First-Tier Tribunal (Mental Health)

Page last updated: 12 May 2022
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The First-Tier Tribunal (Mental Health) continued to hear cases throughout the pandemic, using remote hearings. Listings were paused for only six working days for some community patients (CTO or conditional discharge) at the end of March 2020, and have otherwise continued as normal.

Changing to remote hearings appears to have had no effect on outcome, with similar proportions of discharges to hearings in 2020/21 compared to the previous year. In 2020/21 and 2019/20 the Tribunal discharged patients in about 10% of its decisions relating to detention overall. Around 30% of restricted patients’ appeals resulted in some form of discharge decision, in most cases using the powers given to the Tribunal to order the conditional discharge of restricted patients. Patients detained under the assessment and treatment power (section 2) were roughly twice as likely to successfully appeal as patients detained under treatment powers (section 3 and unrestricted hospital orders) (figure 7). Appeals against CTOs were in general less successful, with about 4% of decisions ordering discharge (figure 8).


Figure 7a: Applications against detention to the First-tier Tribunal (Mental Health) with hearings and outcomes, 2019/20, England
 
  Section 2 Other unrestricted Restricted All detained patients
Applications 10,459 16,662 3,398 30,519
Withdrawn applications 1,220 4,578 1,142 6,940
Discharges by clinician prior to hearing 4,063 5,526 66 9,655
Heard 6,527 9,103 2,611 18,241
Outcome:
Absolute Discharge
374 369 74 817
Outcome:
Delayed Discharge
214 136 1 351
Outcome:
Conditional Discharge
- - 404 404
Outcome:
Deferred Conditional Discharge
- - 162 162
Outcome:
Total discharge by Tribunal
588 505 641 1,734
Outcome:
No discharge
4,805 8,637 1,400 14,842

Source: HM Courts and Tribunal Service, Analysis and Performance Team.
Please note: The number of applications, hearings and outcomes will not match due to outstanding matters at the end of each financial year.

Figure 7b: Applications against detention to the First-tier Tribunal (Mental Health) with hearings and outcomes, 2020/21, England
 
  Section 2 Other unrestricted Restricted All detained patients
Applications 10,361 15,484 3,249 29,094
Withdrawn applications 1,119 4,003 1,145 6,267
Discharges by clinician prior to hearing 4,010 5,372 55 9,437
Heard 6,542 8,307 2,612 17,461
Outcome:
Absolute Discharge
297 271 67 634
Outcome:
Delayed Discharge
191 91 0 282
Outcome:
Conditional Discharge
- - 371 372
Outcome:
Deferred Conditional Discharge
- - 150 150
Outcome:
Total discharge by Tribunal
488 362 588 1,438
Outcome:
No discharge
4,953 8,735 1,417 15,105

Source: HM Courts and Tribunal Service, Analysis and Performance Team.

Notes:
The number of applications, hearings and outcomes will not match due to outstanding matters at the end of each financial year.

Data from HM Courts and Tribunal Service, Analysis and Performance Team. Data for 2019/20 is shown for comparison, but also as we did not request and publish this in last year’s report.


Figure 8: Applications against CTOs to the First-tier Tribunal (Mental Health) with hearings and outcomes, 2019/20 and 2020/21, England
 
  2019/20 2020/21
Applications 4,270 4,853
Withdrawn applications 780 951
Oral Hearings 3,409 3,869
Paper Reviews (considered on papers
and therefore patient not present)
591 616
Discharges by Tribunal 138 113
No discharge by Tribunal 3,128 3,464

Source: Source: HM Courts and Tribunal Service, Analysis and Performance Team.
Note: The number of applications, hearings and outcomes will not match due to outstanding matters at the end of each financial year.


As highlighted in last year’s report, while some people preferred the use of remote hearings, others felt disadvantaged. This was supported by patient feedback on Tribunal hearings in 2020/21. While some people reported a similar experience to face-to-face hearings, others felt that they were not listened to or felt that they were not able to participate fully.

Poor internet connection remained a common concern from patients, staff and Tribunal representatives. For example, on one visit to an acute ward in November 2020, staff told us that they had experienced problems with accessing the Tribunal video link because the trust did not have a compatible web browser. As a result, patients and staff had to use their own devices and data, which could have security and data protection issues.

In our last report we highlighted an example of a tribunal decision being set aside on appeal due to a patient’s video-link being muted and her consequently not being able to alert the panel when she could not hear witnesses. In November 2020, we heard of another case that illustrates other potential problems with remote procedures. In this case, the Upper Tribunal set aside a first-tier Tribunal decision on the basis that it had been wrong to proceed in the patient’s absence, after the patient declined to take part. The patient had previously been assaulted after other patients discovered his history. He was concerned, in this context, that the hearing might be overheard by another patient with whom he was self-isolating due to coronavirus. The Upper Tribunal found that the Tribunal was wrong to have assumed, without investigation, that closing an internal door was sufficient to ensure that proceedings could not be overheard. It also found that the Tribunal had not considered why the patient was anxious and its impact on his ability to participate. As a result, the Tribunal had wrongly approached the adjournment request as if the patient had been concerned with the mode of hearing (i.e. telephone) rather than the fear of being overheard that day.


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