Mental Health Review Tribunal Research Articles

Risky News, Madness and Public Crisis

This case study investigates the central role of news frames in constructing risk knowledge for newspaper readers. In Brisbane in 2001-02, a psychiatric patient absconded from a city mental health facility and within a month a second patient had absconded from another facility. A mental health tribunal had previously judged each man as medically unfit to stand trial for separate murders they had committed. The media coverage culminated in a complaint to the Australian Press Council, which resolved the concerns by mediation. The study has implications for how Australian and other western news media routinely frame people diagnosed with mental illness.

The Power of Mental Health Professionals to Detain a Patient Recently Discharged by a Mental Health Review Tribunal

The Power of Mental Health Professionals to Detain a Patient Recently Discharged by a Mental Health Review Tribunal

Duty of Health and Social Services Authorities to Provide Community Care to Give Effect to Mental Health Review Tribunal Decisions to Discharge Conditionally

Duty of Health and Social Services Authorities to Provide Community Care to Give Effect to Mental Health Review Tribunal Decisions to Discharge Conditionally

An exploratory study of crime and brain injury: Implications for mental health management

There is emerging evidence to link criminal offending and brain injury, but there is still limited research in this area, in particular for people with brain injury and psychiatric disorders. To explore this issue, we reviewed 276 individuals presented to the New South Wales Mental Health Review Tribunal (MHRT), an independent agency that reviews people who are deemed not guilty of offending by reason of mental illness. Nine individuals (3.3%) were identified with brain injury and psychiatric disorders, the majority as a result of non-traumatic brain injury related to alcohol and substance abuse. All of them were male. They were diagnosed with serious psychiatric disorders such as paranoid psychosis and schizophrenia and had committed serious offences such as murder, intent to murder, sexual assault and physical assault. Most had previous psychiatric, criminal, and alcohol and substance abuse histories. Two case studies suggest a lack of treatment follow-up. The study suggests an urgent need to consider early intervention and how services are offered post-rehabilitation, and the importance of collecting and maintaining data to ensure appropriate mental health management and policy formulation.

A New Tribunal?

Mental health review tribunals (MHRTs) were established under the Mental Health Act (MHA) 1959 (UK) as one of the “main safeguards against improper admission under compulsory powers” and “unduly protracted detention”. In the United Kingdom a draft Mental Health Bill was published in June 2002. It proposed a new legal framework for the compulsory treatment and detention of people defined as mentally disordered. The mental health review tribunal is to be replaced by a new mental health tribunal. Although the aim of the new tribunal — the mental health tribunal — remains the same, there are some fundamental differences in the way in which the tribunal will operate. In this article the author uses the findings from previous research on decision-making in mental health review tribunals to assess the nature of the proposed tribunal reforms.

Judicial Review of the Meaning of "Mental Disorder"

New Zealand has recently experienced its first successful judicial review of a discharge decision made by a mental health review tribunal acting under the civil commitment legislation, the Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ). This article discusses the substantive issues in the litigation and the reviewing posture adopted by the courts. The litigation presents numerous issues central to the work of mental health review tribunals including the meaning of “mental disorder” for civil commitment and discharge purposes; the choice between legal and psychiatric readings of mental health legislation; the conflict between psychiatric ethics and community expectations; the right of the Crown to natural justice in tribunal proceedings; and the degree of deference to be shown by a reviewing court to a specialised tribunal.

Mental Health Review Tribunal Decision-making: A Therapeutic Jurisprudence Lens

This article examines a series of commonly identified indicia for when patients should be involuntarily detained on an inpatient or outpatient basis. It distinguishes between actual criteria and other, de facto and under-recognised indicia for such decision-making at a clinical and review level. It asks whether such reasoning is rigorous, fair and likely to have constructive therapeutic outcomes for patients. Adopting a therapeutic jurisprudence lens, the article addresses the use to be made of clinical files and descriptions of circumstances of patients' apprehension and prior treatment. It unpacks the notion of “insight”, examining its different facets and how it interacts with evidence of risks of non-compliance with medication and monitoring if legal controls over a patient's autonomy are relaxed. It addresses factors commonly taken into account by mental health review tribunals in evaluating patient credibility and capacity to make commitments to ongoing cooperation with pharmacotherapy and other forms of treatment. In doing so, it addresses dynamics at play both between clinicians and patients and within the confines of review hearings, exploring the extent to which indicia of reliability can be distilled and utilised for pro-therapeutic decision-making.

