Court of Appeal Clarifies Legal Requirements for Involuntary Admissions Under The Mental Health Act 2001

In its recent decision, in A.A (Anonymised) v Clinical Director of the Ashlin Centre [2025] IECA 30, the Court of Appeal considered the level of detail required when making an application and subsequent order for the involuntary admission of a person suffering from a mental disorder. In her judgment Ms Justice Hyland did a detailed analysis of the interplay between the different sections of the Mental Health Act 2001 (the “Act”) and the forms prescribed by the Mental Health Commission when dealing with an involuntary admission to an approved centre. In this article, Lebeau Jonker, Partner and Ana Harrington, Trainee CKT review the judgment.

Legal Framework

Under the Act, there is a three-stage process for the involuntary admission of a relevant person with a ‘mental disorder’ as defined in the Act. In brief, the way this works is:

• A person makes an application under s. 9 to a registered medical practitioner to have the practitioner recommend the involuntary admission of the relevant person. This application is made by filling out Form 4, as prescribed by the Mental Health Commission.
• The registered medical practitioner then makes a recommendation under s. 10 to an approved centre to have the person involuntarily admitted. This is done by filling out Form 5.
• A consultant psychiatrist from the approved centre then reviews the person and can make an Admission Order detaining the person in the approved centre under s. 14. This is done by filling out Form 6, and a completed Form 6 is deemed to be the admission order itself.

The Facts

In this case, Ms. A, a woman with schizoaffective disorder, was brought to a hospital’s Emergency Department by her husband. A nurse reviewed her, and filled in a Form 4 with the details “husband brought patient in to ED, bizarre behaviour, paranoid” and “observed to be paranoid and psychotic in the ED”.

An hour later, a doctor completed a Form 5, indicating his belief that Ms. A suffered from a mental disorder with the comment “presented with irrational and paranoid thoughts. Evidence of psychosis on a background of schizoaffective disorder.”

Ms. A was then brought to the approved centre where a consultant psychiatrist examined her and filled in a Form 6, again indicating that Ms. A suffered from a mental disorder, with the comment “grandiose & paranoid delusional beliefs, lacks insight into need for treatment.”

Ms. A subsequently challenged the Admission Order under Article 40.4.2 of the Constitution, and following a hearing in the High Court, an Order was made that she be released. The approved centre appealed this decision, and even though the matter was moot as Ms. A had already been released, the Court of Appeal chose to hear the matter in the public interest.

The Dispute

The original challenge had been to the Form 4 and Form 6, on the basis that these forms had not been properly filled out.

In relation to Form 4, s.9(5) requires that a person who is not a relative, authorised officer, or Garda must give reasons why the application is being made, their connection to the relevant person, and the circumstances in which the application is being made. Counsel for Ms. A argued that this required the nurse in this situation to explain precisely why it was appropriate to make an application, and why none of the other listed persons were making it.

The Court of Appeal disagreed with this analysis. In the first instance, they said that the comments made by the nurse on the Form 4 were sufficient to meet the requirements of s. 9(5). Her references to Ms. A’s symptoms were suggestive of her belief that Ms. A was suffering from a mental illness which required hospitalisation. Additionally, it would be unreasonable to expect an unrelated person to be able to explain why numerous relatives were not making the application, particularly where they may not know those relatives, and the relevant person may not be in a condition to explain their circumstances. The purpose of s. 9(5) is simply to act as a procedural safeguard to prevent mischief from uninterested persons making applications. Ultimately, a Form 4 is only triggering the process, it is neither making a recommendation nor an Admission Order.

Counsel for Ms. A also raised issues with the Form 6. One of these was that, although the consultant psychiatrist indicated on the Form 6 that Ms. A was suffering from a mental disorder pursuant to the Act, they did not identify whether the disorder was mental illness, severe dementia, or significant intellectual disability, these being the three categories of mental disorder identified in the Act.

On Appeal, the Judge found that this was reasonable; the Form 6 set out by the Commission did not require that a psychiatrist specify this, and given the limited time available it would not be reasonable to expect a diagnosis. It was sufficient that a psychiatrist had formed the view that the relevant person’s condition fell within the category of mental disorder.

However, a further issue was raised regarding the level of detail provided for the purpose of s. 3(1). Under the Act, a person can be admitted either where there is a serious likelihood of the person concerned causing immediate and serious harm to themselves or others (‘the harm criterion’), or where their judgement is impaired to the extent that failure to admit them would lead to the deterioration of their condition or the prevention of appropriate treatment, that could be given only by such admission, and the reception,  detention and treatment would likely benefit or alleviate their condition to a material extent (‘the treatment criterion’).

In this case, the psychiatrist had ticked the box for the treatment criterion, and while it was possible to infer from the written comments that Ms. A would not get the appropriate treatment if she was not admitted, there was no evidence that the psychiatrist believed that treatment in the approved centre would materially alleviate her condition.

Essentially, the psychiatrist filling out the Form 6 must have regard to the statutory criteria. While it is not necessary that they explicitly refer to these in their written comments, it must be possible to infer from the language used that the criteria have been considered.

Conclusion

The Court of Appeal noted that detailed comments and diagnoses are not required in situations where an admission to an approved centre may be quite urgent. However, given the seriousness of a potential 21-day involuntary admission, and the fact that a psychiatrist is permitted to detain a relevant person for 24 hours to fill out the Form 6, there is a duty on that psychiatrist to consider the statutory criteria for an Admission Order, and it should be possible to infer that they have done so from their written comments on the Form.

In this case, as the psychiatrist had not met that standard, the Court of Appeal upheld the decision of the High Court in granting an Order for the release of Ms. A.

Importantly though, Ms Justice Hyland disagreed with the trial judge in the High Court that the Form 4 came “nowhere close to meeting the statutory requirement” and  that “they did not explain why an involuntary admission may be required, that they referred to symptoms only and no explanation or potential justification as to why the draconian step of applying for involuntary admission had been taken”

Ms. Justice Hyland held that she did not agree that the reasons given do not explain why an involuntary admission may be required. She made it clear that the Form 4 was only triggering the first step in the process.

The Court was satisfied that on proper construction of Section 9(5) of the Act an applicant who falls within subsection (d) is required only to give reasons why he/she is making the application; and not to explain or give reasons why persons who fall within the other categories of potential applicants referred to at subsections (a), (b) and (c) are not making the application.

Any other construction would likely result in the imposition of an obligation which may be impossible to fulfil. This could have the effect of paralysing Section 9 of the Act and make the 1^st stage of the involuntary admission process unworkable.