The extent to which a Mental Health Tribunal will consider evidence about religious beliefs was considered in the recent case of DL-H v West London Mental Health Trust & Another (2017).[1]

Religious beliefs and mental disorder

On appeal to the Upper Tribunal, the judge referred to the fine borderline which can exist between religious beliefs and mental disorder. It is not unusual to see evidence of religious belief presented to a Tribunal in an attempt to explain behaviour. A Tribunal will have to consider if, in fact, the belief is a part of the mental disorder presentation.

The patient had argued before the Tribunal that he was not manifesting signs of mental disorder but of religious belief. He brought in evidence from both present and former hospital chaplains that his beliefs were within the range considered normal in the Pentecostal Church, save that his present chaplain said that he struggled with the patient’s belief that he was John the Baptist.

Assessing religious and medical evidence

In considering the issues raised by an appeal of the decision of the First Tier Tribunal the judge reviewed:

  • Whether in relation to religious beliefs the tribunal was entitled to prefer the evidence of medical experts to that of the religious expert
  • Whether the tribunal was entitled to make its own diagnosis contrary to the evidence at the hearing
  • Whether the tribunal failed to explain its reasoning in a way that allowed the patient to understand how the tribunal reached its conclusions

Having satisfied himself that the assessment of evidence and findings of fact was a matter for the First Tier Tribunal, the judge confirmed the position that there is no rule of evidence that only a religious expert’s evidence is admissible on issues of religion.

Mental Health Act

The judicial nature of a tribunal’s functions is supported by the terms of the Mental Health Act 1983. The judge concluded that the Tribunal is not obliged to accept expert evidence, even if all the evidence agrees, but it must have good reasons for not doing so. There may be more than a ‘mere rejection of the clinical team’s diagnosis’. It may involve a differential diagnosis.

Representations about the clarity of the reasoning for the benefit of the patient were held to be flawed because of ‘materiality’.

In other words, ‘even if the tribunal did make the mistakes on the matters itemised, there would still be ample justification within its findings and reasons to show that detention was required and that treatment was available.’

The appeal was dismissed.

Comment

Each case will turn on its own facts and any diagnosis and evidence submitted is subject to existing procedural safeguards. The Tribunal will consider the evidence as a whole and that will include looking at the benefit of all treatment including medication.tances.