The Mental Health Act 2025, which amends and modernises the Mental Health Act 1983, received Royal Assent on 18 December 2025, albeit the majority of the provisions are not yet in force.
The MHA 2025 was a long-awaited act. Detentions under the MHA 1983 rose by over a third between 2006 and 2016, possibly contributed to, inter alia, by 2007 reforms to the MHA which widened the definition of mental disorders and treatment and reduced availability of alterative community care. It was widely recognised that patients under the Act often felt they had a poor experience of care. It is no coincidence that the December 2018 Final Report of Sir Simon Wessley’s Independent Review of the Mental Health Act 1983 was entitled “Modernising the Mental Health Act”.
There has also been no shortage of hype generated around the changes that the MHA 2025 will introduce, with the act variously described as “groundbreaking” (Sarah Murphy, Mental Health and Wellbeing Minister), “a turning point” (Lord Timpson, Minister for Prisons, Probation and Reducing Reoffending) “a major step” (Dr Adrian James, Medical Director for Mental Health and Neurodiversity at NHS England), and a “landmark” introducing ““urgent reforms… bringing mental health care into the 21st century and empowering patients to take charge of their treatment” (Department of Health Announcement 18.12.25).
There is certainly a focus on autism and learning disabilities within the Act, which were two of the key areas of experience identified in the independent review. Although also billed as “tackling unacceptable [racial] disparities” (), again identified in the independent review, it is unclear which parts of the Act are said to be directed at this goal.
Various aspects of the previous regime amended by the MHA 2025, including prisons and police stations as a place of safety and the grounds for detention, were identified in the December 2018 Final Report of Sir Simon Wessley’s Independent Review of the Mental Health Act 1983 as having a disproportionate impact on black patients. The announcement from the Department of Health seems to indicate that the tackling of racial disparities will be achieved primarily through the future publication of “clearer guidance”. What form that will take, and whether the changes will have the intended effect, is as yet unclear.
Practitioners may welcome the more explicit approach to medical treatment decision-making and the extent to which this echoes the best-interests approach adopted under the MCA 2005. The focus on “least restriction” also echoes the principles for approving deprivation of liberty within the MCA 2005 and Court of Protection.
However, practitioners may also share the concerns of the Joint Committee on Human Rights, as published in their Third Special Report of Session 2024–25 HC 1217, on the lack of guidance as to the interface between the MCA 2005 and the MHA 1983. The government’s response to this concern was that further guidance will be published in the revised Code of Practice.
With many of the changes not yet in force, and appearing to depend on the content of regulations and guidance yet to be produced, the transformative extent of the Act remains to be seen.
10 key changes are spotlighted below.
(1) Revised principles to inform decisions made under the MHA 1983 (ss1-2 MHA 2025)
Pursuant to s118 MHA 1983, the Secretary of State must prepare and from time to time revise a Code of Practice to provide guidance about the MHA 1983.
That Code is required to include a statement of principles, which previously had to address 9 different matters: respect for patients’ past wishes and feelings, respect for diversity, minimising restrictions on liberty, involvement of patients in planning and delivering care, avoiding unlawful discrimination, the effectiveness of treatment, views of carers and other interested parties, patient wellbeing and safety, and public safety.
These 9 discrete matters have been replaced by four new headline principles, which broadly cover the previous 9 matters whilst placing a new emphasis on the patient/person as an individual:
- Choice and autonomy: involvement of patients in decision-making, and consideration of the views of carers and other interested parties
- Least restriction: minimising restrictions on liberty so far as consistent with patient wellbeing and safety and public safety
- Therapeutic benefit: effectiveness and appropriateness of treatment
- The person as an individual: treating patients with dignity and respect and considering their attributes and past experiences
These were the principles identified in the December 2018 Final Report of Sir Simon Wessley’s Independent Review of the Mental Health Act 1983.
It is currently unknown when the new Code of Practice will be published. The last update to the Code of Practice was on 31 October 2017.
(2) Greater protection for those with autism and learning disabilities (ss3-4 and Sch 1 MHA 2025)
Previously, the MHA 1983, which applies to mentally disordered patients, defined “mental disorder” (“any disorder or disability of the mind”) and included a carve-out for those with learning disabilities whose disability was not associated with “abnormally aggressive or seriously irresponsible conduct”.
