Mental Health Review Tribunal Research Articles

The Home Office Mental Health Unit and its approach to the assessment and management of risk

For a minority of offender patients in England and Wales, the court may, on convicting such a person of an imprisonable offence, set aside prison sentence in favour of a hospital order. The Crown (higher criminal) Court may also, if deemed necessary 'for the protection of the public from serious harm', add a restriction order devolving decisions on leave, transfer or discharge from hospital to the Secretary of State at the Home Office (except in the case of discharge which the Mental Health Review Tribunal may also direct). At any one time the Home Office has responsibility for in excess of 2,000 such patients resident in hospital, and over 1,000 more in the community. The Mental Health Unit of the Home Office advises the Secretary of State in the exercise of his power in this regard. The background and system for doing this are described. Similar systems operate for Scotland through the Scottish Office and Northern Ireland through the Northern Ireland Office.

A pilot study of the utilisation and outcome of community orders: client, carer, case manager and Mental Health Review Tribunal perspective.

Mental health problems are a major public health concern due to their prevalence and impact at a personal, family, social and economic level. Compulsory community treatment is being utilised as a health care approach, despite much disagreement and lack of Australian research demonstrating its effectiveness. This pilot study investigated the utilisation and outcomes of community orders from the perspective of a client, carer, case manager and Mental Health Review Tribunal member. The findings indicate that compulsory community treatment had a positive impact upon hospital readmission rates and medication usage. All groups of respondents rated community orders as being of benefit in a number of areas. Further controlled studies are required.

Psychiatry: a risky business?

Following a series of well-publicised tragedies the Department of Health published guidelines on the discharge and aftercare of psychiatric patients (Department of Health, 1994). These guidelines stipulate that at the time of discharge from in-patient care the treatment team will have carried out a risk assessment, with the expectation that professionals will be criticised if things go wrong. Risk assessment is now a routine, if poorly understood, element of clinical practice. The allied concept of risk management, which lacks a simple definition but is “aimed at reducing the likelihood of harming patients during treatment, minimising trauma to those who are affected, and controlling the possibility of subsequent litigation” (Vincent, 1995), is much less familiar to clinicians. The Editor has commissioned a short series of articles that address the topic of risk in psychiatry, covering suicide, dangerousness, the exposed role of Mental Health Review Tribunals in the case of Restricted patients and a variety of professional risks. The aim is not to be didactic but to raise the level of debate about the risky business that psychiatrists are engaged in.

Supervised discharge and the Mental Health Review Tribunals

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The use of Mental Health Review Tribunals

Three hundred and fifty-six patients admitted under sections of the Mental Health Act (1983) were studied. One hundred and twenty-six (35%) patients appealed against their detentions and 52 of these appeals were heard. Only 18 patients were discharged from their detentions by the Tribunal in the study period. Younger patients were more likely to appeal and no patient whose first language was not English appealed in the study period. The tribunals appear to be a fair system once the opportunity to appeal is taken up.

Medical members of Mental Health Review Tribunals

Medical members of Mental Health Review Tribunals

A one year analysis of appeals made to mental health review tribunals in New Zealand.

The aim of the paper is to present data on the first year of all appeals lodged with a Mental Health Review Tribunal against compulsory treatment orders of psychiatric inpatients. Two tribunals have been in operation in New Zealand since the introduction of a new Mental Health (Compulsory Assessment and Treatment) Act in 1992. The case records of all patients who had appeals heard by either the Northern or Southern regional tribunal from 16/12/92 to 7/12/93 inclusive were examined. 145 appeals were heard by the tribunals: 14.5% of appeal hearings resulted in the discharge of a patient from their compulsory treatment status. Discharge rates for the Southern Tribunal were found to be significantly higher at 22%, compared with 10% for the Northern Tribunal (p < 0.05). Application for appeal was initiated by the patient in 72% of cases; District Inspectors initiated the remaining cases. District Inspectors were found to initiate significantly more female review applications (47%) than male applications (22%) (p < 0.05). Of the appeals heard, 126 were lodged under s.79 of the Mental Health Act. The remaining cases were s.80 (special) cases: in no case was discharge from compulsory treatment recommended. Overall, 69% of appellants were represented by a lawyer. It was found however that engaging legal representation did not significantly increase patients' chances of successful discharge but did delay the hearings. Also considered in the study were the presence or absence of witnesses at hearings and the relationship this had to the outcome of the tribunal hearing. Ambiguities within the Act need to be addressed in order that criteria used to judge a patient's fitness for discharge may be standardised. In addition, the Act stipulates a maximum delay of 14 days in reviewing a patient's case; however in practice a mean of 22 days elapses, indicating that this stipulation requires review.

