On February 5, 2018, Patricia was named the head coach of the Detroit Lions. In May 2018, his position received public scrutiny when reporters discovered he had been indicted for sexual assault in 1996. In response, Detroit Lions team president Rod Wood initially stated "I don't know anything about this," but a few hours later said, "I am very comfortable with the process of interviewing and employing Matt. I will tell you with 1,000-percent certainty that everything I’ve learned confirmed what I already knew about the man and would have no way changed our decision to make him our head coach.” He lost his first two games of the 2018 season, the first against the New York Jets, 48–17, on "Monday Night Football" on September 10, and the following week against the San Francisco 49ers, 30–27, on September 16. His first win as a head coach came on September 23, 2018, a 26–10 victory against his previous team, the New England Patriots, with Patricia beating his old mentor, Bill Belichick, in the process. It was also the Lions' first win over the Patriots since 2000, which was Belichick's first year coaching the Patriots.