Community treatment orders

Sir : Trevor Turner et al compare the arguments for community treatment orders (CTOs) with those used to justify car seat-belts (Psychiatric Bulletin, April 2000, 24, 153). The comparison may be apt, but not necessarily as they intend.

John Adams, Professor of Geography and expert on transport, has reviewed social, cultural and practical aspects of ‘risk’ from a wider perspective than is generally found within psychiatry (Adams, 1995). His view of the results of seat belt legislation is unequivocal :

“the law produced no net saving of lives, but redistributed the burden of risk from those who were already the best protected inside vehicles to those who were the most vulnerable outside vehicles.”

This occurs because people wearing seat-belts drive (marginally) more dangerously. Adams suggests :

“if all motor vehicles were to be fitted with long sharp spikes emerging from the centre of their steering wheels (or, if you prefer, high explosives to detonate on impact), the disparities in vulnerability and lethality between cyclists and lorry drivers would be greatly reduced. There would probably be a redistribution of casualties, but also a reduction in total number of casualties.”

Seat-belts reduce driver deaths - but not deaths overall. Although common sense suggests them to be unarguably a good thing, life is more complicated. Are homicide and suicide inquiries equivalent to Adams' spikes or high explosives ? In some ways. Does it help to fit spikes to steering wheels ? Some drivers probably stop driving altogether or at least take early retirement. In terms of risk, will CTOs prove to be like seat-belts ? If so, Turner's or Adams' ?