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02 Jun 2017
Forth Valley Stronger Together


In the ongoing process of examining the review of the Mental Health (Care and Treatment) Act 2003, the question of Compulsory Treatment Order has come up. 

Some people with learning disabilities have expressed concerns to us about the role psychiatrists play in making determination about the treatment of people with learning disabilities and that tribunals do not give them the right support.  .  

Mental Health Tribunals were set up in 2003 to provide a specialist check on the use of Compulsory Treatment Orders.  The service costs almost £9 million per year with Tribunal members being paid about £400 per day when sitting. 

Yet from our research it appears that less than 2% of applications for Compulsory Treatment Orders are refused.  Other research based on a Randomised Control Study from England has suggested that Compulsory Treatment Orders are no more effective at helping people get better than the previous legislative provisions for compulsion in medical treatment.[1]

What do Mental Health Tribunals do?

The main role of the Tribunal is to consider and determine applications for compulsory treatment orders (CTOs) under the 2003 Act.  It also considers appeals against compulsory measures such as short term detention certificates and compulsory treatment orders.  The Tribunal also reviews every compulsory treatment order once it has been in place for two years and every two years after that.

Each Tribunal meeting has a group of three people - a doctor (psychiatrist), a lawyer and another general member, that is a person with relevant skills and experience, e.g. a nurse, social worker or someone with personal experience of mental illness, learning disability or related condition.

Initial Concerns about bias

When the Tribunal were set up there were some concerns that they would be biased towards the views of the psychiatrist.  It was said that many of the “general members” were Community Psychiatric Nurses and more likely to give more weight to the psychiatrist.  The Legal Member who chairs the meeting might make sure the formalities were carried out properly but would not have any medical experience to challenge the view of the responsible psychiatrist. 

The evidence that the tribunal hears comes from either a Mental Health Officer (normally a social worker) or the Responsible Medical Officer (who can often be another psychiatrist).  

The domination of psychiatry in the process led to worries that the patient would not be in a strong position to challenge the use of Compulsory Treatment.[2] 

These worries were challenged at the time as unevidenced and unsupported.  All members of a Tribunal come with their own views and have different approaches.   All parties to the tribunal system have a “discipline-based approach” reflecting their own training and experience.  The point of a Tribunal is to bring together these approaches into a vigorous consideration of the evidence and come to the conclusion that is in the “best interests” of the patient.  [3] 


Read Our Full Paper

The Aberdeen Stronger Together Group met with Lewis MacDonald at his new office in Rosemount Place.   Sadie, George, Calum, Derek and Keith came along and asked Lewis some challenging questions. He answered them well and everyone was really happy that he had listened so well.  

The questions were on 

  • Social Security
  • Housing
  • Bullying and Harassment
  • Making Scotland Better



Stronger Together groups from all around Scotland have been meeting with MSPs to discuss areas of concern and to raise awareness amongst MSPs of the issues that matter to people with learning disabilities.  


In Kilmarnock the group met with Willie Coffey, the MSP for Kilmarnock 

We spoke in frank terms about

  • Personal Independence Payment
  • The Work Capability Assessment
  • Access to Community Activities
  • The Concessionary Travel Scheme
  • Care Charges




In Stirling the group met with Mark Ruskell, one of the list MSPs for Central Scotland

With Mark we talked about                                                                                                                  

  • Education
  • Cuts
  • Benefits
  • Buses


All across Scotland, the 31 Integration Joint Boards have been meeting to begin their official work in running social care in Scotland.   This is a major shift in policy that has been given an easy ride so far.  The NHS is one of our national treasures and bring social care together with health can surely only be a good thing.   But as our article on Page 2 suggests, the NHS may not always guarantee good care.Learning Disability is the elephant in the room

The minutes of all Joint Boards are available online for anyone to have a look at.  We analysed the agendas and papers for 62 meetings of 31 Integrated Joint Boards to see what they talked about. 

There is no mention of Learning Disability Services in these  meetings between March and June of 2016.  Often the poor relation of  social
work, we worry about a lack of priority for people with learning disabilities.   We did spot one reference inside the papers of the Glasgow Board which promised a further review of Learning Disability Services for the year 2017-18 as part of another “efficiency drive.”

The importance of tackling the  “Delayed Discharges” of older people. Is clear.  Some explain that the Scottish Government has provided a strong financial incentive if targets are reached to reduce delays of more than 2 weeks.  Most IJBs discuss delayed discharges at every meeting. Some had 4 agenda items dealing with this.  

Delayed Discharges are about people who no longer need hospital care but can’t leave hospital for various reasons.  This is an expensive cost to health boards.  A former Cabinet Secretary for Health said “The average cost of keeping someone for a week in an acute hospital across Scotland is £4600 a week.  While on average, to keep and treat someone in a home setting is £300 a week.”


The families of two children with severe learning disabilities have been successful in a judicial review into local authority cuts to short breaks services, which they said would leave their children socially isolated.

The families of a 14-year-old boy and 8-year-old girl from Newbury, known only as DAT and BNM, instructed public law experts Irwin Mitchell to take on West Berkshire Council over the cuts, which will see the budget for short breaks services provided by voluntary sector organisations slashed by 48%. The decision was made at a meeting of West Berkshire Council on March 1 this year and reaffirmed at another meeting on May 31.

Irwin Mitchell applied to the High Court for a judicial review on the basis that the £215,600 funding reduction is unlawful as it breaches a number of legal duties, including those arising out of the Children Act 1989 and the Equality Act 2010.

The High Court declared today [July 22] that West Berkshire Council did not properly consider its legal duties before deciding to make the cuts, and that the subsequent decision was merely to “rubber stamp” the first decision without being able to cure the original flaws.

The hearing took place on June 22 and 23 at the Royal Courts of Justice in London with the judge siding with the families, forcing the council to rethink its plans.