First-tier tribunals for mental health in England: are they fit for purpose?
First-tier tribunals for mental health in England: are they fit for purpose?
复制标题
英格兰的一级心理健康法庭：它们是否适合其目的？
DOI：
10.1016/s2215-0366(19)30396-7
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发表时间：
2020
影响因子：
64.3
通讯作者：
Sarah Markham
中科院分区：
文献类型：
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作者：
Sarah Markham
人们普遍认为，对于精神健康状况严重危及自身和他人的个人来说，强制进入精神病院是合理和必要的。尽管如此，这种承认必然会严重侵犯个人自主权。1因此，有必要制定严格和客观的司法程序，以审查和质疑根据《联合王国精神健康法》继续拘留和其他限制性措施。在英国英格兰，一级审裁处（精神健康），通常称为精神健康覆检审裁处，是一组独立的准司法机构，自2008年审裁处服务重组以来，根据1983年《精神健康法》和《精神健康覆检审裁处规则》的规定运作。第一级法庭的主要目的是审查根据《精神健康法》被拘留的病人的案件，并指导任何符合法定出院标准的病人出院。审判小组由三名成员组成：一名法律的法官，一名医学成员（通常是精神病学家）和一名非专业成员。法律的法官负责起草决定的理由并签署决定记录。医疗成员将是一名独立的精神病学家，如果病人愿意，他将在法庭上与病人交谈，但目的是收集证据，而不是管理治疗。病人的主治医生、护士和社会工作者也将提供证据，病人本人也可以提供证据。2.令人关切的是，在实践中，一级法庭的决策主要是临床投入，人权，特别是自由权和诉诸司法的权利被置于较低的优先地位。3联合国关于享有能达到的最高标准身心健康的权利的特别报告员的报告谴责使用精神卫生法庭使胁迫合法化并限制诉诸司法的机会。4
Compulsory admission to psychiatric hospital settings is widely regarded as both justified and necessary for individuals whose mental health condition is such that they pose a serious risk to themselves and others. Nonetheless, such admissions entail a substantial breach of personal autonomy. 1 Hence a need exists for rigorous and objective judicial procedures to be in place to scrutinise and challenge continued detention and other restrictive measures under the UK Mental Health Act. In England, UK, the First-tier Tribunal (Mental Health), more commonly known as Mental Health Review Tribunals, is a group of independent quasi-judicial bodies that have operated since restructuring of the tribunal service in 2008, under the provisions of the 1983 Mental Health Act and Mental Health Review Tribunal Rules. The Firsttier tribunal’s main purpose is to review the case of a patient detained under the Mental Health Act and to direct the discharge of any patient for whom the statutory criteria for discharge have been satisfied. A tribunal panel consists of three members; a legal judge, a medical member (usually a psychiatrist), and a lay member. The legal judge is responsible for drafting the reasons for the decision and for signing the record of the decision. The medical member will be an independent psychiatrist who, if the patient wants, will talk to the patient before the tribunal, but for the purpose of gathering evidence not managing treatment. The patient’s treating doctor, nurse, and social worker will also give evidence, as can the patient themselves.The ability of the First-tier tribunal to achieve its aims has received substantial criticism. 2 Concern exists that, in practice, decision making within the the Firsttier Tribunal is dominated by clinical input and that human rights are given lower priority, especially the rights to liberty and access to justice. 3 The UN Report of the Special Rapporteur on the right to the enjoyment of the highest attainable standard of physical and mental health has condemned the use of mental health tribunals for legitimising coercion and limiting access to justice. 4