The MHA 1983 introduces two new definitions, and moves the definition of learning disability; “autism”, “learning disability”, and “psychiatric disorder” are now defined after “mental disorder” in s1(2) the MHA 1983:
- “autism” means a lifelong developmental disorder of the mind that affects how people perceive, communicate and interact with others;”;
- “learning disability” means a state of arrested or incomplete development of the mind which includes significant impairment of intelligence;” (maintained from the old version of the MHA 1983)
- “psychiatric disorder” means mental disorder other than autism or learning disability”.
The old carve-out for those with learning disabilities is replaced by a new s1(2A), which defines when a person’s learning disability has “serious behavioural consequences”; “if it is associated with abnormally aggressive or seriously irresponsible conduct by the person.”.
The new trinity of concepts – autism, learning disability, and psychiatric disorder – is deployed throughout the MHA 1983 to greater protect those with autism and learning disabilities from compulsory admission and and treatment.
In particular, Schedule 1 of the MHA 2025 amends Part 2 of the MHA 1983, (which concerns compulsory admission to hospital and guardianship) limiting the application of ss3 (admission for treatment), 17A (community treatment orders), 17E (power to recall community patient to hospital), and 20 (renewal of authority in relation to admission for treatment and guardianship) to psychiatric disorders, rather than the more broadly defined mental disorder.
However, applications for guardianship may still be made on the basis of autism or learning disability, in addition to psychiatric disorder.
A new Part 8A has been inserted which contains greater detail on “People in England with Autism or Learning Disability”. Duties imposed under Part 8A include making arrangements for care, education and treatment review meetings for certain patients liable to be detained under the Act, and a duty on ICBs to establish and maintain a register of people who (a) the ICB has responsibility for and (b) the person is someone the ICB considers to have autism or a learning disability and specified risk factors, and who (c) consent to inclusion in the register or lack capacity/competence to consent but in respect of whom the ICB considers it in their best interest to be in the register. ICBs and local authorities must have regard to the register when exercising their commissioning and marketing functions.
(3) Removal of police stations and prisons as a place of safety (s48 MHA 2025)
This amendment is introduced by s48 MHA 2025. There are a greater range of places of safety for children and young persons (a community home provided by a local authority or a controlled community home, or any hospital, surgery, or any other suitable place, the occupier of which is willing temporarily to receive a child or young person) than there are for adults (any hospital the managers of which are willing temporarily to receive that person), but for children, adults, and young people, a prison or police station is no longer a place of safety.
(4) Changes to the grounds for assessment and treatment (ss5-7 MHA 2025)
The core concepts in the old statutory language – a mental disorder of a nature or degree which warrants the detention, combined with a concern for safety of the patient or others (and, where relevant, availability of treatment) – are maintained. However, the new statutory language introduces a higher threshold (risk of serious harm) and includes an explicit balancing exercise.
Compare, for example, the old test for an application for admission for assessment under s2 MHA 1983 to the new test under s2 MHA 1983 (emphasis added):
Old test: (2) An application for admission for assessment may be made in respect of a patient on the grounds that—
(a)he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
(b)he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.
New test: (2) An application for admission for assessment may be made in respect of a patient on the grounds that—
(a)he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period;
(b)serious harm may be caused to the health or safety of the patient or of another person unless the patient is so detained; and
(c)given the nature, degree and likelihood of the harm, the patient ought to be so detained.”
Compare also the changes to s3 MHA 1983 (admission for treatment) (emphasis added):
Old criteria: (a) he is suffering from a mental disorder of a nature or degree which makes it appropriate for him
to receive medical treatment in a hospital; and
(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c)it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section; and
(d)appropriate medical treatment is available for him.
New criteria: (a)he is suffering from a mental disorder of a nature or degree which makes it appropriate for him
to receive medical treatment in a hospital; and
(b)serious harm may be caused to the health or safety of the patient or of another person unless the patient receives medical treatment,
(c)it is necessary, given the nature, degree and likelihood of the harm, for the patient to receive medical treatment,
(d)the necessary treatment cannot be provided unless the patient is detained under this Act, and
(e)appropriate medical treatment is available for the patient.”
Similar changes have been introduced to ss17A (community treatment orders) and 20 (renewal of authority in relation to admission for treatment and guardianship), and the grounds for discharge by a tribunal (s72) have been brought in line with these amendments). The “serious harm” threshold has also been introduced to s5 (detention for six hours pending application for admission).
