand trial as well as criminal responsibility, both of which are relevant to forensic psychiatrists. The authors also summarise a list of instruments that could be used to assess criminal responsibility.

Part 5 specifically addresses some of the conundrums that arise in trying to align mental health law with the CRPD framework. The authors assert that capacity law needs to be compatible with mental health law. They suggest that risk assessments of harm to self or others are limited in their utility, and this still forms part of the criteria for detention under mental health legislation while compulsory community treatment remains controversial and without strong evidence in its favour. Professor Mary Donnelly suggests that mental health law needs to factor in relationality as family can greatly influence the course of mental illness. The right to liberty must remain in a balance with the right to mental health care. Professor Mark Bell argues that changes to other forms of legislation such as employment law are needed to promote inclusion for people with mental health problems and the focus should not rest solely on mental health legislation. In fact, the authors argue that the whole area of socio-economic inclusion requires deeper reflection due to its multi-factorial nature. Part 5 includes a very specific but particularly interesting discussion regarding the intersection between the law, psychiatric genomics and consenting for prevention among those with disabilities. While psychiatric genomics research is low risk, the book describes how patients are engaging in research that may deny fundamental aspects of their identity.

Having started with an account of the history of psychiatry, this book concludes with a section on ‘Future directions’. These future directions begin with a more comfortable discussion regarding interdisciplinary collaboration within the mental health sector as well as coordinated service delivery with outside agencies; moving on to digitisation of mental health legislation; the potential for global mental health law in the context of the ‘Westphalian duo’; and lastly exploring the possibility of the abolition of mental health law. The final chapter is written by Tania Gergel, an individual with lived experience and Senior Research fellow with the Mental health and Justice research project who evaluates the CRPD as a ‘catalyst for change’ and explores ways to enhance autonomy through legislative change.

International human rights approaches, namely the CRPD, are actively changing the mental health laws that we use in our daily practice. These changes are unavoidable and while there are challenges, there are also opportunities. As a speciality marred in controversy and in which we do regularly deprive people of their liberty, we need to continuously question and modify our practice. This book is comprehensive and unafraid to broach controversial topics. It is certainly a must-have on a psychiatrist bookshelf.