• anorexia nervosa;
  • definitions;
  • mental health law;
  • mental illness;
  • review tribunals

Objective:  To explore the tension between the definition of mental illness in clinical psychiatry and its embodiment in legislation applied by tribunals reviewing decisions to treat.

Method:  Severe anorexia nervosa is used as a case exemplar of the tension between the appropriate narrative to express the clinical imperative to treat and the law's focus on finer technical language which secures individual civil rights and liberties. Australian and international experience is reviewed.

Results:  The paper finds that the clinical and the legal narratives about how to ‘define’ mental illness do differ at the formal level of expression where they necessarily intersect in the setting of tribunal review of involuntary treatment decisions. However, in practice mental health admissions and tribunal reviews generally endorse the clinical applications of that more capacious and fluid terminology of clinical psychiatry.

Conclusions:  While tribunal reviews of clinical decisions may occasionally require clinicians to participate in an unfamiliar legal dialogue about narrowly construed definitions of mental illness, tribunals apply more complex tests which are sensitive to clinical practice and good therapeutic objectives.