Decision-making in Mental Health Review Tribunals

Summary:

Mental Health Review Tribunals (MHRTs) were established under the Mental Health Act (MHA) 1959 as one of the ‘main safeguards against improper admission under compulsory powers’ and ‘unduly protracted detention’. The statutory provisions were tightened in the 1983 MHA in an attempt to provide a better safeguard for the rights of patients (MHA Commission, 1985).

This study set out to examine how MHRTs make decisions about whether or not to discharge patients detained under sections 2 and 3 of the Mental Health Act (1983). The research identified significant differences in operation between tribunals from the pre-hearing meeting through to the deliberation. Such was the degree of variation that questions must be raised about the extent to which tribunals in general can be said to provide a safeguard against unduly protracted detention in hospital. Four factors were found to constrain the fairness of tribunal decision-making. These were:

tribunal structures and procedures;
the legislation, and in particular the section 72 criteria for discharge;
the actual process of decision-making; and
training.

Since this research was undertaken, a new draft Mental Health Bill has been published. The draft Bill (2002) contains plans for revising the legal framework to take account of changes in mental health services, treatment and patterns of care. The reforms propose a new Mental Health Tribunal with a new remit and composition. While the overarching framework within which tribunals operate will change, the task of the tribunal remains to decide, on the basis of evidence put to it, whether the conditions for continuing care and treatment under compulsory powers are met. Whether the tribunal conducts its business through an oral hearing or through a paper-based exercise, the same challenges as those identified in this study arise in relation to decision-making.