The United Kingdom (UK) population is ageing. This change is accompanied by an increase in the number of people aged over 65 who come into contact with psychiatric services. The use of the Mental Health Act 1983 (MHA) in patients above 65 years of age is limited. These patients are less likely to appeal against their detention and may vary in sociodemographic and clinical characteristics compared with younger patients who are more likely to appeal against their detention. All patients detained for the first time under the MHA in the ten-year period 1992-2002 at Queen Elizabeth Psychiatric Hospital, Birmingham, were studied for socio-demographic and clinical characteristics. More appeals against detention came from people below 65 years of age. Patients detained on section 2 (MHA) appealed more often than patients on section 3. Only a few patients with a diagnosis of dementia appealed against their detention. Additional safeguards should be introduced for this group. We recommend that the appeal process should be simpler and should provide information in all the major languages used in the UK.