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Managers' hearings and patients' rights

Hinchingbrooke Healthcare Trust South Building, Primrose Lane, Huntingdon, Cambridgeshire PE29 1WG

Sir: I read Gregory's opinion (Psychiatric Bulletin, October 2000, 24, 366-367) and Kennedy's humorous editorial reply (Psychiatric Bulletin, October 2000, 24, 361-362) with interest. As a practising clinician and long time medical member of the mental health review tribunal I would like to make the following points.

Manager's tribunals have no discretionary powers. They must decide on the legality of the section, continue if it is legal, discharge if it is not. Kennedy is right that discharges by managers are rare, I believe the national figure is less than 1% but there is a wide variation, with some trusts having a figure above 20%. If there are a significant number of illegal sections this is a cause for enquiry. I suspect the truth is that a minority of managers overstep their remit.

Issues of medication, side-effects, polypharmacy, prescribing within British National Formulary limits and consent to treatment (Gregory) are all matters that managers should concern themselves with. They should ensure that their trust has policies and procedures in place to monitor these matters. They have no part in a manager's appeal.

Kennedy is right to raise the matter of legal representation at managers' appeals. This has crept into practice and should be stopped or else the panel must have legal expertise in all cases. Lawyers rehearse their questions for a future tribunal — this runs contrary to the British legal system and is akin to the American system of predisclosure of testimony.

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