Published: 17/02/2005, Volume II5, No. 5943 Page 36

Mental health tribunals where a patient appeals against being detained against their will under a section of the Mental Health Act are one of those countless administrative activities which are the bane of our lives in NHS psychiatry.

They are also an important safeguard and an essential aspect of the human rights of our patients, yet one looks forward to dentist appointments with more relish. They are a thankless task: getting grilled by lay members, lawyers and independent doctors as your clinical practice is dissected.

I recently attended one such tribunal, setting aside several hours for it - as one needs to these days. On this occasion the tribunal was adjourned at the request of the patient's solicitors, apparently because they needed more time to prepare their case - though they had had several weeks already.

Having set aside yet more time for the adjourned tribunal the patient's solicitors then kept us waiting for well over an hour while they wrestled with their case further. Then at the very last minute, they withdrew their application and the tribunal ended without ever having begun.

NHS staff frequently find themselves at the hard end of unreasonable behaviour by other professionals outside the service, but because we work in such a defensive atmosphere we seem to feel unable to be assertive when we are treated badly. This defensiveness means NHS staff almost universally feel exploited by outside agencies, who increasingly act with imperious impunity over the abuse of NHS staff time.

Hospitals need to stick up for their staff more and actively seek examples of where their staff are badly treated by outside agencies and seek to assertively respond, ensuring these agencies know they cannot abuse staff time and get away with it.

It is another example of the lack of confidence endemic within the organisation and which means that a fear of complaints is the fundamental driver of practice. If staff are not protected and instead come to expect to be abused then their sense of personal value and the worth of their work becomes demeaned.

Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.