Mental Health Review Tribunals and the Council on Tribunals

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Transfer Delays in a Special Hospital Population

Forty-four cases referred for transfer/trial leave from a Special Hospital in the latter part of 1989 were followed up and their progress on 1 January 1992 was examined. Thirty-four were accepted but only 19 moved out to psychiatric units offering treatment under conditions of lesser security. Three of the original 44 patients were discharged by Mental Health Tribunals and one has died. Twenty-three have never left maximum security. Factors largely beyond the control of Special Hospital consultants accounted for most of the delay in the transfer procedure. Fifty-eight per cent of the total time taken for transfer was attributable to delays by regional/district services i the assessment, response and admission of cases. Noticeable delays in receiving Home Office recommendations were also encountered in restricted cases. Suggestions for improving current standards are made.

Mental Health Review Tribunals and the Home Office

Mental Health Review Tribunals and the Home Office

Mental health review tribunals. Why the delay?

Abstract An examination of case notes and administrative records of patients appealing against detention under the Mental Health Act 1983 was conducted. Whereas appeals against section 2 were heard promptly, there were long delays between appeal and the tribunal hearing in section 3 appeals and even longer delays in appeals against detention under Part III of the Act (the forensic sections). Despite this, Part III patients were more likely to be discharged by the tribunal. The majority of social work and medical reports were provided within the statutory time limits. The main delay would appear, therefore, to lie within the mental health review tribunal (MHRT) office. It is imperative that the causes of such delays are clarified and action taken to reduce them.

Mentally disordered attackers and killers: Towards a taxonomy

Abstract Only a very small percentage of papers on homicide deal with multiple killers in spite of their intrinsic and theoretical interest for forensic clinicians. It is argued that prediction of future violent behaviour is one of the most important aspects of forensic psychiatry and psychology, particularly for mental health review tribunals (MHRTs) and for administrative officials. This article presents an analysis of interpersonal violence in terms of three broad interrelated concepts: ‘internal’ motivation, self-control and environment. Factors which predispose individuals to interact violently with their environment raise the probability of the occurrence of a particular piece of behaviour so that a range of precipitating factors will produce the behaviour. In other contrasting instances the precipitating or ‘trigger’ factors are pre-eminent in the understanding of the genesis of the behaviour. Attacks are dichotomized as premeditated and unpremeditated, and these two contrasting styles are describe...

The Mental Health Review Tribunal Service: applications for medical membership

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Ex parteA: Psychopathy, treatability and the law

Abstract In its recent decision in R. v Canons Park Mental Health Review Tribunal, ex parte A [1994], the Court of Appeal addressed the meaning of the treatability test and its application in the context of Part V of the Mental Health Act 1983 to patients detained under the legal category of ‘psychopathic disorder’. This article considers the decision and that of the Divisional Court, which it reversed, together with its legal and clinical implications.

Mental Health Review Tribunals: A comparison of the content of tribunal reports for discharged and not discharged patients and for the effect of legal classification

Abstract This study examined the content of reports provided for Mental Health Review Tribunals. A retrospective design was used to compare the tribunal reports of fifty patients. Two groups of twenty five patients were compared, one including patients discharged by tribunals and the other patients not discharged. Social combination theory and valence theory were used to analyse the content of the reports and to assess whether they were associated with tribunal outcome. Opinion statements discussing suitability for discharge were more closely associated with outcome than fact statements. For the statements presenting subjects positively or negatively, fact statements were more closely associated with outcome. The valence of both types of statements was also found to be related to outcome, with more positive values being achieved for discharged subjects. Comparison of reports written for previous tribunals before any of the subjects in the study were discharged indicated that those subjects who went on to ...

The cost of Mental Health Review Tribunals

The cost of Mental Health Review Tribunals

The Mental Health Review Tribunal Service: Applications for medical membership

The Mental Health Review Tribunal Service: Applications for medical membership

The pattern of delays in Mental Health Review Tribunals

Mental Health Review Tribunals (MHRTs) are intended to protect the liberty of the detained patient. In practice, however, they have been said to fall short of providing this safeguard. This is frequently for administrative reasons. We report a systematic examination of the pattern of delays in holding MHRTs. Our main finding is that delay cannot be attributed to a single factor but rather reflects the inherent complexity of some cases.

‘Passing the buck’ – A valid use of Mental Health Review Tribunals?

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The cost of Mental Health Review Tribunals

There has been a substantial increase in the number of Mental Health Review Tribunals (MHRTs) and hence the cost of administering the tribunal system. We report an estimate of the cost of MHRTs taking account, for the first time, of both direct and indirect costs to the various government departments. We estimate that the total cost is currently £12,274,380 per annum.