The legal member may be a senior lawyer or judge (often senior counsel) and acts as the chair; the medical member may be a senior (e.g. consultant) psychiatrist and has often held clinical responsibility for detained patients before; and the community/specialist/'non-legal' member is neither a lawyer or medical doctor but has relevant qualifications (often at postgraduate level) and/or specialist experience in mental health, either as a mental health professional or a specialist layperson.
The hearings may be held privately or may be open to the public, depending on the jurisdiction and individual circumstances.
Many Western developed nations use a tribunal model (they may be termed review boards) for mental health.
Independent tribunals of specially selected members with expertise in the area are said to be more competent bodies if operated properly.
However, the WHO states that there must always be a right of appeal in a timely manner as well as "ongoing, automatic, mandatory and regular reviews of status."
A balance is required between avoiding delays in necessary admission/treatment, reviewing as soon as possible, preventing harm, and recognising rights to mental health care as well as to refuse treatment.
[3] The Principles for the Protection of Persons with Mental Illness ('MI Principles'), adopted by the United Nations General Assembly in 1991, has some basic standards concerning the need for a legal hearing for patients who are detained or treated against their will or whose capacity to make decisions is questioned.
It shall, in formulating its decisions, have the assistance of one or more qualified and independent mental health practitioners and take their advice into account."
Concerns have been raised about the lack of scrutiny of medical evidence in Australia; carers in Scotland have criticised a "hierarchy of opinion" mirroring decision making in medical settings; and forensic patients in Canada commented on the influence of the treating teams and particularly psychiatrist in decision making.
[5]: 509 Individuals may feel intimidated by the number of people present at the tribunal particularly if their friends and family members in attendance.
It hears appeals (and sometimes judicial reviews) relating to decisions of the First-tier Tribunal and MHRT for Wales.
Following the commencement of parts of the Mental Capacity Act (Northern Ireland) 2016, it was renamed as simply the Review Tribunal.
The Tribunal panel consists of a psychiatrist, a lawyer (either a solicitor or a barrister) and a lay member.
In many other jurisdictions, where mental health reviews are stipulated they tend to be carried out by a judge rather than by specialist tribunals.
[7] Turkey does not yet have a single coherent mental health law and there is no established system of review or appeal of detentions.