Mental Health Tribunals

A Mental Health Tribunal is a formal meeting where a group of people discuss the decision to continue to care for and treat you in hospital. Mental Health Tribunals are also known as Mental Health Review Tribunals in Wales.

Mental Health Tribunals can be requested by people who are detained under a Section. A Section is when you are admitted to hospital whether or not you agree to it, and have to stay in hospital for a period of time. Some sections allow you to be treated in the community, i.e. at home.

You can request a Mental Health Tribunal if you would like your Section to be discussed or reconsidered.

The group of people who make the decision at a Mental Health Tribunal is called an ‘independent panel’, which means they are not linked to your hospital. The Mental Health Tribunal is also sometimes called a hearing.

In England, you have the right to choose whether you have your hearing by video or in person. In Wales, you can request how you have your hearing, but your request will not be guaranteed.

You will receive an application form if you are requesting a hearing, where you can specify whether you want the hearing to be done at the hospital or by video, or if you don’t mind.

When you can apply to have a Mental Health Tribunal depends on the Section used to detain you. You can ask hospital staff on the ward what rights you have to apply to the tribunal. Or you can ask the Mental Health Act Office if there is one at your hospital.

You are entitled to a hearing whether you are:

• in hospital
• being treated with a community treatment order (CTO) where you are receiving care in the community, or
• under a restriction order

There are three people on the Mental Health Tribunal panel:

1. A Judge, who is in charge of the hearing.
2. A Tribunal Doctor - This person will be a Consultant Psychiatrist. The Tribunal Doctor is independent, which meant they won’t have been involved in your care previously.
3. A Specialist Member – This person will have experience of working in mental health care. They will also have detailed knowledge of the Mental Health Act.

There are certain things that the panel are legally allowed to do, or decisions they are legally allowed to make. What powers they have will depend on the Section of the Mental Health Act you are detained under. You can find out more about this in our resource on being Sectioned.

The Mental Health Tribunal is a legal meeting, similar to a hearing in a courtroom. Because of this, it is necessary for the setting and procedures to be very formal.

When you have a Mental Health Tribunal you are entitled to free legal aid and representation. You might hear this person referred to as a solicitor.

Your legal representative can do several things to support you throughout the Mental Health Tribunal, including:

• advising you on when to apply for a Tribunal and how to give your evidence
• helping you to understand the role of the Tribunal and make your case at the hearing
• helping you to decide whether you want your hearing by video or in person.

Your legal representative can visit you in hospital or speak to you over the phone.

You can represent yourself, but the Tribunal panel will ask your doctor whether you are able to do this properly. They will ask if you ‘have capacity’, which means:

• being able to understand and remember information, and
• being able to make decisions based on that information.

Sometimes, people are said to ‘lack capacity’ to make specific decisions. Your doctor might decide that you lack capacity to represent yourself.

It is generally not recommended that you represent yourself, as Mental Health Tribunals are legal meetings. A legal representative can help you to understand the issues the Tribunal is discussing, and will help to represent you best.

Your legal representative might suggest that you invite a trusted individual such as a partner or relative to come to the hearing. You also have the right to an Independent Mental Health Advocate (IMHA) who can come to the hearing with you instead of a partner or relative. You can find out more about what an IMHA is on Mind's website.

If you are on a Section 2, the Tribunal Doctor will always arrange to talk to you before the hearing. This is called a ‘pre-hearing examination’, and usually only you and the Tribunal Doctor will be there.

This will probably be done online, and if you are in hospital the ward staff will log in for you. If you are in the community, your care co-ordinator will help arrange this. If the interview is done in person, then this will be in a private room, and if you are doing it online you should be offered a private place to do this.

You can choose if you want someone else with you, such as a nurse, and your legal representative might be able to join you if this can be arranged. If you are upset or distressed, or feel like you might become upset during the meeting, you might find it helpful to have a supportive person in the meeting with you.

If you are not on a Section 2 and want to have an interview with the Tribunal Doctor, either you or your legal representative must ask for this:

• in writing, using a T129 form that the Mental Health Act Administrator can give you
• at least 14 days before the day of the Tribunal hearing.

Before the hearing starts, the panel and your legal representative will read the reports written about you by your care team. These will include:

• a medical report
• a nursing report
• a report from your care co-ordinator.