Dilemmas in the Case Manager's Role: Implementing Involuntary Treatment in the Community

Frontline non-medical practitioners in mental health services are frequently working as case managers with involuntary clients in the community who are subject to community treatment orders (CTOs). In this work they often experience tensions between the various legal and organisational expectations of their role, their professional orientation and wider understandings of social justice and consumer rights. This paper reviews literature on the purpose and efficacy of CTOs before discussing the current, limited role of the case manager within the Mental Health Review Board (MHRB) process in Victoria. In the concluding sections, it is argued that a more involved function for the case manager may enhance the decision-making process of mental health review tribunals.

The ACT Mental Health Tribunal: A Different Approach

This article outlines the Australian Capital Territory (ACT) statutory system for assisting people considered mentally ill or mentally dysfunctional. It provides a brief overview of the development of the ACT's Mental Health (Treatment and Care) Act 1994. In particular, emphasis is given to the role, function and powers of the Mental Health Tribunal, including a brief description of the process it follows in determining applications. The article also outlines recent amendments to the ACT's mental health legislation, briefly touching on cross-border issues, and highlighting the difficulties small jurisdictions sometimes face in catering to the needs of persons afflicted with a severe mental illness. The article concludes by providing case examples in the context of the legislative amendments, and an indication of the efforts being made to overcome service gaps for those with mental illnesses within the ACT.

International Human Rights and Mental Health Review Tribunals Obligations

International Human Rights and Mental Health Review Tribunals Obligations

An Optimally Rights Recognising Mental Health Tribunal - What Can Be Learned from Australian Jurisdictions

An Optimally Rights Recognising Mental Health Tribunal - What Can Be Learned from Australian Jurisdictions

The Ritual Environment of the Mental Health Tribunal Hearing: Inquiries and Reflections

The Ritual Environment of the Mental Health Tribunal Hearing: Inquiries and Reflections

The use of mental health review tribunals by older people

This article focuses on the proportion of older people who are detained under the Mental Health Act 1983 who make applications to tribunals in comparison to younger adults. Some implications for social work practice are explored, both under current legislation, and in the context of legislative reform.

A new tribunal?

Mental health review tribunals (MHRTs) were established under the Mental Health Act (MHA) 1959 (UK) as one of the “main safeguards against improper admission under compulsory powers” and “unduly protracted detention”. In the United Kingdom a draft Mental Health Bill was published in June 2002. It proposed a new legal framework for the compulsory treatment and detention of people defined as mentally disordered. The mental health review tribunal is to be replaced by a new mental health tribunal. Although the aim of the new tribunal — the mental health tribunal — remains the same, there are some fundamental differences in the way in which the tribunal will operate. In this article the author uses the findings from previous research on decision-making in mental health review tribunals to assess the nature of the proposed tribunal reforms.

International Human Rights Obligations and Mental Health Review Tribunals

All Australian states and territories, as part of the first Mental Health Plan, agreed to enact legislation which complied with the United Nations Principles. As Victoria considers the possibility of updating its mental health legislation, it is timely to gauge whether the current legislation, the Mental Health Act 1986, complies with the United Nations Principles. In those instances where the current Act falls short of the requirements of the principles, the policy arguments for and against changing the legislation to comply with the principles are considered.

