Mersey Care NHS Trust, R (on the application of) v Mental Health Review Tribunal

A Mental Health Review Tribunal has an original jurisdiction and must reach its own judgment on the evidence before it. It may rationally disagree with medical evidence, including where written reports favour continued detention, particularly when oral evidence provides a more current picture. Its reasons must explain the essential reasoning, but need not rehearse all background material or answer every submission. In judicial review, later amplification of reasons may be considered, especially where the alternative would be continued detention. The ordinary civil standard applies, but cogent proof is required where personal liberty is at stake.

Mersey Care NHS Trust sought judicial review of a decision of the Mental Health Review Tribunal, Liverpool, which discharged D from liability to detention under section 3 of the Mental Health Act 1983, with discharge deferred for one month. The claimant alleged irrationality, inadequate reasons and procedural unfairness. The central issue was whether D’s clinical improvement enabled her to live in the community with support despite written reports recommending continued detention.

1. Application refused. The Tribunal’s decision was based on written and oral evidence, including evidence from D and staff with day-to-day knowledge of her condition.
2. The Tribunal had an original jurisdiction and was required to exercise its own judgment. It could rationally disagree with psychiatrists. The written reports were not fully up to date, and the Tribunal was entitled to rely on more current oral evidence.
3. The decision in R v Ashworth Special Hospital Authority (ex parte H) [2003] 1 WLR 127 was distinguishable. Here, discharge was deferred for a month, D had accommodation, and evidence supported the possibility of arranging aftercare.
4. The Tribunal’s reasons were brief but adequate. It was not required to set out all background material or address every item of evidence expressly. The court could also consider unanimous amplification of the reasons in witness statements.
5. The procedural unfairness challenge failed because the Responsible Medical Officer had not asked to question D or make final submissions and had appeared as a witness rather than an authorised representative.
6. The claimant was ordered to pay the defendant’s and interested party’s costs, including costs of the stay application. D was to be released.

First-instance judicial review proceedings. Permission was granted and a stay was ordered pending the hearing. Keith J later declined to discharge the stay and directed an urgent hearing. The substantive application was refused.