Article Text

Download PDFPDF
Current appeal system for those detained in England and Wales under the Mental Health Act needs reform
  1. Paul Gosney1,
  2. Paul Lomax1,
  3. Carwyn Hooper2,
  4. Aileen O’Brien2
  1. 1 South West London and St George’s Mental Health NHS Trust, London, UK
  2. 2 Institute of Medical and Biomedical Education, St George’s University of London, London, UK
  1. Correspondence to Dr Paul Gosney, South West London and St George’s Mental Health NHS Trust, London SW17 7DJ, UK; pgosney{at}


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.

  • involuntary civil commitment
  • psychiatry
  • capacity
  • law

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors PG and PL contributed equally to this paper. PG: conception of work, acquisition and analysis of data; drafting and revising. PL and AOB: conception of work, interpretation of data; drafting and revising. CH: interpretation of data; drafting and revising. All authors were involved in the final approval of version to be published and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CH is the General and Company Secretary of the IME and a member of the IME BMJ Management Committee for the Journal of Medical Ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

Other content recommended for you