‘Odyssey of Hope’: The role of carers in mental health tribunal processes and systems of mental health care

Abstract

This article examines carers' involvement in the interconnected processes of mental health care planning and mental health tribunal hearings, decision-making processes which often dramatically impact on carer-service-user relationships and effectively impose obligations on some carers to assist in implementing legally binding orders. It explores concerns expressed by carers about difficulties accessing information about, and contributing to, these processes, and identifies associated dilemmas and conflicts. Whilst carer involvement may not be appropriate in all cases, the article concludes that carers should be better engaged at the service delivery level from the first point of contact and on an ongoing basis. It argues that a more consistent approach which assists and encourages carer participation in tribunal processes should be adopted. It also suggests that there is a need for additional processes and efforts to deal with conflicts arising between serviceusers, carers, and health services in the mental health context.

Are mental health tribunals operating in accordance with international human rights standards? A systematic review of the international literature

“…Likewise, a study in three jurisdictions in Australia revealed that some informants valued the opportunity to have their views heard, although they were limited in what they could discuss (Carney & Tait, ). This has led to criticisms of parochialism with mental health tribunals in Australia, focusing narrowly on the fulfilment of the legal criteria and excluding information about the social and family context and the iatrogenic effects of medication (Beaupert & Vernon, ; Carney, ). As a result, calls have been made for wider engagement with subjective experiences of treatment (Carney & Tait, ) and other pertinent issues that are neglected within tribunal deliberations (Beaupert & Vernon, ).…”

“…The included studies revealed that carer participation is variable. In their study examining carer involvement in care planning and tribunal decision‐making processes in three jurisdictions in Australia, Beaupert and Vernon () found that tribunal discretion shaped carer involvement. When carers did participate they reported being treated with respect, had the opportunity to share their views and, crucially, felt they were listened to.…”

“…However, many carers did not participate in tribunal proceedings. This was largely due to not being informed about tribunal proceedings and not understanding its scope and purpose (Beaupert & Vernon, ). In a Scottish study, Ridley, Hunter, and Rosengard () found that named persons felt empowered by their formal role and felt they were listened to by professionals, although carers who were not named persons were not fully included in decision‐making.…”

“…Studies indicate that disruptions to family relationships can also occur as a result of involvement in the tribunal (Beaupert & Vernon, ; Carney, ; Grundell, ; O'Donoghue et al, ). This has clear implications for recognising the right to respect for family life identified in Article 8 ECHR and Article 23 CRPD.…”

“…Families are often involved in providing evidence to mental health tribunals or in instigating involuntary treatment (O'Donoghue et al, ). Tensions can arise as a result of this, particularly where there is a disagreement of views between individuals and their relatives (Beaupert & Vernon, ; Carney, ; Grundell, ). In an Irish study, it was reported that families instigating involuntary treatment had a negative effect in 27.5% of cases and a positive impact in 15% of cases (O'Donoghue et al, ).…”