Mental health, medical incapacity, and political leadership in the United Kingdom: A multidisciplinary analysis of the intersections between psychiatry and constitutional law.

Smith, Alexander J; Theil, Stefan; Weinberg, Ashley; Bhugra, Dinesh; Liebrenz, Michael

Abstract

Mental ill-health and medical incapacity in governmental leadership could affect democratic accountability, possibly necessitating complex psychiatric, judicial, and political interactions. Notably, as a prominent democratic jurisdiction, governmental structures in the United Kingdom and the role of its Prime Minister are generally underpinned by constitutional conventions, rather than enforceable legal frameworks. Political continuity and stability thereby rely on the actions and integrity of constitutional agents, which could engender dilemmas if medical incapacity due to mental ill-health becomes evident. Accordingly, based on a critical analysis of relevant legal documents, this paper examines this largely overlooked topic in relation to the office of the United Kingdom's Prime Minister. In doing so, it does not speculate on the mental health of any individual (past or present) and instead explores hypothetical circumstances and constitutional precedents, including the potential for voluntary resignation and involuntary removal, to promote wider knowledge synthesis. Interdisciplinary interpretations are offered for such situations, where constitutional decisions would likely require informal exchanges with mental health specialists and invoke challenges in conducting psychiatric assessments in politically-charged contexts. Finally, to pre-emptively respond to conceivable scenarios and address existing ambiguities, the paper concludes with some interprofessional recommendations aligned with the democratic values of the United Kingdom.

• Journal Article Type: Article
• Acceptance Date: May 9, 2025
• Online Publication Date: May 14, 2025
• Publication Date: 2025-07
• Deposit Date: Jun 13, 2025
• Publicly Available Date: Jun 13, 2025
• Journal: International journal of law and psychiatry
• Print ISSN: 0160-2527
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 101
• Article Number: 102109
• DOI: https://doi.org/10.1016/j.ijlp.2025.102109
• Keywords: Goldwater Rule, Prime minister, Political psychology, Functional capacity, Fitness to govern, United Kingdom, Medical incapacity