Sunday, 10 April 2011

Detained patients give their views on the mental health tribunal process

A ground-breaking report is published today on the experiences of patients who appealed to a tribunal against their detention under the Mental Health Act.

First-hand information has been obtained from patients of their personal experiences of appearing before the First-tier Tribunal (Mental Health), formerly the Mental Health Review Tribunal.

This type of information has never been gathered before to this extent because of the practical difficulties in gaining access to mental health patients.

The report was commissioned by the Administrative Justice and Tribunals Council (AJTC) and the Care Quality Commission (CQC).

CQC’s Mental Health Act Commissioners carried out more than 150 interviews with patients who volunteered to participate in the study.

In 2009-10 the First-tier Tribunal (Mental Health), which serves England, dealt with just over 25,000 appeals, almost 5,000 more than the previous year. The introduction of community treatment orders in November 2008 accounted for a significant part of this increase.

Key points in the report:

* Patients’ experiences of tribunals were diverse, ranging from positive to strongly negative.
* Those whose appeals were allowed were, not surprisingly, much more positive about the system than those who received a negative outcome.
* Patients are not always well placed to ensure their lawyers are providing a good standard of advice and representation.
* Delays are a substantial factor in many patients’ negative experiences of the tribunal process.
* A large part of the distress caused by delays was due to a lack of information about how long the process would take.
* The way pre-hearing medical examinations are carried out is very variable.
* Patients had positive experiences of some parts of the tribunal hearing, but there were concerns about the provision of information and access to medical reports.
* A significant minority said they were not given enough time to be heard by the tribunal.
* Nearly all said they received a very rapid decision. However, follow-up information was lacking and patients felt poorly informed of any further right to appeal.

The report makes recommendations for improvement aimed at those bodies and individuals involved in the tribunal process, including hospital managers and staff, the Tribunals Service, the tribunal judiciary, mental health clinicians and other health care professionals, the CQC, the Legal Services Commission and the Law Society.

In their joint foreword to the report, the respective chairs of the AJTC and the CQC, Richard Thomas and Jo Williams, express the hope that the recommendations will be considered carefully and acted upon and that the study’s methodology will form a blueprint for future similar studies.

Richard Thomas said: “This is the first time the voice of patients themselves has been heard. Whilst we recognise and welcome the considerable efforts made by the Tribunals Service and the judiciary, particularly in the last 18 months, to introduce a number of measures to secure improvements in the tribunal process, we trust that the findings of this study will enable further improvements to be made.”

Jo Williams said: “People who exercise their right to apply to the tribunal place a great deal of hope in the process as a means of being able to participate in their care and potentially to have their liberty restored. It is important for their well-being that they come out of the tribunal hearing – whether successful or not – feeling that they have been treated fairly and given every opportunity to make their case.”


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