Nottingham Healthcare NHS Trust, R (on the application of) v Mental Health Review Tribunal (Northern Region)

A mental health review tribunal must give reasons of sufficient quality to explain its decision, particularly where it rejects substantial psychiatric or other expert evidence. The reasons must identify the reasoning process by which evidence is accepted or rejected and engage with the competing analysis. The duty is comparable to the duty imposed on courts when resolving an intellectual dispute involving expert evidence. The evidence of a responsible medical officer is not determinative, but its weight must be assessed by reference to all relevant circumstances, including the duration and depth of the officer’s involvement, the strength of the clinical opinion and other medical evidence. A tribunal decision that fails to meet these standards is liable to be quashed and remitted for redetermination.

The claimant NHS trust applied for judicial review of a decision by the Mental Health Review Tribunal (Northern Region) that GK did not suffer from mental illness and should be discharged from Rampton Hospital. The tribunal had rejected the diagnosis of catatonic schizophrenia despite detailed evidence from GK’s responsible medical officer, an independent psychiatrist and the clinical team.

The trust challenged the decision on irrationality, inadequacy of reasons and apparent bias on the part of the medical member. The central issue was whether the tribunal’s reasons sufficiently explained its rejection of the expert evidence.

1. Application allowed. The tribunal’s decision was quashed and the matter was remitted to a differently constituted tribunal. The court did not determine the irrationality or bias grounds because the inadequate-reasons ground was sufficient.
2. Under rule 23(2) of the Mental Health Review Tribunal Rules 1983, the tribunal had a statutory duty to give reasons. Brevity is not itself a defect, but the reasons must explain the basis of the decision with sufficient clarity.
3. Where a tribunal rejects expert evidence, especially the evidence of the responsible medical officer and an independent psychiatrist, it must indicate the reasoning process by which it accepts some evidence and rejects other evidence. The standard is analogous to that applied by courts resolving an intellectual dispute involving reasons and analysis, as explained in R (H) v Ashworth Hospital Authority [2002] EWCA Civ 923 and Flannery v Halifax Estate Agencies Ltd [2000] 1 All ER 373. The same requirement was confirmed in R (KW) v Avon and Wiltshire Mental Health Partnership Trust and Bristol City Council [2003] EWHC 919 (Admin).
4. The importance of adequate reasons is heightened because mental health tribunal decisions affect both the patient’s liberty and the public risk associated with discharge. The tribunal’s reasons did not engage adequately with the detailed clinical evidence or explain why the diagnosis was rejected. Its reliance on the absence of three symptoms was particularly problematic because those symptoms did not appear in the ICD-10 or DSM-IV classification systems.
5. The weight given to a responsible medical officer’s opinion remains a matter for the tribunal. Relevant considerations include the length of the officer’s responsibility for the patient, the strength of the clinical judgment, other clinical opinions and the reasons given for disagreement, following R (K) v West London Mental Health NHS Trust [2006] EWCA Civ 118.
6. Although bias was not determined, the circumstances gave sufficient concern to justify remittal to a differently constituted tribunal. There was no order for costs.