Patricia (by her Accredited Legal Representative) v Cygnet Healthcare Ltd & Ors [2026] EWCOP 29 (T3)
Judge: Mr Justice Peel
Date: 23 July 2026
Background
Patricia was a 26-year-old woman with diagnoses of anorexia nervosa, autism and Pathological Demand Avoidance. She had received treatment for her eating disorder over a prolonged period of years, including compulsory treatment, none of which had worked. She had previously been the subject of Court of Protection proceedings concerning compulsory nasogastric tube (NGT) feeding.
Since September 2025, Patricia had been detained under s.3 Mental Health Act 1983 (MHA) at a specialist eating disorder unit operated by Cygnet Healthcare. Until July 2026, she received a combination of oral nutrition and NGT feeding. However, following concerns that her treatment plan was failing to achieve sufficient weight gain, clinicians introduced a regime under which all nutrition was provided via NGT with use of restraint and sedation where necessary. This was the first time in 17 years of treatment that Patricia had received nutrition entirely via tube feeding. Patricia strongly objected to the regime, although she remained willing to eat and drink orally. The hospital’s position was that anything short of a complete NGT feeding regime would be clinically ineffective and potentially life-threatening.
Patricia applied to the Court of Protection seeking declarations that she had capacity to decide whether to accept calories orally or by forced feeding, that continued forcible feeding was not in her best interests and breached Article 3 ECHR, and that the hospital had unlawfully refused to obtain an independent second opinion. The hearing before Peel J was limited to the preliminary question of whether the Court of Protection had the jurisdiction to determine those issues.
Decision
The court concluded that the Court of Protection did not have the power to make the declarations sought.
Although Peel J was satisfied that there was reason to believe, on an interim basis, that Patricia lacked capacity to conduct the proceedings and to make decisions about feeding treatment, the key issue was the interplay between the Mental Capacity Act 2005 (MCA) and the compulsory treatment provisions of the MHA. The MHA gives the power to decide whether to compulsorily treat a patient to the Responsible Clinician and not to the Court.
There was no dispute that NGT feeding constituted treatment for Patricia’s mental disorder and therefore fell within sections 63 and 145(4) MHA. The consequence of those provisions for Patricia was that the Responsible Clinician could lawfully direct that the treatment took place even if she did not consent. This was so, whether or not she was capacitous.
Patricia argued that s. 28 MCA prevented the Court of Protection from authorising treatment under the MHA but did not prevent it from declaring that a particular treatment regime was contrary to her best interests. The judge rejected that argument. He held that a declaration under the MCA which prevented compulsory feeding would inevitably interfere with treatment being lawfully provided under s. 63 MHA. Treatment and non-treatment were “two sides of the same coin” and s. 28 MCA excluded the Court of Protection from exercising such a supervisory role.
The application was therefore dismissed.
Comment
This decision provides important clarification regarding the boundary between the MCA and MHA. Peel J confirmed that where an incapacitated patient is detained under s. 3 MHA and is receiving treatment for a mental disorder pursuant to s. 63, the Court of Protection cannot use its best interests jurisdiction to review, alter or prohibit that treatment. Responsibility for those decisions rests with the Responsible Clinician under the statutory framework of the MHA.
The judgment will be particularly significant in cases involving anorexia nervosa and compulsory feeding, where questions frequently arise about the interaction between the two statutory regimes. It reinforces the principle that Part IV MHA takes precedence over the MCA in relation to compulsory treatment for a mental disorder.
Importantly, the court recognised that Patricia was not without remedy. Challenges to treatment provided under s. 63 MHA may still be brought by way of judicial review or under s.7 Human Rights Act 1998.
The full judgment can be found here.
