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When religion and madness collide

How will the Mental Health Tribunal approach my religious beliefs?

Religion understandably plays an important role in many people’s lives. Being able to practice a religious faith and express religious views is an important concern for many hospital patients receiving treatment under the Mental Health Act.

When patients appeal against their detention to a tribunal, it follows that they may have concerns about how a Mental Health Tribunal will look at their expressions of their faith. In this article, our Stephen Beard looks at the 2017 Upper Tribunal case of DL-H v WEST LONDON MENTAL HEALTH TRUST AND THE SECRETARY OF STATE FOR JUSTICE. This case focussed on a number of themes – one of which was the kinds of evidence which can be heard at a tribunal in relation to a patient’s religious beliefs.

The topic of a patient’s religious beliefs, and how relevant these are to a patient’s behaviour, is a particularly interesting one to focus on. From a lawyer’s perspective it is something which clients will regularly, and understandably, wish to raise at a tribunal. They may have concerns that their legitimately-expressed beliefs are being misinterpreted by medical professionals as signs of mental disorder. They may fear that a misinterpretation of their religious beliefs may disadvantage them at a tribunal appeal hearing or indeed when moving towards discharge. The D L-H case helps to clarify how tribunals should approach evidence about religious beliefs and their relevance to a patient’s behaviour / presentation.

This case involved a patient with a lengthy forensic (criminal) history who, in 2006, had been placed under a hospital order with a restriction – (section 37/41 of the Mental Health Act 1983). At the time of the case coming to tribunal his diagnoses were said to be schizophrenia and personality disorder. After a lengthy 6-day hearing, the First-tier Tribunal in 2016 did not discharge the patient.

Specifically this case looked at whether, in relation to religious beliefs, the tribunal was entitled to prefer the evidence of medical experts (for example the patient’s psychiatrist) to that of the religious experts. The patient put it to the tribunal that he was not showing signs of mental disorder and that he was instead simply expressing his religious views. Indeed, his present and former hospital chaplains had also stated that his beliefs were within the range of those considered normal in the Pentecostal Church. However, the patient’s present chaplain said that he ‘struggled’ with the patient’s belief that he was John the Baptist.

In the medical evidence at the hearing, it was argued that whilst the patient did indeed have strong religious beliefs, it could not be said that his ideas and behaviour were solely attributable to these beliefs. In other words, it was argued that he displayed evidence of symptoms of mental disorder independent of any religious beliefs. This kind of argument may well sound familiar to many tribunal lawyers who have represented patients with firm and longstanding religious views. Another argument that may be put forward by psychiatrists at a tribunal is that whilst a patient’s expressions of faith alone do not demonstrate mental disorder, it is the extent to which they express their beliefs, or the level of ‘preoccupation’ with their beliefs, which indicates possible mental disorder.

One of the most important points in the DL-H case is that the tribunal looked at all the patient’s beliefs (religious and others) in reaching its decision. In this sense it was able to show that it had considered all relevant matters, including any distinction between religious beliefs and symptoms of mental disorder. From the perspective of lawyers representing patients at tribunal hearings, this case teaches us the importance of ensuring that a tribunal has properly demonstrated (including in their full written decision) that they have looked at these issues thoroughly and shown their reasoning as to why a patient’s behaviours are felt to be manifestations of mental disorder and not simply the expression of reasonable religious beliefs.

Judge Jacobs, in the Upper Tribunal’s written decision, made a number of comments which are especially helpful in showing how tribunals will now approach these kind of issues:

“An appeal to the Upper Tribunal lies only on a point of law. In deciding whether the First tier Tribunal’s decision involved the making of an error on a point of law, the Upper Tribunal does not undertake its own assessment of the evidence or substitute its findings of facts for those of the First-tier Tribunal. The issue for the Upper Tribunal is whether the First-tier Tribunal’s assessment was rational. This is sometimes expressed by saying that there will only be an error of law if the tribunal’s findings were perverse in the sense that no tribunal acting judicially could properly have made them.”

“There is no such rule [that only the evidence of religious experts is admissible on matters of religion] and it is well that there is not. The borderline
between religious beliefs and mental disorder can be a fine one and one that is-

difficult to draw. It is right that evidence from both sides of the divide should be

admissible to help the tribunal make a soundly-reasoned decision.”

“In this case, the tribunal was obliged to consider the evidence as a whole. It  did so and the judge has explained how it assessed that evidence. His explanation discloses a rational approach to the task.”

“As I read its decision, the point made by the tribunal was that there was ‘clear evidence of positive symptoms’ of a mental disorder over and above anything that might be attributable to religious beliefs … It mentioned his belief that he was John the Baptist, but it did not base its decision on that alone and I consider that its analysis would have been the same if that evidence had not been before the tribunal.”

This case may provide some reassurance to patients. Whilst the patient in question was not discharged, at least the importance of the tribunal carefully considering all religious beliefs has been underlined. This will provide a useful precedent for future tribunals.


Stephen Beard, Peter Edwards Law

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