Complex medical roles in mental health review tribunals

Gibson (2000) makes a thoughtful rejoinder to the suggestion by Richardson & Machin (2000) that the dual nature of the roles exercised by the mental health review tribunal (MHRT) medical member precludes open-mindedness. That this need not be the case was demonstrated some years ago by Langley (1990, 1993) and Brockman (1993). Gibson suggests that the role of the MHRT doctor was introduced in the 1959 Act to facilitate examination of the “hospital notes without ruffling medical feathers”. In reality, the issue of the medical member's role was more complex than this. During the parliamentary debates on the 1959 Act there were very conflicting views expressed as to who was best fitted to make judgements concerning the need for detention, bearing in mind the then current legislation which involved a purely judicial decision. A compromise appears to have been reached by the introduction of the present three-member MHRT panel.

Gibson's remedy, which would involve tribunal members reading the medical notes for half an hour prior to the hearing, has two serious weaknesses. First, in many cases the notes are too voluminous and complicated to make this possible in the time-scale suggested. Second, medical notes sometimes require a certain degree of medical interpretation for the benefit of the two non-medical members of the panel. However, these issues may turn out to be academic in the light of the current Government's proposals for reform of the 1983 Act (Department of Health, 1999) involving a considerably more complicated (and, most likely, more costly) system than we have at present; a system which also comes very close to infringing the European Convention on Human Rights' mandates. It is also very clear that the Government's proposals have not found favour with some members of the Scoping Study Review Team (Peay, 2000). There is an old adage ‘marry in haste, repent at leisure’. Maybe in this case it would be appropriate to substitute for this phrase, ‘legislate in haste’ (on the basis of a pre-determined and heavily constrained remit and time-scale by Government) and we will be most certain to ‘repent at leisure’.