If the hearing is online

A nurse will sit with you and help you to log in. On the screen, you will see the three panel members who will hear your case, and you might also see your legal representative, doctor and care co-ordinator on the screen.

Below is a diagram that shows what an online hearing might look like:

If the hearing is at the hospital

You can ask to see the room where the Tribunal hearing will be held ahead of the meeting, so that you know what to expect. Below is a diagram that shows how people should be sitting when you have a face-to-face Tribunal:

You will sit opposite the Judge, next to your legal representative.

At some point, you might be asked if you agree for an observer to sit in at your hearing. This would be a member of your clinical team, such as a trainee psychiatrist or nurse, who is learning about tribunal hearings. The observer will not have any input into your case, and will just be there to watch.

The events of the hearing

Whether the hearing is done online or in person, the same things will happen in this order:

1. The Judge will begin by introducing the panel to you.
2. They will ask the members of your clinical team to introduce themselves.
3. One by one the members of the panel will ask questions of the psychiatrist, the ward nurse and the care co-ordinator.
4. Your legal representative will then ask questions of the psychiatrist, the ward nurse and the care co-ordinator.

You can find out more about these questions further on in this resource.

The kinds of things you might find helpful at your hearing will depend on you. Here are some examples that you might find make the hearing easier:

• Speaking first and then leaving – If you choose to do this, your legal representative will continue to put your case forward and question the clinical team after you have left.
• Taking breaks - Tell your legal representative before the hearing starts when you want a break. For example, halfway through, after 20 minutes etc.
• Sitting next to your nurse so that you can tell them if you are feeling overwhelmed.
• Bringing a paper and pen to make notes. Remember, recording the hearing on any device is a criminal offence.
• Bringing anything that helps you to manage stress. E.g. a stress ball or an object that brings you comfort.

Your legal representative will advise you about how you can best make your views clear to the Tribunal. They will be very aware that you might not be used to speaking to a group of strangers in this way.

Your legal representative will ask you questions before the panel members ask you anything. You might want to speak to the Tribunal panel early in the hearing, so that you are sure that they know what you want. Ask your legal representative about this. You might also be invited to have the last word at the end of the hearing.

Your legal representative will advise you about how and when you can ask questions. Even if you disagree strongly with what is being said, you should try not to interrupt the psychiatrist, nurse or care co-ordinator when they are answering questions from the panel or from your legal representative.

They should also not interrupt you when you are speaking or answering a question. If you hear something you disagree with, you might want to write it down so that you can discuss it once the person has finished speaking.

You don’t have to come to your Tribunal hearing if you don’t want to. Tell your nurse, doctor and legal representative if this is what you would prefer.

If you want the Tribunal panel to know what you want from the hearing, you could also write a note and give it to your legal representative. They will tell the Judge at the hearing that you have asked them to do this, and this will mean that the hearing can go ahead.

Your views and opinions will still be heard by the Tribunal.

Do I have to stay for the whole hearing?

If you decide you want to attend the hearing, you can stay for as long as you like. Make sure that if you do leave early, your legal representative knows what you want from the hearing.

Some of the questions in the hearing can sound complicated. This is because they are about the legal justification for your detention. Below are the sort of questions and words you will hear.

You might notice that the panel member and your legal representative write notes when someone gives them an answer to their questions.

Questions that might be asked of your doctor or nurse

Is the patient suffering from a mental disorder?

If you were admitted on a Section 2, which is a Section you’ll be given if you need to be properly assessed, you may not have had a clear diagnosis when you were admitted. In the hearing, your doctor will be asked about your current diagnosis.

Is the patient's disorder of a nature that requires detention?

'Nature' means the type of disorder you have. This will include:

• your diagnosis
• whether you improve with treatment
• what you think about treatment.

Is the patient's disorder of a degree that requires detention?

This is about how well you are at the moment, and your doctor might talk about any symptoms you have.

Has the assessment of the patient been completed?

This question will only be asked if you are detained on a Section 2. The hospital has up to 28 days to do an assessment, and is legally required to do it within this time.

What is the appropriate treatment for the patient?

This is everything the hospital, or your community team, are doing to try and help you. This includes:

• medication
• nursing care
• occupational therapy
• psychotherapy
• accommodation
• carers support
• employment support
• benefits advice
• social services.

It also includes what follow-up arrangements will be made when you leave hospital. This would usually involve a Community Mental Health Team, Crisis Team or Home Treatment Team.

