All Party Parliamentary Group for Mental Health

Notes of meeting: June 2002

Tuesday 18 June 2002

Speaker: Michael Christie

Chair North London & East Region Mental Health Review Tribunal

Members present: Dr Lynne Jones MP, Virginia Bottomley MP, Sandra Gidley MP, Rudi Vis MP, Liz Blackman MP

In attendance: Martin Aaron (JAMI), Hannah Davenport (Lord Chancellor’s Department), Philip Dixon-Phillips (UK Federation of Smaller Mental Health Charities), Dr Roger Freeman (Royal College of Psychiatrists), Philip Hales (Lord Chancellor Department), Peter Kinderman (British Psychological Society), Anna Olek (Mental Health Foundation), Joan Penrose (Mind), John Ricketts (Lilly) and Christopher Walden (Royal College of Psychiatrists).

Mr Christie explained the role of the Mental Health Review Tribunals (MHRTs). They review the detention of a person in hospital (occasionally outside) and had to weigh up a person’s liberty with public safety. The hearings always take place at hospitals or psychiatric units. The MHRT panels are made up of a legal member, a medical member and a lay member.

The Lord Chancellor appointed all members of the MHRTs and the Regional Chairmen and was responsible for ensuring they act in a judicial manner. The Department of Health (DoH) was responsible for operational matters and ensuring that the MHRTs delivered an adequate service for mental health service users. The DoH was also responsible for forming the documentation for MHRT decisions and supervising budgets for training purposes. There had been a recent development whereby MHRTs were expected to be brought under an overall Tribunals Board as recommended by Sir Andrew Leggat’s report

In 2000 there was a total caseload of 20,000 cases however the actual number of cases heard was 11,000. This was compared to a caseload of 5,000 in 1986. The rise was probably due to patients becoming more aware of their rights. Mr Christie had estimated that 40 new psychiatrists would be needed in his area in order to end the delays in MHRTs hearings.

It was suggested that there maybe a case for the MHRT to have the power to impose sanctions in order to encourage speedier presentation of reports for hearings. There was also a significant problem with a lack of clerks to service the Tribunal hearings. The most serious problem affecting the MHRTs was the lack of consultant psychiatrists nationally.

The Government’s proposals for reform of the Mental Health Act 1983 included reform of the MHRTs. This would demand new training for clinicians, social workers and the other Tribunal members. The new MHRTs would examine packages of care and was expected to be a more demanding role for the Tribunals and their members.

Mr Christie emphasised that the MHRTs were the most important of the Tribunals because they had real effects on human rights and civil liberties and so any reform should be considered seriously.

Questions and discussion

In response to concerns from Dr Lynne Jones and Virginia Bottomley Mr Christie said that the current delays in MHRT hearings were severe but he did not have exact figures. It was agreed that the DoH should hold such figures and they could probably be obtained through a PQ.

The proposed new mental health act would create more work for the Tribunals as every Order for detention under an equivalent Section to the current Section 2 of the 1983 Act would require a Tribunal sitting.

Concerns were raised about how many of the lay members of the Tribunal had been users of the mental health system. Philip Dixon Philips said that the users could often get off their Section quicker by waiting for it to end normally rather than waiting for a Tribunal hearing.

Dr Freeman said that the major problem with the Tribunal system was that it covered two very different scenarios – people with the more common mental health problems such as schizophrenia and depression and also for those who have committed very serious offences. The MHRT procedures had not been adapted for each of these two scenarios.

Dr Jones said that the Government’s proposals for the care plan for each patient to be referred to a MHRT would create a considerable increase in workload. Dr Kinderman felt that this could, if it worked effectively, improve the situation because the information on the patient would be kept together and it would make consequent decisions about a patient’s care better informed.

Mr Christie raised the issue of the Data Protection Act whereby patients ask for access to their medical records. If and when a patient requested access this could often delay proceedings if it the request was contested. The medical member of the MHRT could make it possible for the patient/patient’s representative to have access to their medical records if he felt it was in their best interests. RMO’s reports are made available to patients unless specific reasons are stated why they should not have access. Dr Freeman said cases where access was restricted usually involved the safety of others.

Dr Jones asked if the Government had made any statement since the High Court ruling in April. Mr Christie said that there had not been a Government statement and this may have been because the announcement of the level of damages was expected soon.

It was agreed that a letter should be sent to the relevant Ministers in the Department of Health and the Lord Chancellor’s Department from the joint chairs of the All-Party Group raising the issues from the meeting. These would include:

·         What action was the Government taking in direct response to the recent High Court judgements on delays in the MHRT hearings

·         The effect of the Government’s proposals for automatic referrals to tribunals under a new mental health act

·         The need for clarification on whether the tribunal would become the detaining body and the appeal body under the proposals for reform

·         If there were any plans to ensure that MHRTs had to take into consideration any advance directive made by the patient

·         The lack of clerks for the current Tribunals often meant that retired NHS staff or students were providing the administrative support even though the DoH are supposed to produce clerks – what action was being taken in this regard?

·         Had there been any survey of user perceptions of the work of the MHRTs?

·         Whether they have considered a procedure for access to patients’ records and whether it is reasonable to withhold patient information.

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