By Paul Gosney, Paul Lomax, Carwyn Hooper, Aileen O’Brien
We felt that there was an acceptance in mental healthcare that appeal tribunals are an inherently good thing, that they are an appropriate counterweight to the power the state gives health professionals to detain and treat people against their will. This praise of tribunals is found from national reviews of the mental health law down to our own daily interaction with patients.
However when reflecting on our actual experience it seemed very few patients had their care directly changed by the tribunal process. On few occasions, it seemed, were the plans made by healthcare professionals rejected by the tribunals.
The aim of the paper was to analyse the potential impact of tribunals on patient care. Are they a vital safeguard to the rights of a patient? Are they an irrelevant window dressing? Or are they potentially damaging to the patient and the wider health system?
Finally we thought about what advice we should be giving to patients about appealing against their detention, if any. Should we be encouraging people to assert their right to an appeal? On the face of it, yes. But what if we know the chances of successful appeal are slim and that it will cause distress and cost valuable resources.
The main problem we faced in considering the issue is; what is an appropriate rate of discharge from a Tribunal? Does a low rate of successful appeal against detention represent a well functioning system that makes few errors, or a system stacked against the patient? We hope that this work feeds in to the ongoing discussions about how the Tribunal system works and how it could be improved.
Authors: Paul Gosney1, Paul Lomax1, Carwyn Hooper2, Aileen O’Brien2
1 South West London and St George’s NHS Mental Health NHS Trust.
2 St George’s University of London.
Competing interests: Carwyn Hooper is the General and Company Secretary of the IME and a member of the IME BMJ Ltd Management Committee for the Journal of Medical Ethics.