Frank Holloway - Fee-paid Medical Member of the First-tier Tribunal, Health, Education and Social Care Chamber (Mental Health)

Dr Frank Holloway was appointed as a Fee-paid Medical Member of the First-tier Tribunal, Health, Education and Social Care Chamber (Mental Health) in 2010.

The main purpose of the First-tier Tribunal (Mental Health) is to review the cases of patients detained under the Mental Health Act and to direct the discharge of any patients where the statutory criteria for discharge have been satisfied.

"I have a long-standing interest in mental health law, including providing training for psychiatrists on the Mental Health Act 2007. The medical member role was a natural extension of this interest.

I was looking for things to do prior to my planned retirement as a Consultant Psychiatrist and Clinical Director in South London and Maudsley NHS Foundation Trust. I kept an eye on the JAC website. It was an interesting and quite demanding selection process. There were no unexpected questions or other surprises in the interview, and the role play was very engaging and quite fun. While I felt I spotted the issues quite quickly, I did find it difficult to play the role, and it is worth thinking about this beforehand. I was asked to play a role I had never done before and interact with other tribunal members. To be successful you need to convince the interview panel that you have the manner and demeanor for a quasi-judicial role - that you can inspire confidence and respect and manage tricky and potentially conflicting situations.

I started sitting in January 2011, in London, Kent, Surrey and Sussex, and I am enjoying it. It is always varied. No tribunal hearing is the same as another and there is no completely routine case.

I had previous experience of the tribunal from the other side as a psychiatrist giving evidence, but the approach and thought process of a medical member is quite different. There is also more to mental health law than I thought - some aspects of the law are not obvious to the responsible clinician.

In the role of medical member you need to see the patient for a preliminary examination before the tribunal. The range of patients is much wider than any psychiatrist's routine clinical practice. I have seen quite a lot of patients in secure settings. I've found sitting on 'restricted' cases quite challenging, particularly patients who have been conditionally discharged and are living in the community: when is absolute discharge of someone who has committed a very serious offence in the context of a mental illness the right thing to do? If you are not a forensic psychiatrist, this is new, and the recommendations you are making could have dangerous consequences.

In my brief experience to date and talking to tribunal members the most difficult cases aren't the forensic (detained) patients, who tend to be well documented. The tribunal has to provide a very quick turnaround on Section 2 (detained for assessment) cases. Here the decisions can be very difficult, particularly when the person is not already known to the local mental health service.

Sometimes the biggest practical challenge is locating the patient and arranging a way of assessing them before the tribunal hearing. This is a particular problem for patients on Community Treatment Orders (CTO): some CTO patients do not want to engage with the process and do not attend meetings.

If you are thinking of applying to become a medical member you need to be clear that you want to do it. I have to confess that before doing the role I had at times seen the tribunal as something of an irritation. I was clear I was right about my decision to use the Mental Health Act. But we need to think carefully about the fact that psychiatrists have unusual powers to deprive someone of their liberty and force treatment on them and therefore why we have a tribunal system. If you do become a medical member of the tribunal your challenge will be to assess the case and consider all the information to ensure the process is fair for all concerned. You are making decisions which are significant; both to the people involved, and to the wider public. There is good quality training for the role - a two-day induction and top-up training each year.

On average I hear cases once or twice a week, but you can sit much less frequently if you wish, and fit the cases around your practice. You are allowed to choose your sitting days well in advance. It is surprisingly sociable since you are sitting as a panel. There is a legally qualified member - the judge - and a specialist member. The specialist members come from very varied backgrounds, for example psychologists, social workers and managers of mental health services.

I very much enjoy going to different places and talking to patients as a medical member. I would recommend the role. It is interesting, but demanding, and hopefully a beneficial way of using your existing skills and developing some new ones."