MHRT Memorandum To: Directors of Area Mental Health Services/Responsible Clinicians

MENTAL HEALTHREVIEWTRIBUNAL

MentalHealth(CompulsoryAssessment and Treatment)Act1992

Memorandumto: DirectorsofAreaMentalHealthServices/ResponsibleClinicians

From:Secretary,MentalHealthReviewTribunal

Guidelinesfor Reports to the ReviewTribunal

Introduction

WhenreviewingtheconditionofpatientstheTribunalisperforminganimportantstatutoryfunctionwhichbearsontherightsandinterestsofbothpatientsandthecommunityatlarge.

The review process isexpensive, ofteninvolvingTribunal memberstravellingfromafarforthepurpose ofonlyoneortwohearings.

TheTribunalplacesmuchrelianceonresponsibleclinicianreportstoassistitmakeinformedandcorrectdecisions.

TheTribunalexpectsthereforethatthestandardofresponsibleclinicianreportswillreflecttheabovepoints.

Scopeandlevelofdetail

Thescopeandlevelofdetailwhichshouldbeprovidedinreportswillvaryaccordingtothecircumstancesofeachcase.

Indicatorsthatreportsmightbemorecomprehensivethanotherwiseincludecomplexity,difficulty,novelty,highrisk,politicalsensitivityandabsenceofpreviousreviews.

Itisalwaysamatterofjudgementhoweverastowhattoincludeinareport.Abalanceneedstobestruckbetweenprovidingtoomuchortoolittleinformation.

Commonshortcomings

ThemostfrequentcriticismsmadebytheTribunalofreportsare:

(i)Copyingandpastingfromotherdocumentsresultingindisjointedreportsfeaturingjumbledchronologyanduncertaintyaboutthedateandauthorshipofcitedquotations.

(ii)ExcessiveorirrelevantdetailrenderingitdifficultfortheTribunaltoobtainaclearoverviewandtoidentifykeyissuesandevidence.

(iii)FailuretoalerttheTribunaltospecialorunusualdifficulties,occurrencesorissues.

(iv)Failuretoaddresskeylegalissuesandcriteriaresultingintimebeingwastedathearingsinrequestingthatinformation.

(v)Notexplainingacronymsorabbreviationsnotknowntothoseoutsidethegeographicalareaornotunderstoodbythenon-psychiatristmembersoftheTribunal.

Avoidassumingavailabilityofpreviousreports.

TheTribunalarchivesmaterialrelatingtopreviousTribunalreviews. Itcannotbereadilyretrieved.ThereforeeveniftherehasbeenapreviousTribunalreviewdonotassumeTribunalmembershaveseenpreviousreports.ItisacceptabletoprepareanupdatingreportannexingpreviousreportstotheTribunal.

Thetypicalreport

Theresponsibleclinician’sreportshouldtaketheformofafairlystandard“clinicalreport”, but with a particularfocusonlegal definitionsand criteria.

Inthecaseofpatientssubjecttocompulsorytreatmentorders,theTribunalisparticularlyinterestedintheresponsibleclinician’ssubstantiationofwhyheorsheconsidersthepatientismentallydisorderedintermsofthedefinitioncontainedinsection2.

Inthecaseofspecialpatients,thelegalcriteriaforcontinueddetentionshouldbeaddressedandthereasonswhyorwhy notthepatient shouldremain aspecialpatient.

Thereportwillusuallyincludeasuccinctsummaryoffamilyandculturalbackground,occupationalandsocialfunctioning,clinicaland forensichistory,riskbehaviours,diagnoses,currentcondition,treatmentstrategies,complianceandresponsetotreatmentandwhycompulsorytreatmentorspecialpatientstatusisdeemednecessary.

Whereverpossible,factsshouldbeverifiableandsubstantiated,especiallyiftheyaredisputed.

Detailwhichitisoftenusefultoinclude,whetherwithinthebodyofthereportorinappendedmaterial,is:

• Achronologyofalladmissionanddischargedatestogetherwithabriefsummaryastoconditionondateofadmission;

• Achronologyofdatesofcourtordersandchangesofstatus.

AppendingMaterial

Thereportshouldbeastandalonedocument,understandablewithoutreferencetootherdocumentation.

Itisoftenusefulhowevertoappenddocumentationwhichprovidesgreaterdetailandservestoverifythecontentsofthereport.Suchappendedmaterialalsoenablesthereporttobemoresuccinct.

TheTribunalfindsthefollowingdocumentstooftenbeofassistance:

• Inthecaseofspecialpatients,acopyoftherelevantpolicecaptionsheet/summaryoffacts,orderofdetentionandlistofpreviousconvictions;

• In all cases the current order by which the patient is detained orcommitted;

• Dischargesummaries;

• Secondopinions;

• Specialist reports (e.g. psychologist, social worker or occupationaltherapist).

Itisnotmandatorytoprovidethis material. It isa matterofjudgement fortheresponsiblecliniciantodecidewhatshouldbeappended.Usually,theTribunalwouldexpectnomorethanabout20pagestobeappended.

DisclosureofReport

TherulesofnaturaljusticemeanthattheTribunalisnotpermittedtoreceiveevidencethatisnotdisclosedtothepatient.Theentirereportandaccompanyingmaterialmustbemadeavailabletothepatient.Itshouldthereforebepreparedonthatunderstanding.

ENDS