Medical representation at mental health review tribunal

Sir: Attendance at the mental health review tribunals (MHRTs) is the responsibility of the responsible medical officer (RMO) or the community RMO. In unforeseen circumstances where the RMO cannot attend, the tribunal expects him or her to arrange for the attendance of a medical colleague who is concerned with the patient's treatment, or sufficiently acquainted with the case to be able to report knowledgeably about the patient.

On occasions, unfortunately it is a new registrar on his first rotation in psychiatry who attends the tribunal in place of the RMO. Nervous, struggling with the use of English, the junior doctor makes it known to the tribunal that he or she has never been in this situation before. He or she may have interviewed the patient only a few times. He or she did not admit the patient and cannot explain why a patient with a history of four previous psychiatric admissions was admitted this time on Section 2. A more knowledgeable social worker helps him or her out with questions about the Mental Health Act. I wonder how many RMOs would have wished that on themselves at that stage of their psychiatric formation. The principle of ‘do unto others as you would like to be done unto’ seems to have been forgotten.

On other occasions it is a staff grade doctor who comes to represent his or her consultant in a Section 2 hearing. He or she has been called upon at such short notice that he or she attends with no written report. He or she reads the out-patient report or last letter to the general practitioner until the Chairman calls him or her to address the main issue: “Has your patient a mental disorder, the nature and degree of which warrants his or her detention in hospital for his or her own health and safety and for the safety of others?”

The above situations expose the College training to some criticisms by some of the tribunal members. This is an additional reason why the College should do something about it. In my view, the following measures ought to be taken to avoid such embarrassing situations:

1. (a) No junior doctor on his or her first rotation in psychiatry should be allowed to represent the RMO in a MHRT. Indeed only those with Part 1 of the Membership or a degree in psychiatry should be trained to do so.

2. (b) Consultants should take their junior doctors as observers to the MHRTs in order to expose them to the realities of the tribunal.

3. (c) Senior house officer/registrars prepare 54% of the reports (Ismail et al, 1998), but these should be discussed and modified by the RMO before the report is sent to the tribunal office.

4. (d) There should always be a written medical report in Section 2 cases, no matter how brief the report. This is irrespective of who attends the tribunal, the RMO or his/her deputy.

Unless we keep our house in order these few cases will mar the excellent work done by a majority of RMOs. Junior doctors should be protected; the College owes it to them.