Letters Crisis in mental health

Are mental health tribunals only a nominal challenge?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1836 (Published 11 April 2017) Cite this as: BMJ 2017;357:j1836
  1. Paul Gosney, ST5 GA psychiatry1,
  2. Paul Lomax, ST6 GA/OA psychiatry1,
  3. Aileen O’Brien, reader in psychiatry and education2
  1. 1South West London and St George’s Mental Health NHS Trust, London SW17 7DJ, UK
  2. 2St George’s University of London, London SW17 0RE
  1. paul.gosney{at}gmail.com

We read with interest Wise’s article regarding the rise in detentions under the Mental Health Act (MHA), outlining the obvious human rights concerns.1

What happens to people detained under the MHA once they enter hospital is rarely discussed. Their legal rights are protected by the Mental Health Review Tribunal system.

We examined the outcomes of patients who had been detained under section 2 at one London mental health trust. Assessing six months of data in 2016 we found that, of 399 patients detained under section 2 of the act, 96 (24%) appealed. Only four patients were discharged by the tribunal—1.0% of the total number detained and 4.1% of those who appealed. This reflects the 2015-16 national data, where 4.3% of appeals resulted in absolute discharge and 2.1% in delayed discharge.2

The real power of the appeal may be to persuade the consultant to discharge the patient before the tribunal. The outcome for 201 patients (50.3%) was discharge from the section 2 by their consultant. We found that, although appealing made discharge by the consultant no more likely, the time spent detained was considerably reduced: 14.2 (SD 6.1) days, compared with 18.4 (SD 8.3) days (P<0.001).

The fact that so few patients are successful in section 2 appeals could be interpreted as evidence of the appropriate use of MHA powers at initial detention. A more sceptical view is that the tribunal system, with the weight it gives to professional opinion, makes it difficult for patients and their representatives to make a persuasive case.

The tribunal system is expensive.3 If it is merely a nominal challenge to professional authority, can the current system be justified?



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