Current appeal system for those detained in England and Wales under the Mental Health Act needs reform

J Med Ethics. 2019 Mar;45(3):173-177. doi: 10.1136/medethics-2018-104947. Epub 2018 Dec 4.


The approach to managing the involuntary detention of people suffering from psychiatric conditions can be divided into those with clinicians at the forefront of decision-making and those who rely heavily on the judiciary. The system in England and Wales takes a clinical approach where doctors have widespread powers to detain and treat patients involuntarily. A protection in this system is the right of the individual to challenge a decision to deprive them of their liberty or treat them against their will. This protection is provided by the First-tier Tribunal; however, the number of successful appeals is low. In this paper, the system of appeal in England and Wales is outlined. This is followed by a discussion of why so few patients successfully appeal their detention with the conclusion that the current system is flawed. A number of recommendations about how the system might be reformed are offered.

Keywords: capacity; involuntary civil commitment; law; psychiatry.

MeSH terms

  • Commitment of Mentally Ill / economics
  • Commitment of Mentally Ill / legislation & jurisprudence*
  • Costs and Cost Analysis
  • England
  • Humans
  • Involuntary Commitment / legislation & jurisprudence*
  • Mental Competency / legislation & jurisprudence
  • Mental Disorders / therapy
  • Mental Health / legislation & jurisprudence*
  • Wales