High Court ruling in Derbyshire Health Care NHS Trust case clarifies need for in-person psychiatric examinations under Mental Health Act 1983.

Citation: [2023] EWHC 3182 (Admin)
Judgment on


The High Court of Justice’s recent ruling in Derbyshire Health Care NHS Trust v Secretary of State for Health and Social Care engages with essential statutory construction around the Mental Health Act 1983 (the 1983 Act), specifically the interpretations of the terms related to ‘examination’ within sections 17A, 20, and 20A. This article aims to dissect the legal principles that underpin this case and to reflect on their significance in relation to remote psychiatric assessments.

Key Facts

Derbyshire Health Care NHS Trust brought proceedings seeking declaratory relief on whether the “examine” mandates in sections 20 and 20A of the 1983 Act necessitate face-to-face examination for lawful imposition of restrictions on the liberty of a person suspected to have a mental disorder. Additionally, the Trust queried whether section 17A requires any form of examination before issuing a Community Treatment Order (CTO). The debate was precipitated by the advancement of remote examination technologies and the ruling in a previous case, Devon Partnership NHS Trust v Secretary for State for Health and Social Care (Devon), which held that “personally seen” and “personally examined” entail physical presence.

The case revolved around several core legal principles:

  1. Statutory Interpretation: The court’s task was to ascertain Parliament’s intention at the time of enacting the legislation. In doing so, they engaged with principles such as the presumption of consistency and the concept that legislation is ‘always speaking’.

  2. ”Always Speaking” Doctrine: The court considered whether the statutory phrase ‘examine’ might encompass methods not available or foreseen at the enactment time, such as remote examinations via video conferencing. The court adopted the principle that statutes dealing with ongoing situations should be interpreted in the present tense.

  3. Nature of Examinations: There was consideration of what constitutes an “examination” under the 1983 Act, whether it is inherently tied to physical presence and the multi-sensory aspects that might be vital in psychiatric evaluation.

  4. Safeguards and Liberty: The court noted statutes that potentially curtail liberty must be construed strictly. The principle of liberty posits that any deprivation or restriction of liberty must be grounded in clear statutory authority and construe statutory language with precision.

  5. Precedent: The court heavily relied on the Divisional Court’s decision in Devon, which distinguished between the importance of face-to-face interaction and remote assessments in the context of mental health evaluations.

  6. Consistency and Clarity: Given divergent advice and practices following the Devon case, the High Court recognized the need for consistent and clear interpretation to guide future actions under the 1983 Act.


The court rejected the Trust’s application for all three declarations. It concluded that remote means of examination cannot be assumed to always be as effective as an in-person examination. This was based on current evidence and societal consensus, or lack thereof, regarding the equality of quality between remote and in-person psychiatric assessments.


This case emphasizes the judiciary’s cautious approach to statutory interpretation concerning personal liberties in the context of mental health law. The court firmly underscored the import of physical presence in psychiatric examinations when extending detention, guardianship, or a CTO under the 1983 Act. The decision reinforces the notion that advancements in technology do not automatically translate to changes in the statutory framework, especially when the legislation in question involves fundamental rights. The ruling leaves the door open for legislative amendment should a broader approach to psychiatric assessment be deemed appropriate in the future.