Sir: In a recent edition of the Bulletin, Gregory (Psychiatric Bulletin, October 2000, 24, 366-367) argued for and Kennedy (Psychiatric Bulletin, October 2000, 24, 361) against the role of the hospital managers in hearing appeals by detained patients. We are aware of no systematic evaluation of managers' hearings.

We reviewed 52 case notes of 55 patients (in one community mental health team) who applied to the managers or mental health review tribunal (MHRT) over 4 years. Ninety-seven appeals were made, 35 against Section 2 (28% were managers' hearings) and 62 against Section 3 (59% were managers' hearings).

There were 49 managers' hearings, five patients were discharged and 26 detentions upheld. There were 48 MHRTs, five patients were discharged and 22 detentions upheld. Most of the remainder were previously discharged by the responsible medical officers. Adverse outcomes (resection or arrest in 1 month) occurred after three of managers' and two of the MHRTs discharges. The mean delays in receiving an appeal date for Section 2 were 13 days (managers' hearings) and 9 days (MHRTs). For Section 3, the delays were 35 days (managers' hearings) and 77 days (MHRTs).

We found similar numbers of appeals to and discharges by the hospital managers and the MHRTs, countrary to Kennedy's comment that discharges by managers “are now unheard of”. The average waiting time for a Section 3 MHRT was 42 days longer than for a manager's hearing. The abolition of managers' hearings may erode patients' rights. Larger studies are required before the right of appeal to hospital managers is abolished in the new Mental Health Act.