Judicial Review of the Meaning of “Mental Disorder”

New Zealand has recently experienced its first successful judicial review of a discharge decision made by a mental health review tribunal acting under the civil commitment legislation, the Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ). This article discusses the substantive issues in the litigation and the reviewing posture adopted by the courts. The litigation presents numerous issues central to the work of mental health review tribunals including the meaning of “mental disorder” for civil commitment and discharge purposes; the choice between legal and psychiatric readings of mental health legislation; the conflict between psychiatric ethics and community expectations; the right of the Crown to natural justice in tribunal proceedings; and the degree of deference to be shown by a reviewing court to a specialised tribunal.

Mental Health Review Tribunal Decision-making: A Therapeutic Jurisprudence Lens

This article examines a series of commonly identified indicia for when patients should be involuntarily detained on an inpatient or outpatient basis. It distinguishes between actual criteria and other, de facto and under-recognised indicia for such decision-making at a clinical and review level. It asks whether such reasoning is rigorous, fair and likely to have constructive therapeutic outcomes for patients. Adopting a therapeutic jurisprudence lens, the article addresses the use to be made of clinical files and descriptions of circumstances of patients' apprehension and prior treatment. It unpacks the notion of “insight”, examining its different facets and how it interacts with evidence of risks of non-compliance with medication and monitoring if legal controls over a patient's autonomy are relaxed. It addresses factors commonly taken into account by mental health review tribunals in evaluating patient credibility and capacity to make commitments to ongoing cooperation with pharmacotherapy and other forms of treatment. In doing so, it addresses dynamics at play both between clinicians and patients and within the confines of review hearings, exploring the extent to which indicia of reliability can be distilled and utilised for pro-therapeutic decision-making.

Dilemmas in the Case Manager's Role: Implementing Involuntary Treatment in the Community

Frontline non-medical practitioners in mental health services are frequently working as case managers with involuntary clients in the community who are subject to community treatment orders (CTOs). In this work they often experience tensions between the various legal and organisational expectations of their role, their professional orientation and wider understandings of social justice and consumer rights. This paper reviews literature on the purpose and efficacy of CTOs before discussing the current, limited role of the case manager within the Mental Health Review Board (MHRB) process in Victoria. In the concluding sections, it is argued that a more involved function for the case manager may enhance the decision-making process of mental health review tribunals.

The ACT Mental Health Tribunal: A Different Approach

This article outlines the Australian Capital Territory (ACT) statutory system for assisting people considered mentally ill or mentally dysfunctional. It provides a brief overview of the development of the ACT's Mental Health (Treatment and Care) Act 1994. In particular, emphasis is given to the role, function and powers of the Mental Health Tribunal, including a brief description of the process it follows in determining applications. The article also outlines recent amendments to the ACT's mental health legislation, briefly touching on cross-border issues, and highlighting the difficulties small jurisdictions sometimes face in catering to the needs of persons afflicted with a severe mental illness. The article concludes by providing case examples in the context of the legislative amendments, and an indication of the efforts being made to overcome service gaps for those with mental illnesses within the ACT.

Powering — and Empowering — Through Change: The Queensland Tribunal's Experience of Transition from Old Systems to New

The Queensland Mental Health Review Tribunal which came into operation on 28 February 2002 has a critical role in giving effect to the underlying thrust of the Mental Health Act 2000 (Qld), which has a focus on access to justice. This role has involved recognition of all stakeholders, inclusiveness in tribunal processes, ensuring that tribunal procedures are informal, meaningful participation by patients in tribunal hearings, and appropriate access to material by parties. Meeting the demands of the role, and maintaining a consistency of service, presents challenges for the tribunal. Some of these derive from the need to change some well-established localised cultures. Others derive from the need to develop a strong unified organisational culture with respect for a set of shared values. The tribunal's special role in relation to forensic matters adds an interesting element to its activities. The Act requires the application of newly formulated tests in determining some of the forensic issues. The impact of the new provisions in that regard is still evolving. Equally, the effectiveness of interaction of the Queensland legislation with that of other jurisdictions is also being put to the test. This paper addresses the way in which some of these challenges are being met at this early stage of the new system, and identifies perhaps more challenges for the future.