Clinicians need to be vigilant about whether the court’s intervention is required because of a dispute or specific legal requirement in relation to their patient. Circumstances may arise when it is necessary to obtain authority from a court regarding the lawfulness of a treatment (either to be given or withdrawn) when a patient refuses, lacks capacity or there is a difference of opinion regarding best interests. In other cases, a judgment from the court may protect a clinician from claims that they have acted unlawfully. Of course, the courts are also there to safeguard the welfare of the patient. We discuss the role of the First-Tier Tribunal (Mental Health) and that of decision-making capacity of patients to participate in tribunal proceedings. We then explain the Court of Protection and its powers, and the pathways for application to the court, as well as the evidence that a clinician may be required to provide. We consider common health and welfare cases that the Court of Protection may be asked to decide on and then discuss the role of the inherent jurisdiction of the High Court in protecting the vulnerable but capacitous.

In England, the Care Quality Commission is responsible for monitoring the way the MHA is used and protecting the interests of patients under the Act. The Commission have observed that between 2005–06 and 2015–16, the reported number of uses of the MHA increased by 40%. They proposed a number of factors that influenced the rates of detention, including the increase in population size and in sections of the population ‘at risk’ of detention, especially older people with dementia. Furthermore, there has been a striking change in policy and practice as a result of the Supreme Court judgment in P and Q and P in Cheshire West and how criteria for detention are now applied to people with dementia. The effect of this has meant that most patients with dementia and who lack the capacity to consent to admission to psychiatric in-patient care are now detained under the MHA. We will therefore give a brief overview of the MHA, especially as it relates to dementia, and other practical applications will be dealt with in more detail in the chapters to follow.