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

The court considered whether section 63 of the Mental Health Act 1983 permits treatment without consent only for the particular form of mental disorder specified in the order or application authorising detention, or for any mental disorder from which the patient is suffering. The court held that the ordinary meaning of section 63 allows treatment without consent for any mental disorder from which the patient is suffering, subject to the specific safeguards for particular treatments in sections 57 and 58. The court rejected the argument that classification for detention should limit the scope of treatment, observing that classification relates to the grounds for detention and not to the narrow definition of permissible treatment under section 63, and that other statutory protections (sections 57 and 58), ordinary negligence law and the Human Rights Act 1998 provide safeguards against inappropriate or disproportionate treatment.

This was an appeal from the Court of Appeal which had declared that treatment without consent for a psychopathic disorder was unlawful unless and until the patient was classified by a Mental Health Review Tribunal under section 72(5) as suffering from such a disorder. The respondent patient had been detained under a hospital order with a restriction order under sections 37 and 41 of the Mental Health Act 1983, classified in the order as suffering from mental illness (schizophrenia). Over time clinicians also considered that he displayed personality disorder/psychopathic traits and he was placed on a ward aimed at addressing those traits. The patient challenged the placement and the treatment for personality-disordered behaviour as unlawful.

The House of Lords identified the central legal issue as the proper construction of section 63 of the Mental Health Act 1983: whether it permits compulsory treatment only for the classified form(s) of disorder specified in the order or application, or for any mental disorder from which the patient is suffering. The court analysed the text of section 63 and related statutory provisions (including sections 16, 72(5), 3, 37, 56 and the definitions in section 1(2)), the statutory history and the practical implications of the rival constructions. The court emphasised that section 63 uses broad language authorising 'any medical treatment' for 'the mental disorder from which he is suffering' and that the Act elsewhere uses the phrase 'form of' where a narrower focus was intended (for example, in the reclassification powers of section 16 and section 72(5)).

The court also considered policy and human rights dimensions. It observed that classification governs authority to detain and related procedural safeguards, whereas treatment decisions are governed by section 63 together with the special safeguards in sections 57 and 58, the ordinary law of negligence and Convention rights under the Human Rights Act 1998. Practical difficulties and the risk of injustice if treatment were limited by classification, and the common occurrence of diagnostic uncertainty and co-morbidity in psychiatry, supported a broad construction of section 63. The court therefore concluded that compulsory treatment without consent may be given for any mental disorder from which the patient is suffering, not only for the particular form recorded in the order or application.

Nature of claim: judicial review seeking to quash ward placement and declarations that treatment for personality disorder was unlawful. Issues framed: construction of section 63; interplay with classification/reclassification provisions (sections 16 and 72(5)); relevance of sections 57 and 58; human rights implications under articles 3, 5 and 8 as applied through the Human Rights Act 1998. Reasoning: textual analysis of section 63 and related provisions; statutory history; consideration of policy and practical consequences; conclusion that classification relates to detention not the outer limits of treatment without consent, and existing safeguards are adequate.

Appeal allowed. The House of Lords held that section 63 of the Mental Health Act 1983 authorises treatment without the patient's consent for any mental disorder from which the patient is suffering, not only for the specific form(s) of disorder recorded in the application, order or direction justifying detention. The court reasoned from the ordinary language of section 63, the contrast with provisions that use the phrase 'form of' disorder (for reclassification and admission criteria), the statutory history, and practical and human rights considerations; it observed that other statutory safeguards (sections 57 and 58), negligence law and Convention remedies protect patients from inappropriate treatment.

First instance: judicial review dismissed by Sir Richard Tucker (July 2002). Court of Appeal allowed the patient's appeal and made a declaration (reported as R (B) v Ashworth Hospital Authority [2003] 1 WLR 1886; [2003] EWCA Civ 547). The House of Lords allowed the hospital's appeal and set aside the Court of Appeal declaration ([2005] UKHL 20).