Mental Health Act Reform: Where the 2025 Bill Stands and What It Will Change

The current Mental Health Act dates from 1983 and was substantially amended in 2007. By the 2010s evidence of systemic problems was clear:

• Disproportionate detention of Black, Asian and Minority Ethnic patients — Black patients are 3-4 times more likely to be detained.
• Rising detention rates overall, with around 51,000 detentions a year under the 1983 Act.
• Use of the Act for people with learning disability or autism who do not have a treatable mental health condition.
• Patient autonomy concerns — limited statutory weight for advance decisions, treatment without consent, and Community Treatment Orders applied broadly.

The 2018 Independent Review of the Mental Health Act (the Wessely Review) recommended 154 changes built around four principles: choice and autonomy, least restriction, therapeutic benefit, and treating people as individuals. The government published a White Paper in 2021, a draft Bill in 2022, and the current Mental Health Bill in 2024-2025. It is now progressing through Parliament with broad cross-party support.

The main reforms (subject to final amendments during passage):

1. Section 3 grounds tightened. Detention under section 3 (treatment for up to 6 months initially) will be limited to a "therapeutic benefit" test — there must be a reasonable prospect that treatment will produce a therapeutic benefit, not just management of risk.
2. Learning disability and autism removed from section 3. People with learning disability or autism who do not have a co-occurring mental disorder will no longer be detainable for treatment under section 3. The current widespread practice of detaining autistic people in mental health units for years will be unlawful. The "long stay" cohort in Assessment and Treatment Units is intended to come out as a result.
3. Statutory advance choice documents (ACDs). A new statutory framework lets patients record their preferences about treatment for use during future episodes when they lack capacity. ACDs must be considered by clinicians and recorded reasons given if departed from.
4. Nominated person replaces nearest relative. The current nearest relative (often a family member chosen by an inflexible statutory hierarchy) is replaced by a Nominated Person chosen by the patient themselves. The NP has the right to be consulted, to refuse certain treatments on the patient's behalf, and to apply for tribunal review.
5. Faster tribunal review. Automatic tribunal referral after a shorter period than the current 6-month review point.
6. Tightened Community Treatment Orders (CTOs). CTOs will require evidence of clear therapeutic benefit, will have tighter review, and will not be used for people primarily for risk management without treatment benefit.
7. Statutory care and treatment plan. Every detained patient must have a CTP within a set period of admission, covering treatment, discharge planning, and aftercare.
8. Section 117 aftercare strengthened. Clarified scope and reinforced duty on health and social care commissioners.
9. Police and prison transfers. Limits on use of police cells as a place of safety under s.136 (already largely achieved by s.135/136 changes in 2017 but reinforced) and faster prison-to-hospital transfer timescales for prisoners needing inpatient treatment.

The Mental Health Bill was introduced in the 2024-2025 session. It has cross-party support and is expected to receive Royal Assent within this Parliament. However, as of mid-2026:

• The Bill is in the later stages of Parliamentary consideration but not yet enacted.
• Even after Royal Assent, most provisions will not commence immediately. They require implementing statutory instruments, an updated Code of Practice, and significant operational change in NHS Trusts and ICBs (training, system change, recruitment of approved mental health professionals, expansion of community provision).
• Realistic timeline: phased commencement over 2026 to 2030, with the learning disability/autism changes and ACDs expected first.
• The government has committed to additional funding for community mental health services to absorb the workload shift from inpatient to community.

Until each provision commences, the 1983 Act as amended in 2007 remains in force unchanged. Detention, treatment, CTOs, tribunal rights, and aftercare all continue under existing law.

The current framework — what you can rely on while the reforms are being implemented:

• Detention under sections 2 and 3. Section 2 (28-day assessment) requires an approved mental health professional or nearest relative application and two doctor recommendations. Section 3 (treatment up to 6 months) similar requirements plus a treatable disorder. Section 2 detailed guide; Section 3 detailed guide.
• Section 132 information rights. The hospital must inform the patient of the legal basis for detention, the patient's rights, and how to apply for tribunal review.
• Independent Mental Health Advocate (IMHA). Available to all detained patients to help them understand and exercise their rights. Free, independent of the hospital. Guide to IMHAs.
• Nearest relative. Under the current statutory hierarchy (s.26 MHA 1983) — partner first, then ascending age order through children and other relatives. Can apply for detention, object to section 3 admission (effective veto in many cases), and apply for tribunal review.
• First-tier Tribunal (Mental Health) review. Detained patients have an automatic right to apply for tribunal review of detention. Tribunal guide.
• Section 117 aftercare. Once a person has been detained under s.3 they are entitled to free aftercare from health and social services for as long as needed. Section 117 guide.
• Community Treatment Order (CTO). Currently used for many s.3 patients on discharge. Reform will tighten the criteria but CTOs continue in their current form until commencement. CTO guide.

While the reforms are being implemented you can:

• Make an advance decision under the Mental Capacity Act 2005. Currently the most enforceable way to record treatment preferences. Section 26 of the MCA gives statutory weight to advance decisions about refusing specified treatment if validly made. Talk to your psychiatrist and GP about creating one.
• Make an advance statement. Less formal than an advance decision but still considered by clinicians. The Wessely Review's ACDs build on this practice — you can already write one and ask for it to be added to your medical record.
• Lasting Power of Attorney for Health and Welfare. Names a trusted person to make health and welfare decisions if you lose capacity. Includes mental health treatment decisions where you have specifically authorised them.
• Section 132 rights. Always know and exercise these — request an IMHA, apply for tribunal review, ask for the legal basis of any treatment without consent.
• Section 117 entitlement. After s.3 discharge, you are entitled to free aftercare. Insist on a CPA-equivalent care plan, named care coordinator, and clarity about which services are provided.
• Complaints. If treated poorly during detention, complain via the NHS complaints procedure and escalate to the Parliamentary and Health Service Ombudsman after exhaustion. Care Quality Commission can also receive concerns about hospital practices.
• Free legal aid for tribunal proceedings — mental-health legal aid is not means-tested for s.21A or s.66 applications. Find a solicitor with the relevant legal aid contract early.