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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., Competing Interests: 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., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Intellectual disability (also known as learning disability in UK health services) and autism are distinct from the serious mental illnesses for which the Mental Health Act is designed to be used. Their inclusion in the definition of mental disorder is discriminatory, resulting in unjust deprivations of liberty. Intellectual disability and autism should be excluded from the Mental Health Act.Declaration Of Interest: None. [ABSTRACT FROM AUTHOR]

Courtenay,6 Watts7 and Khan12 raise concerns that removing intellectual disability and ASD from the MHA would lead to a risk of people being processed by the criminal justice system. We welcome the responses to our editorial on removing intellectual disability and autism spectrum disorder (ASD) from the Mental Health Act (MHA)1 and value the authors' contributions to this important debate. De Villiers2 questions why we seek to remove only intellectual disability and ASD from the definition of mental disorder in the MHA. [Extracted from the article]