The Scottish Mental Health Tribunal’s progress three years on

The Scottish Mental Health Tribunal system allows carers and patients to determine treatment. But it’s failing to give people time to prepare a case.

It must be a daunting experience for mental health patients to have a court decide your treatment. But this is all in the past for those in Scotland, since the Scottish Mental Health Tribunal was set up in October 2005. Brought in by the Mental Health (Care and Treatment) (Scotland) Act 2003, the tribunal aims to provide an independent and impartial service when making decisions on the compulsory care and treatment of people with mental health problems, as well as allowing patients and their carers to be involved in determining care for the first time.

Before the tribunal’s existence, a sheriff’s court would decide on a patient’s on-going treatment after they were sectioned. Now decisions are made by the tribunal panel, consisting of a legal member (solicitor or advocate), a medical member (psychiatrist) and a general member (which include service users, carers, and social workers with mental health experience).

Tribunals are held at hospital and community-based venues across Scotland to help patients felt more comfortable and cut down their travelling time. In its first three years the Scottish Mental Health Tribunal received 8,700 applications – 4,500 of which were for compulsory treatment orders (CTOs) – and heard 11,100 cases.

Graeme Henderson, director of services and development at Scottish mental health charity Penumbra and a panel member for the tribunal, says: “The tribunals try to be less formal so people don’t feel frightened by the process. Patients are generally treated with respect and dignity. Before, the sheriff would be sitting up at the bench with a few lawyers and the patient would be excluded from the proceedings.”

He believes better decisions are being made because patients and their families are involved and cases are looked at in more depth. The Scottish government commissioned two reports to examine how well the system is performing. The first, focusing on efficiency and quality, was published earlier this month, while the second, looking at the whole act, is due out shortly.

While it is generally acknowledged that the patient experience is better, there is a feeling that the tribunal still needs some improvement.

For example, the report found the numbers of hearings ending in CTOs went from 55% in the fourth quarter of 2005 to 42% in the same quarter of 2007. But the hearings which lead to an interim CTO – so just a temporary measure – went from 30% in the fourth quarter of 2005 to 41% in the same quarter 2007.

Arrangements for a CTO must be made within 28 days of a person being detained and the hearing must take place no later than five days after that. This means the parties are not always prepared to give full information at the first hearing. In over half of cases more than one hearing was needed to make a full decision on each application, the report found.

Donald Lyons, director of the Mental Welfare Commission, says: “There are too many interim hearings for each individual case which is more time consuming for professionals and distressing for service users.

“If social workers or medical professionals get dragged into long hearings they lose time for other patients.”

Charlie McMillan, director of research, influence and change for the Scottish Association for Mental Health, says: “The tribunal has got off to a strong start but it needs to tighten up its processes. This means making sure the individual has the information they need explaining what the process is going to be like. It’s also about making sure they feel an active part of the proceedings.”

According to the tribunal’s president Joe Morrow, the system is now being “refined”.

“Initially this was a big developmental job and now it’s about trying to make the system more effective and efficient.”

For example, steps have already been made to reduce the number of hearings, including giving tribunal chairs extra training, he adds.

Morrow wants to make further improvements in administration and introduce an extensive training programme. “It was a new way of working and everyone was a bit unsure how it worked. Now there’s a bit of confidence building up and solicitors and social workers are also confident about how to deal with it.”

He is determined to maintain an independent tribunal which keeps patients’ treatment and care as its focus. “We have a Scottish solution that could be used internationally,” he says. “We have a world class system and need to make sure we build on that.”

• Read the report, An Exploration of the Early Operation of the Mental Health Tribunal for Scotland
  
• Click to find out about the tribunal system in England and Wales

This article is published in the 26 March 2009 edition of Community Care magazine under the headline Hearings with confidence