This monograph provides a comprehensive examination of mental health tribunal hearings in Australia. It deals with a wide and far-reaching landscape of theories and concepts and their practical application to the day-to-day operations of the tribunals in New South Wales, Victoria and the Australian Capital Territory. The study is extensive and broad in its approach, going beyond a critical assessment of the individual tribunals to an examination of the supporting mental health services, and of the complex area of human rights as they relate to the care and treatment of people with a mental illness. It documents the universal tensions between the ‘pragmatic’ (what is ‘affordable’ and ‘politically acceptable’), the ‘normative’ (human rights and common law principles) and the ‘evidence based’ (what ‘works best’). The entire discourse is framed within a concern to uphold the rights of those living with a mental illness and a desire to bring about paradigm-shifting changes to improve mental health processes for all stakeholders. It presents considered views on tribunals’ future directions, commending existing ‘good practices’ and charting possible directions for reform of legislation and operations.