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Patients' awareness of the mental health tribunal and capacity to make requests

  • Nuwan Galappathie (a1) (a2), Rajendra Kumar Harsh (a1), Mathew Thomas (a1), Amina Begum (a1) and Danielle Kelly (a1)...
Abstract
Aims and method

To evaluate patient awareness of the mental health tribunal and identify any association between capacity to request a tribunal and frequency of completed hearings. A cohort of detained patients within a secure hospital were assessed and data for past tribunals evaluated by presence of capacity and mode of application.

Results

Of the 65 patients evaluated, 78% were aware of the tribunal's power to discharge, 14% were aware of its power to recommend leave and 4% were aware of its power to recommend transfer; 12% lacked capacity to request a tribunal. Patients with capacity received more completed hearings per year than those without, both overall (0.58 v. 0.29 per year, P = 0.04) and by patient application (0.45 v. 0.12 per year, P = 0.03).

Clinical implications

Hospital managers should ensure that all detained patients have regular assessments of their capacity to request a tribunal and that those who lack capacity are referred to the Secretary of State when it is considered that a tribunal would be in their best interests. Hospital managers should consider referring such cases to the Secretary of State every 12 months.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Nuwan Galappathie (ngalappathie@standrew.co.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
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Patients' awareness of the mental health tribunal and capacity to make requests

  • Nuwan Galappathie (a1) (a2), Rajendra Kumar Harsh (a1), Mathew Thomas (a1), Amina Begum (a1) and Danielle Kelly (a1)...
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eLetters

Research ethics approval and discrimination

Louise McCarthy, Research Nurse
13 January 2014

We read with envy Galappathie et al's study (1) of detained patients' awareness of the Mental Health Review Tribunal (MHRT). We applaud their decision to regard their study as part of service evaluation rather than as a research project requiring National Research Ethics Service Committee(NRESC) approval.

We applied for NRESC approval for a study asking patients detained under Section 2 or Section 3 of the Mental Health Act about their views on the chances of the MHRT rescinding their detention if they appealed. The crucial question was 'What do you think are the chances thatyou will be discharged by the Tribunal if you appeal?'

The NRESC which reviewed the application did not have a mental healthpatients' representative, carers' representative or mental health professional as its member. Therefore, it sought expert opinion from a retired clinical psychologist. The NRESC ruled that "the study should not be done in the acute phase of treatment when participants are detained andit would be more appropriate once they have been discharged. This would remove concerns about the ability of the participants to give informed consent whilst under detention and in a vulnerable condition".

We appealed against the decision and our application was referred to another NRESC which also did not have a mental health patients' representative or carers' representative, but had a psychologist as a member. We attended the review and explained that we endeavoured to assess detained patients' views and that post-discharge retrospective assessment would be futile. We argued that the first principle of the Mental Capacity Act is the presumption of capacity. The GMC guidance also states that one must not assume that a patientlacks capacity to make a decision solely because of their medical condition including mental illness. We confirmed that patients who did not have capacity todecide whether to take part in the studywill not be offered the opportunity to take part.

This second NRESC agreed with the first one for the same reasons, that is, detained patients don't have capacity to decide whether to take part in the study.

This is an example of ignorance and consequent stigmatizing attitudesheld by those in authority resulting in discrimination against mental health patients, carers and professionals. Members of NRESCs believingthat those who are mentally ill lack the capacity to make simple decisionscould significantly hamper research into mental illness and perpetuate themyth that psychiatry is the most unscientific medical specialty. Mental health professionals and patients groups may share part of the blame by not representing themselves on NRESCs.

References:

1. Galappathie N, Harch RK, Thomas M, Begum A, Kelly D. Patient's awareness of the mental health tribunal and capacity to make requests. The Psychiatrist 2013; 37: 363-366.



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Conflict of interest: None declared

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