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

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

Author information

South West London and St George's Mental Health NHS Trust, London, UK.
Institute of Medical and Biomedical Education, St George's University of London, London, UK.


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.


capacity; involuntary civil commitment; law; psychiatry

Conflict of interest statement

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.

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