B, R (on the application of) v Ashworth Hospital Authority

The Court of Appeal held that section 63 of the Mental Health Act 1983 must be read in its statutory context and permits compulsory medical treatment only for the mental disorder for which the patient is formally classified as suffering. Reclassification provisions in sections 16, 20 and 72(5) maintain the link between the disorder that justifies detention and the disorder for which forcible treatment may be given. The common law doctrine of necessity remains available to permit urgent treatment of a non-classified disorder in appropriate cases. The judge below (Sir Richard Tucker) was wrong to construe section 63 as authorising compulsory treatment for any disorder diagnosed by clinicians irrespective of classification.

This was an appeal from the Administrative Court (Sir Richard Tucker) in judicial review proceedings brought by a long-term restricted patient (B) detained under sections 37 and 41 of the Mental Health Act 1983. B was classified by the Crown Court order as suffering from mental illness (schizo-affective disorder / schizophrenia) though clinicians also diagnosed a psychopathic personality disorder; the tribunal had not reclassified him as suffering from psychopathic disorder.

The appellant sought judicial review of the hospital’s decision to place and treat him in a personality-disorder unit. The core question on appeal was whether section 63 permits compulsory treatment by or under the direction of the responsible medical officer for any mental disorder that clinicians diagnose, or only for the mental disorder specified in the application, order or tribunal classification.

The court framed the issues as:

• the proper construction of section 63 in the statutory scheme of Parts II, III, IV and V of the Mental Health Act 1983;
• whether compulsory treatment may be given for non-classified disorders, and if so whether that displaces the reclassification regime (sections 16, 20 and 72(5)); and
• whether the common law doctrine of necessity survives to permit urgent treatment of non-classified disorders.

The Court of Appeal analysed the statutory scheme and concluded that the Act ties detention and the authority to treat without consent to the mental disorder for which the patient is classified. Section 63 therefore authorises forcible treatment only for classified mental disorders (subject to the narrowly defined exceptions in section 62 and the safeguards in sections 57–58). The court held that the common law power to treat in emergencies is not impliedly displaced for non-classified disorders. The decision below was reversed and the appeal allowed.

Appeal allowed. The Court of Appeal held that section 63 authorises compulsory medical treatment only for the mental disorder for which the patient is classified as suffering; reclassification provisions in sections 16, 20 and 72(5) maintain the essential link between lawful detention and the disorder for which forcible treatment may be given. The common law doctrine of necessity remains available for urgent treatment of non-classified disorders.

Appeal from the Administrative Court (Sir Richard Tucker), which had dismissed the appellant's judicial review challenging treatment in a personality disorder ward; the Court of Appeal allowed the appeal. Neutral citation of this court: [2003] EWCA Civ 547.