Background
Yaa Foriwaa Appiah was transferred from prison to a secure psychiatric facility in December 2018 under sections 48 and 49 of the Mental Health Act 1983. After those powers were due to expire, two approved psychiatrists assessed her and recommended detention for treatment under section 3. Because her husband, Peter Kwesi Appiah, opposed that detention as her nearest relative, the county court temporarily displaced him and assigned the relevant functions to Leeds City Council. Mrs Appiah was detained under section 3 from 26 April until 23 August 2019.
A Mental Health Tribunal ordered her immediate discharge on 23 August 2019, finding that the statutory case for continued detention had not been established. The Tribunal was not satisfied that she then had a mental disorder of a nature or degree warranting detention, or that detention was necessary. The High Court emphasized, however, that the Tribunal was deciding whether detention should continue at that time, not whether the earlier detention had been unlawful.
The Appiahs sought £1.5 million in damages from the NHS trust. Their claims included false imprisonment, alleged procedural violations of the Mental Health Act, and breaches of Articles 3, 5 and 8 of the European Convention on Human Rights. Mrs Appiah also alleged that staff had violently restrained her and administered depot antipsychotic medication improperly. The claim against Leeds City Council had previously been excluded after the High Court refused the statutory leave required to sue it.
The Court’s Holding
Tom Little KC, sitting as a Deputy High Court judge, dismissed the claim. On the balance of probabilities, Mrs Appiah had a mental disorder requiring detention when section 3 was invoked on 26 April 2019, and her detention remained lawful until the Tribunal discharged her. The court accepted the contemporaneous clinical assessments and expert evidence that her condition improved with treatment, concluding that the Tribunal hearing occurred at the earliest point when detention was no longer necessary.
The court found no procedural breach. Section 3 did not require a definitive psychiatric diagnosis or prior detention under section 2; a clinically supported working diagnosis could suffice. The section 5 holding power permitted detention for up to 72 hours and did not require clinicians to wait the full period before using section 3. The trust had also taken practicable steps to inform Mrs Appiah of her rights under section 132.
The court rejected Mrs Appiah’s account of sustained violence during medication as grossly exaggerated and inconsistent with the contemporaneous records. It found that the depot medication and associated restraint were necessary and proportionate. The Article 3, 5 and 8 claims therefore failed, as did Mr Appiah’s related Article 8 claim.
Key Takeaways
- A Tribunal decision ending a patient’s detention does not, without more, establish that the detention was unlawful from its inception or during an earlier period.
- Section 3 of the Mental Health Act can be supported by a clinically grounded working diagnosis; neither a definitive diagnostic label nor prior use of section 2 is invariably required.
- The 72-hour period under section 5 is a maximum holding period, not a mandatory waiting period before detention under section 3 may begin.
Why It Matters
The judgment distinguishes the prospective question before a Mental Health Tribunal—whether detention should continue—from the retrospective question in a damages action—whether earlier detention was lawful. A patient’s improvement and eventual discharge do not themselves prove that the original clinical decision was unlawful.
It also provides practical guidance on the relationship among sections 2, 3 and 5 of the Mental Health Act and confirms that courts may assess compulsory treatment and restraint by reference to contemporaneous clinical records, necessity and proportionality.