Scottish mental health legislation includes a unique criterion for the use of compulsion in the delivery of mental health care and treatment. Under the Mental Health (Care and Treatment) (Scotland) Act, 2003, patients must exhibit ‘significantly impaired decision-making ability’ (SIDMA) in order to be eligible for psychiatric detention or involuntary psychiatric treatment outside the forensic context. The SIDMA requirement represents a distinctive strategy in ongoing international efforts to rethink the conditions under which psychiatric compulsion is permissible. We reconstruct the history of the Scottish SIDMA requirement, analyse its differences from so-called ‘fusion law,’ and then examine how the SIDMA standard actually functions in practice. We analyse 100 reports that accompany applications for Compulsory Treatment Orders (CTOs). Based on this analysis, we provide a profile of the patient population that is found to exhibit SIDMA, identify the grounds upon which SIDMA is attributed to individual patients, and offer an assessment of the quality of the documentation of SIDMA. We demonstrate that there are systemic areas of poor practice in the reporting of SIDMA, with only 12% of CTOs satisfying the minimum standard of formal completeness endorsed by the Mental Welfare Commission. We consider what lessons might be drawn both for the ongoing review of mental health legislation in Scotland, and for law reform initiatives in other jurisdictions.

苏格兰精神卫生立法包括在提供精神卫生保健和治疗中使用强迫的独特标准。根据 2003 年《心理健康（护理和治疗）（苏格兰）法案》，患者必须表现出“决策能力严重受损”（SIDMA），才有资格接受精神病拘留或法医以外的非自愿精神病治疗。 SIDMA 要求代表了国际社会不断努力重新思考允许精神强迫行为的条件的独特策略。我们重建苏格兰 SIDMA 要求的历史，分析其与所谓的“融合法”的差异，然后研究 SIDMA 标准在实践中的实际运作方式。我们分析了强制治疗令 (CTO) 申请随附的 100 份报告。基于此分析，我们提供了被发现表现出 SIDMA 的患者群体的概况，确定了 SIDMA 归因于个体患者的理由，并对 SIDMA 文档的质量进行了评估。我们证明，SIDMA 报告中存在系统性的不良做法，只有 12% 的 CTO 满足精神福利委员会认可的正式完整性的最低标准。我们考虑可以为苏格兰正在进行的精神卫生立法审查以及其他司法管辖区的法律改革举措吸取哪些经验教训。