Service users’ experiences of mental health tribunals in Ireland: a qualitative analysis

Abstract

Objectives. To explore the mental health tribunal experiences of people admitted involuntarily under the Mental Health Act 2001.Methods. Employing a qualitative descriptive study design, data were collected from 23 service users who had experienced mental health tribunals during a recent involuntary admission. Face-to-face semi-structured interviews were conducted 3 months post-revocation of their involuntary admission order. Data were analysed using an inductive thematic process.Results. The majority of participants reported mixed experiences comprising positive and negative aspects in relation to information provision, emotional support and an inclusive atmosphere. Some participants reported receiving accessible information about the tribunal process, felt emotionally supported throughout, and encountered respectful and dignifying practices during the tribunal proceedings. However, many participants described experiencing non-inclusive practices, reported feeling ill-informed regarding the tribunal process, emotionally unsupported during and after the tribunal, and distressed by what they perceived as adversarial tribunal proceedings.Conclusions. Systemic changes could ensure that the positive experiences encountered by the minority of participants in this study are more consistently experienced. Ongoing education and training of stakeholders in the provision of inclusive tribunal practices, and the provision of accessible information and emotional support to service users through the stages of the involuntary admission process appear likely to be beneficial. Service users should automatically be offered the option of having a support person of their choosing present during tribunals.

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

“…A range of barriers and facilitators to participation were identified within the literature. One study in Ireland found that having the opportunity to share ones' views and having these listened to reinforces that individuals' perspectives are valued (Murphy et al, ). Nonetheless, tribunal cultures have been condemned as a barrier to participation with the weighting afforded to psychiatric evidence and the use of reports perceived to be inaccurate being particular issues (Murphy et al, ).…”

“…One study in Ireland found that having the opportunity to share ones' views and having these listened to reinforces that individuals' perspectives are valued (Murphy et al, ). Nonetheless, tribunal cultures have been condemned as a barrier to participation with the weighting afforded to psychiatric evidence and the use of reports perceived to be inaccurate being particular issues (Murphy et al, ). In addition, inaccessible jargon, not being able to challenge evidence as it is presented, being the last person to speak during proceedings and being discouraged from speaking altogether reduces autonomy and disrupts the participatory potential of the tribunal (Livingston et al, ; Murphy et al, ).…”

“…The way in which information is presented is also pertinent to recipient understanding. The importance of receiving information at different times and in an informal way has been demonstrated (Murphy et al, ). In an Irish study, only a minority of informants received clear information and many felt that they lacked understanding about the purpose, process and outcome of the tribunal and consequently felt unprepared (Murphy et al, ).…”

“…As indicated above, one of the distinctive features of the CRPD is its shift away from a medical model of disability towards a more socially grounded perspective (Degener, ) whereas the ECHR permits rights limitations on the basis of mental disorder. Despite tribunals being multi‐membered and multidisciplinary, evidence suggests that they are significantly influenced by the medical domain (Carney, ; Carney & Tait, ; Livingston et al, ; Murphy et al, ; Ng et al, ; Ridley et al, ). The use of medical discourse and the predominant focus on clinical expertise (Carney, ; Carney & Tait, ) perpetuate the dominance of the medical within tribunal cultural practices.…”

“…Although tribunals may be considered a safeguard against unlawful detention, evidence has demonstrated that their limited jurisdiction may restrict their ability to do this (Carney, ; Carney & Tait, ). Furthermore, the over‐reliance on clinical evidence and the dominance of the health domain, have been cited as undermining the jurisdiction of the tribunal (Carney, ; Murphy et al, ). Resourcing may also impact on the availability of patient representation, such as independent advocacy (Mental Welfare Commission for Scotland, ; Scottish Independent Advocacy Alliance, ).…”