The new Mental Health Act
After 40 years of campaigning, the Mental Health Act has finally been reformed for the 21st Century. In December 2025, the Mental Health Bill received Royal Assent - the final step in the parliamentary process, and a landmark moment for mental health rights.
This is a historic campaign win towards modernising the outdated laws that dictate what happens when someone is detained under the Mental Health Act.
People with lived experience have been at the heart of this journey - their expertise and persistence has driven the movement for reform from the very beginning. Their contributions remain central to what happens next. Our priority now is to shape the new Code of Practice, the guidance that will determine how the new Act works in practice every day.
What's in the new Mental Health Act?
The new Mental Health Act aims to put choice, dignity and respect at the heart of compulsory care. There are four guiding principles which underpin the new Act:
- Choice and autonomy
- Least restriction
- Therapeutic benefit
- The person as the individual
These principles will be considered when writing the Code of Practice that professionals will use when implementing the new Act. Advance Choice Documents will be introduced, which will allow individuals to record treatment preferences that services must consider. They allow a patient to set out their wishes, feelings, values and beliefs when they are well, and to guide clinical decision-making when they are unwell. There is significant research which demonstrates the benefits of Advance Choice Documents for all patients, and particularly those from racially minoritised communities.
The new Act will replace the “nearest relative” with a chosen Nominated Person to support decision-making. This marks a powerful shift toward dignity, autonomy and real choice for people who may be detained in the future. This has been a long-standing demand of campaigners. The Nominated Person model will give a detained individual far greater control at one of the most vulnerable moments in their lives, and ensure that decisions about care, detention and treatment reflect the voices of those they genuinely trust.
Other changes include:
- The ability to formally challenge detention through more frequent access to Mental Health Tribunals.
- The introduction of statutory care and treatment plans and the need to record the reasons for compulsory treatment and restrictive practices to improve transparency.
- Increased access to Independent Mental Health Advocates, including for involuntary patients.
- Increased threshold for detention and the improvements to care for those in contact with the criminal justice system.
- Police cells and prisons can no longer be used as ‘places of safety’ for people who have been detained for mental health reasons.
- A 28 day limit on transferring patients from prison to hospital if they need treatment for their mental health.
What was wrong with the old Mental Health Act?
There were several problems with the old Mental Health Act (1983) – it was outdated, overly restrictive, and often failed to respect people’s rights or dignity.
It was also designed for a very different era, when care was more institutional, and people had very little say in decisions about their treatment. It didn’t reflect modern understandings of mental health, people’s rights, or what good, compassionate care looks like today.
The old law gave patients limited influence over how they were treated and automatically appointed a ‘nearest relative’ to be involved in their care - an approach that ignores complex family relationships. This caused distress, sidelined supportive friends or partners, and often put people at risk.
The Act has also contributed to deep inequalities. Black men are four times more likely to be detained under the Mental Health Act and eight times more likely to be placed on a Community Treatment Order after leaving hospital, which can severely restrict their freedoms and require ongoing compulsory contact with services.
There were also weak safeguards and limited accountability. Reviews of detention were infrequent, patients had few routes to challenge poor decisions, and safeguards weren’t strong enough to protect people from unnecessary or prolonged detention.
The law didn’t encourage community support, crisis alternatives, or prevention. Too often, people were detained simply because services were overstretched and the law offered few other options.
What will change for someone detained in the future?
Under the new Mental Health Act, detention should be more transparent, person-centred and focused on genuine need. It should only be used when there is clear evidence that it will help and when there is a serious risk of harm.
One of the biggest shifts will be a stronger emphasis on patient choice. People will have more say over their treatment, with services required to meaningfully consider their preferences and any Advance Choice Documents they have agreed. When detained, people will benefit from stronger safeguards. Reviews of someone’s detention would happen more frequently, giving them quicker opportunities to challenge decisions. As mentioned, the outdated “nearest relative” rules would be replaced by a new right to choose a “nominated person,” ensuring that individuals can appoint someone they trust to advocate for them.
Day-to-day care will become more personalised and respectful. Services would need to ensure people understand their rights, involve them in care planning and take greater account of their cultural background, family situation and recovery goals.
Discharge planning would start earlier to prevent unnecessary long stays, while wider changes to crisis care aim to reduce the use of police involvement and ensure health services lead the response. Overall, the reforms are designed to create a system that is fairer, more transparent and more focused on people’s dignity and autonomy.
Are there any remaining concerns?
Yes, although the new Act aims to modernise mental health law and strengthen rights, there are significant concerns about how well it will work in practice. Much depends on services having enough staff, resources and community alternatives, without which stronger legal rights may not translate into real change.
We want all patients detained under the Mental Health Act to have equal access to advocacy, to Mental Health Tribunals and other rights, no matter what part of the Act they are detained under. There will be some differences depending on whether a person is involved in criminal proceedings. We are particularly concerned that this will have a disproportionate effect on people from racially minoritised backgrounds, who are already significantly more likely to both be detained under and have negative experiences under the Mental Health Act.
We must see adequate funding for community services to address any potential unintended consequences for people with learning disabilities and autism under the new Act. The changes affecting children and young people detained under the Mental Health Act will need to be very carefully managed.
Finally, many reforms rely on detailed regulations and implementation plans that are not yet in place, creating uncertainty about how consistently the new system will be applied and whether it will genuinely improve people’s experiences.