Last week, the UK Government unveiled its much-anticipated Mental Health Bill, which contains a raft of measures aimed at significantly overhauling the Mental Health Act. This reform seeks to give people better rights, reduce inequalities, and improve mental health outcomes for all.
The Mental Health Act 1983 is the main legal framework in England and Wales for assessing and treating people with severe mental health difficulties. It allows people to be detained and treated without their consent if they are considered a risk to themselves or others. But for years, the Act has faced criticism for being inconsistently applied and harming certain groups, particularly Black people, autistic people, those with learning disabilities and those in prison or immigration settings.
Calls for reform led to an independent review, which highlighted the need to modernise the Act and better address these issues. Following the review, the previous government published a Bill incorporating some of these recommendations, and this Bill went through further examination by a Joint Committee, which proposed additional changes. Now, with this new Bill, there’s hope for a mental health framework that’s fairer, more consistent, and better aligned with today’s understanding of mental health and community needs.
So, what’s in it?
The 2022 version of Mental Health Bill introduced a number of key reforms which largely drew wide support, this includes:
- Tightening criteria for detention and compulsory treatment, with faster, more frequent reviews and appeals
- Introducing a statutory Care and Treatment Plan for anyone detained under the Act, so that it is always clear what treatment is being provided and why it is necessary for the person
- Increasing patient voice in care and treatment through collaborative clinical checklists between the patient, clinicians and carers
- Allowing patients to choose a nominated person instead of the current Nearest Relative to have a say in how they are treated during detention
- Extending the provision of independent mental health advocacy services for people in hospital
- Limiting detention for people with learning disabilities and autistic people to 28 days for assessment under Part 2 (the civil sections of the Act, as opposed to the parts relating to the criminal justice system, in Part 3). Detention for treatment (under Section 3) would only be allowed if they also have a co-occurring mental health condition requiring hospital care and meet the Act’s detention criteria
- Requiring commissioners to monitor crisis risk for people with learning disabilities and autistic people and ensure adequate community services to prevent unnecessary admissions to hospital
- Updating Community Treatment Order (CTO) criteria and increasing oversight
- Removing police stations and prisons as designated “places of safety” for mental health crises
- Enforcing a 28-day limit for transferring those in the prison or immigration detention systems needing mental health care to a hospital
- Creating a new supervised community discharge option for criminal justice patients needing conditional, non-hospital-based supervision.
The Mental Health Bill 2025 introduces several important amendments that we welcome, including:
- The Bill adopts the Joint Committee’s recommendations to introduce a duty on health services to inform people about their right to make Advance Choice Documents which enable patients at risk of detention to express their wishes on their care and treatment
- The Bill also incorporates the Joint Committee’s call to include the four core principles outlined in the Independent Review: choice and autonomy; least restriction; therapeutic benefit; and treating the person as an individual into the legislation and the forthcoming Code of Practice
- Additionally, the Bill introduces a new requirement for hospital clinicians to collaborate with a second professional from a community service when making decisions about discharging patients under the Act, including when making a CTO.
Modernising the Act
There’s a lot to welcome in these provisions. Overall, the net effect of this Bill will be to make the Act better for people who need compulsory hospital admissions or treatment. It’s important that the Act is only used when someone can benefit therapeutically from it, yet at present this is not required. It’s right that people should choose their Nominated Person rather than the current Nearest Relative being chosen for them. And we know from research that Advance Choice Documents can help to ensure people are treated better when they are unwell.
Finally placing a time limit on transfers from prison to hospital will end the scandal of people being left for months in prison when they need to be in hospital. And ending the use of police cells and prisons as “places of safety” will stop people being criminalised and traumatised needlessly in these settings. For these provisions to be successful, it will be essential to have clear systems of accountability for finding hospital beds for people who need them, and to ensure people can move on from secure settings when they are ready to leave.
The provisions for autistic people and those with learning disabilities to prevent the prolonged use of the Act for treatment have been welcomed by charities representing these groups. It’s vital that this law change is accompanied by significant investment in better community services so that people who might otherwise face long spells in hospital get the right help outside an institutional setting for as long as they need it.
How can the Government go further?
While this Bill marks an important step forward, we believe there are additional amendments needed as it progresses through Parliament to ensure it fully addresses critical gaps in mental health support and rights.
For example, the Joint Committee on the Mental Health Bill recommended the creation of a Mental Health Commissioner to scrutinise and coordinate mental health policies across government, ensuring there is parity of esteem for mental health. We explored what this might look like, similarly to the existing Children’s Commissioner role, earlier this year in our briefing.
The Bill makes some important changes to better regulate the use of CTOs, but it stops short of adopting all of the Independent Review’s recommendations. For example, it allows CTOs to continue indefinitely, rather than placing a time limit on each CTO, with the option to make a new one if it is still needed.
As the use of CTOs is the most starkly disproportionate element of the Mental Health Act among racialised groups, it’s vital that their use is more tightly regulated and closely scrutinised. The benefits of CTOs are yet to be proved at scale, and the risk is that they remain a coercive and racially inequitable measure without the necessary controls on their use.
The Bill introduces more distinctions than is the case now between Parts 2 and 3 of the Act. This is due to the different purposes of the two parts, with the latter applying to people in the criminal justice system. But this divergence will have consequences, and it will be for Parliament to debate and discuss the risks this will bring – once again, with racialised communities bearing the brunt of these measures given the disproportionate use of secure care particularly for Black men.
In partnership with the Children and Young People’s Mental Health Coalition, we have also been advocating for a stronger focus on the needs and experiences of children and young people. One key improvement to the new Bill would be the inclusion of a decision-making test for those under 16, which would help clarify the rights and decision-making processes for clinicians, children, and their carers. This would ensure more transparency and consistency in how decisions are made for younger patients.
We would also like to see provision for people’s housing rights while they are detained in hospital. Too many people are made homeless when they are in hospital, for example because they lose their tenancies. We would like to see the new Act require health and local authorities to take affirmative steps to protect people’s housing rights and ensure no one is either discharged homeless or stuck in hospital for too long because accommodation isn’t available for them.
Wider changes needed
Reforming the Mental Health Act is a crucial step, but it is not the only necessary change to build a truly effective and inclusive mental health support system for everyone.
The upcoming 10-year NHS health plan should include a strong focus on investing in high-quality community services for people experiencing mental health problems. This must be supported by adequate funding, both for the provision of services and the urgent updating of the mental health estate, and a well-defined workforce strategy to ensure that people receive coordinated, timely, and compassionate care across all settings. A long-term commitment to the Patient and Carer Race Equality Framework must also be made clear, so that the vital work of changing systems to address racism in mental health care is sustained for as long as it is needed and until Black people’s experiences are on a par with those of the white population.
It’s taken a long time to get this far, and there’s still a long way to go. The Bill will be debated in Parliament in the coming months, and implementation may take a matter of years once the Bill is passed into law. That’s why it’s so important that the Government takes the necessary steps now to modernise our mental health services in line with the legislative framework it’s creating. It’s about time.