What is the risk if the patient’s Section is lifted?

There are three categories of risk. These are:

• Risk to your health – This is about whether your health would get worse if your Section was lifted. This question will need to consider:
• your mental and emotional health, such as whether you are distressed by your symptoms
• your physical health, if you have not been able to look after yourself.

If you do not take medication, your symptoms may become worse. This question is also to help the panel to understand if you were likely to stop taking your medication or not.

• Risk to your safety – This is about whether you might become unsafe if your Section was lifted. This could be because of self-harm or suicide. Or it could be because you put yourself in risky situations when you are unwell.
• Risk to others – This is about whether you might put someone else in danger if your Section was lifted. For example, if you become verbally or physically threatening when you are unwell.

Questions to your care co-ordinator

If you have a care co-ordinator, they will be someone from your community mental health team. They will know about your social situation, such as where you live and how well you are able to look after yourself, and any follow-up arrangements for you after you leave hospital.

Your care co-ordinator may be asked similar questions to your doctor and nurse. However, they will also be asked about your accommodation, finances, and what the views of your nearest relative are.

Questions to the ward nurse

If you are or have been an in-patient on a ward, the ward nurse might be asked about:

• your behaviour on the ward
• how you look after yourself
• how you get on with staff and other patients
• how you seem to have responded to any treatment.

Your legal representative will ask the panel to say exactly why you have to stay on the Section if this is what they are recommending.

After all the questions have been asked by the panel and your legal representative, your legal representative will then:

• give a summary of your case to the panel as to why the Section should be lifted
• or, ask for a recommendation if that is what you wish to happen.

At the end of the presentation of evidence, and after your legal representative has spoken, everyone apart from the panel is asked to leave the room and wait. If you are online, you will be asked to leave the meeting and then rejoin later.

The panel stay in the hearing room and decide whether the legal criteria for detention have been met.

The panel can decide to do one of several things:

• Immediate discharge – This will happen if the panel feels that the criteria have not been met to keep you under Section. If this happens you can agree to stay voluntarily in hospital, or you can choose to leave hospital immediately. Once this happens, you can choose to make decisions about the treatment you receive.
• Deferred discharge – This means your Section will be lifted at a particular date in the future, usually within a few days. This is usually to allow time for follow-up arrangements to be made that will help you to be supported better.
• Continue the Section – This means that you will continue to be under Section. The Tribunal may make recommendations to your care team about your continuing care. Or they may suggest you continue the Section with your current treatment plan.
• Continue the Section, but suggest that your care team consider a Community Treatment Order (CTO) – This is where you would remain under a Section, but receive your care in the community. You can ask your team for more information about this.

Once you have told the panel what you want, you can leave and don’t have to come back. Your legal representative can tell you afterwards what the panel decided.

Usually, the panel can say whether you have been discharged or not on the same day as the hearing.

The panel must then write and tell your legal representative why they made that decision. This will take a few days. 

What if I'm not discharged from the Section?

The result of the Tribunal might not be what you wanted or expected. If this is the case, you might want to have another Tribunal. Your legal representative will be able to tell you when you can next do this, or what to do if you want to appeal the decision made by the Tribunal panel.

You might feel that the Tribunal was helpful even if the Section wasn't lifted. For example, if you found it helpful to hear why the clinical team are detaining you, or feel like you had a fair hearing.

One question that may be useful to ask your care team is: "What would need to happen for the team to lift the Section in the future?". The answer may help you to understand what you can do with your team going forward to get the section lifted.

Sometimes hearings do not proceed. You might hear this being described as ‘the panel adjourning’.

This might happen if:

• There is missing information that would mean that your case cannot be fairly heard. For example, because a report has not been done.
• A person who knows you well (a doctor, nurse or care co-ordinator) is not on duty and no one can step in.

• Apply for the Mental Health Tribunal – This information from the Government explains how to apply to the Mental Health Tribunal.
• Easy Read information about Mental Health Tribunals – This resource from the Government explains Mental Health Tribunals in images and simplified language using the Easy Read format.
• Being Sectioned – The College’s resource on being Sectioned looks at what it means to be Sectioned, and the different types of Section.

Other organisations

• Rethink Mental Illness
• Mind

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Joan Rutherford and Judge Sarah Johnston

Thank you to expert by experience Sarah Markham who helped to develop this resource.