John Spencer's appraisal of the tribunal system ('Tribune group', features, page 28, 23 September) lacked three important points.
First, patients are entitled to be legally represented. A whole branch of the legal profession has grown up which undertakes this work expertly, acting as the patient's friend, concerned to secure the best possible outcome for their client.
Second, the patient's legal representative is entitled to an expert witness, usually a psychiatrist from another area, who will visit the patient, review the medical information and present a written report to the tribunal. The independent psychiatrist may or may not agree with the responsible medical officer concerning diagnosis, risk assessment or the need for continued detention.
They may also comment on the treatment plan, perhaps suggesting a trial with one of the newer atypical drugs.
Third, the patient's carer is entitled to attend the tribunal, and will be given an opportunity to present their point of view.
Tribunals will in any case pursue their own determined lines of enquiry. I have, for instance, known a tribunal critical of minimal social work input, or of the unkempt condition of a female patient. I have also known a tribunal adjourn a hearing so as to place pressure on managers who were reluctant to authorise the use of an expensive drug recommended by the second psychiatrist.
The tribunal system is, as your contributor suggests, a valuable safeguard, and the principle needs to be continued when legislation to replace the 1983 Mental Health Act is drafted. What a pity that the tribunal system does not extend to long-stay informal patients who lose the advantage of a periodic independent review of their care.
Rev Frank Crowther Group co-ordinator for North Nott inghamsh ire National Schizophrenia Fellowship