Book review: Mental Health Homicide and Society: Understanding Health Care Governance (David P Horton, Hart Publishing, 2019, hardback and ebook, c£70)
This book, based, it would appear, upon the PhD thesis of the author, seeks to draw upon the systems theory of Niklas Luhmann to develop a frame through which to analyse the mandatory investigations that follow a homicide by a person with a mental disorder under the care of health service professionals in England. In very crude summary, Luhmann’s theory insists that society is differentiated into functional spheres of closed autonomous communication, each functional sphere being impervious to influence, control and domination by other functional spheres.
This book is a challenging one in two senses. It is, firstly, usefully challenging in its critical analysis of mental health homicide investigations. Based on original research, including, significantly, interviews with investigators, the book asks important and difficult questions about the purpose, processes and effectiveness of such investigations. Drawing upon Luhmann’s work, Horton offers interesting insights into why they so often appear neither to satisfy the competing demands upon them nor to lead to change; it also, for a lawyer, frequently makes uncomfortable reading as regards the place and value of law – its resonance in the social systems of medical and psychiatry being described at one point as “one of sluggish learning, confusion and a frustration of clinical practice,” and its “strained relationship with families [of homicide victims]… being unable to speak directly to many of the needs, concerns and ambitions of families.”
It is, however, also challenging in a less fruitful way. Horton rather ruefully acknowledges in his conclusion that it is difficult for abstract social theories to ‘speak to’ policy makers, should that be the goal of those working upon and within those theories. This book, itself, illustrates why this might be so. In his monograph Horton focuses upon a number of spheres (including law, medicine and politics) in his interrogation of inquiries. This reader at least had an increasing feeling whilst making his way through the book that the academic sphere is equally one of closed autonomous communication. In other words, communication modes recognised as valid within that sphere are just as distinct, and just as impenetrable, as are the modes required by law and medicine. This rather prosaic reader found himself wishing at times that Horton could have broken free of the shackles of the language required in academia so as to be able to relay directly his insights in language policy-makers might respond to – even if this might be something which Luhmann’s own theory would suggest is impossible.
Nonetheless, this dense and closely argued book rewards the close reading that it requires, and the author is to be congratulated on bringing such detailed and sustained attention to this complex area.
[Full disclosure: I am grateful to the publishers for providing me with a review copy of this book. I am always happy to review works in or related to the field of mental capacity, health and mental law (broadly defined)]