A ruling was recently passed in the Court of Appeal, and this judgment is likely to have a significant bearing on psychiatrists working with patients detained under the category of mental impairment and psychopathic disorder.

The Court was hearing an appeal against the decision of the high court about ‘B’, an in-patient at Ashworth hospital. B had been detained under a restriction order under the category of mental illness. The responsible medical officer had recommended to the Mental Health Review Tribunal (MHRT) that B suffers from a mental illness as well as a personality disorder. The MHRT chose not to reclassify B under the category of psychopathic disorder.

B was subsequently transferred to a ward in the personality disorder unit and B sought a judicial review claiming that he should not be treated for psychopathic disorder because he was not detained under that category. The high court dismissed the application and B's solicitors appealed against the decision.

The Court of Appeal heard the case in April 2003 and ruled that compulsory treatment could be given only for the mental disorder for which the patient has been detained.

Patients detained under the category of mental impairment and psychopathic disorder often have comorbid mental illnesses which may not be severe enough to warrant detention on their own accord. These patients often receive treatment for the mental illness even though they are not classified as having mental illness under the Act.

As a result of the ruling of the Court of Appeal, it will become necessary to reclassify all such patients under the additional category of mental illness, unless it can be established that psychotropic medication is being administered exclusively for the treatment of mental impairment or psychopathic disorder.

This is likely to present problems for patients who are under restriction orders because the RMO does not have the power to reclassify them and would need to wait for a tribunal to do the reclassification. If the tribunal chooses not to reclassify, it might become difficult to justify administration of psychotropic drugs to these patients.

It would be interesting to see if Ashworth Health Authority chooses to take the case to the House of Lords.