Lack of challenge to substantive criteria at mental health tribunals: Amplifying the medical perspective?
Bibliographic record
Abstract
Mental health tribunals provide legal safeguards for compulsory treatment for mental illness. Despite one of these tribunals' purposes being to give people subject to compulsory treatment a "day in court", research has shown that individuals' experience of mental health tribunals is highly negative. To understand these negative experiences, we conducted a multi-stakeholder study of the Consent and Capacity Board, a mental health tribunal in Ontario, Canada. Our research revealed that disputes in the hearings tended to focus on procedural requirements of the compulsory treatment orders, and although substantive legal criteria were addressed, the medical conclusions underlying those criteria were not directly challenged. Further, in cases where a client "wins" and the treatment order is revoked, our analysis shows the medical perspective remained authoritative. Finally, although people subject to treatment orders were given a chance to speak at hearings, in most cases theirs was the only voice challenging the psychiatrist's medical conclusions, and their contribution would usually only lessen the chance of the order being revoked. Therefore, we argue that rather than challenging medical decision-making, as may be expected, tribunal hearings unintentionally amplify the medical perspective in a manner that is likely to be upsetting for people subject to the treatment orders. We acknowledge that this effect is ingrained in the current system and will be challenging to ameliorate. Nonetheless, it is an important consideration for those in legal and clinical practice, and policy makers. We give some suggestions about how these experiences could be improved and for further research opportunities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.059 | 0.114 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.022 | 0.051 |
| Scholarly communication | 0.024 | 0.017 |
| Open science | 0.004 | 0.013 |
| Research integrity | 0.006 | 0.010 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".