Such cases usually involve making a balanced judgement on a number of serious issues such as the freedom of the individual, the protection of the public and the best interests of the patient.
Most specialist members are senior or experienced practitioners or therapists with at least 5–7 years standing and will hold a range of experience within the mental health sector.
Most specialist members are educated to postgraduate level in mental health, they may hold an advanced degree in psychology or forensics in RPP cases.
Members can be drawn from the NHS, voluntary organisations, adult social services or the private health sector.
At the hearing they, together with the other members of the Tribunal, have the responsibility of deciding whether or not the patient should continue to be detained or remain on a community treatment order.
This is because it would be unfair and contrary to a basic principle of natural justice if the Tribunal members were to take notice of information that had not been shared with all the other parties at the hearing.
Prior to the Covid -19 pandemic the hearings would take place in the hospital or community unit where the patient is detained.
These include the detained person, his or her solicitor, the member of the multi-disciplinary team responsible for the detained person's care in hospital, known as the Responsible Clinician or RC (usually a consultant psychiatrist), a representative of the nursing staff at the hospital and the Approved Mental Health Professional (AMHP).
Additionally, the RC and AMHP (or more frequently the patient's care coordinator) are required to submit written reports on the person's state of health to the Tribunal in advance of the hearing.
The parties are told of the decision at the conclusion of the hearing (following the panel taking time to consider the submissions and evidence).
In all cases the Judge will provide detailed written reasons which set out the background, evidence, and the Tribunal's findings and conclusion.
Technically the First-tier Tribunal (Mental Health) consists of two distinct elements, within a single non-departmental public body.
The first element is Judicial part of the Tribunal with the responsibility for hearing applications or references concerning people detained under the Mental Health Act 1983.
The Minister of State for Courts and Legal Services is responsible for meeting the expenses of Tribunals in England and for providing accommodation and staff.
The Welsh Assembly has similar responsibilities for Tribunals in Wales and administration is carried out at the Secretariat office in Cardiff.
A study in 2017, looked at the correlation between a number of predictors and the outcome of the decisions of the First-tier Tribunal (Mental Health): The study commented that their "findings imply that decisions are not biased in terms of age, sex, ethnicity, mental health diagnosis, or even index offence", rather its findings "suggest that by reducing levels of agitated behaviour, verbal aggression and physical violence on the ward, working towards being granted unescorted community leave, and specifically targeting items on the HCR-20 risk assessment" patients can increase their chance of discharge.