Limits to the value of mental health review tribunals for offender patients. Suggestions for reform.
BACKGROUND
Reform of mental health legislation for England and Wales is due. MHRTs offer an important check in the balance between patient and public rights.


OBJECTIVE
To study the quantity and outcome of MHRTs in special (high-security) hospitals.


METHODS
Data were extracted from the records of 1670 patients detained under mental illness or psychopathic disorder classifications in special hospitals during 1992.


RESULTS
There were 661 MHRT hearings, mostly requested by patients. Forty-three (7%) discharges were ordered, often without key data about continuing care in the written evidence. There were 56 recommendations for transfer to lesser security. Correlates of MHRT discharge were: female gender, younger age (in women), a legal classification of psychopathic disorder and shorter length of stay. Conditional discharge did not necessarily mean departure from special hospital.


CONCLUSIONS
Special hospital MHRTs result in few changes in patient status. A probable need for improvement in the evidence put before an MHRT was found. Legislation reformers should consider an extension of MHRT powers to order transfer between levels of security.
Taylor
P J
PJ
Department of Forensic Psychiatry, Institute of Psychiatry, London.
Goldberg
E
E
Leese
M
M
Butwell
M
M
Reed
A
A
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders; D003688:Deinstitutionalization; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric; D006782:Hospitals, Special; D006806:Human Rights; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D010344:Patient Advocacy; D012926:Social Control, Formal; D014852:Wales