(5) A new definition of appropriate medical treatment (ss8-9 MHA 2025)
Linked to the amendments above is the new definition of appropriate medical treatment at s1A (replacing the old definition in s3(4) which has been removed).
New s1A now reads:
In this Act –
(a) references to appropriate medical treatment, in relation to a person suffering from mental disorder, are references to medical treatment which, taking into account the nature and degree of the disorder and all other circumstances—
(i)has a reasonable prospect of alleviating, or preventing the worsening of, the disorder or one or more of its symptoms or manifestations, and
(ii)is appropriate in the person’s case;
(b)references to medical treatment, in relation to mental disorder, are references to medical treatment the purpose of which is to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.”
The old definition was “medical treatment which is appropriate in his case, taking into account the nature and degree of the mental disorder and all other circumstances of his case”. The new definition adds the concept that the treatment must have a “reasonable prospect of alleviating, or preventing the worsening of, the disorder or one or more of its symptoms or manifestations”.
(6) A process for making treatment decisions which is not, but which echoes, best-interests decision making (see ss11-21 MHA 225, which cover treatment)
A new s56A has been introduced which sets out comprehensively the steps to be taken and the factors to consider in making a treatment decision:
(1)In deciding whether to give medical treatment to a patient by virtue of this Part, the approved clinician in charge of the treatment must—
(a)identify and evaluate any alternative forms of medical treatment available for the patient;
(b)take such steps as are reasonably practicable to assist and encourage the patient to participate, as fully as possible, in the decision-making process;
(c)not rely merely on—
(i)the patient’s age or appearance, or
(ii)a condition of the patient’s, or an aspect of the patient’s behaviour, which might lead others to make unjustified assumptions about what medical treatment might be appropriate for the patient;
(d)consider the patient’s past and present wishes, feelings, beliefs and values, so far as it is reasonable to regard them as relevant and so far as they are reasonably ascertainable;
(e)consider the relevant views of the following, so far as they are reasonably ascertainable—
(i)anyone named by the patient as someone to be consulted on the decision in question, or decisions of that kind;
(ii)the patient’s nominated person and any independent mental health advocate from whom the patient is receiving help by virtue of section 130A or 130E;
(iii)any donee or deputy for the patient;
(iv)any other person who cares for the patient or is interested in the patient’s welfare and whom the approved clinician considers it appropriate to consult;
(f)consider all other circumstances of which the approved clinician is aware and which it would be reasonable to regard as relevant.
(2)Where the patient lacks capacity in relation to matters that, in the opinion of the approved clinician, are relevant to the decision, the approved clinician must also consider any wishes, feelings, views and beliefs that the clinician thinks the patient would have in relation to those matters but for the lack of capacity (including any relevant written statement made by the patient when they had capacity).
(3)In subsection (1)(e), “relevant views” means—
(a)views about the nature of the patient’s past and present wishes, feelings, beliefs and values,
(b)where the patient lacks capacity in relation to matters that, in the opinion of the approved clinician, are relevant to the decision, views about the nature of the wishes, feelings, views and beliefs the patient would have in relation to those matters but for the lack of capacity, and
(c)views about whether the medical treatment should be given to the patient.”
Practitioners familiar with the MCA 2005 will recognise the new statutory language, which bears a strong similarity elements of to s4 MCA 2005 (best-interests decision making).
A new s57A has also been introduced, which sets out that treatment which a capacitous patient has not consented to, or which conflicts with a valid and applicable advance decision or decision of a donee or deputy or the Court of Protection, may only be given where there is a compelling reason to give treatment of that form and a second opinion appointed doctor (covered by new s56B) has certified various matters in writing, including that the treatment was appropriate and the decision to give the treatment was made in accordance with new s56A.
There is also a new duty for the appropriate practitioner to prepare a care and support plan for patients liable to be detained otherwise than by virtue of an emergency application or for assessment/under ss135 and 136. The care and support plan should be made in accordance with regulations by the Secretary of State: see new s130ZA, and compliance with this duty must be monitored by the managers of the hospital/registered establishment/local authority.
(7) Replacement of nearest relatives with nominated persons (ss24-28 and Sch 2 MHA 2025)
The “nearest relative”, intended as a safeguard for those to whom the MHA 1983 applies, is not the same as a next of kin, but was defined by reference to a not-uncomplicated hierarchy set out within the MHA 1983 itself.
The MHA 2025 has replaced the concept of the “nearest relative” with a “nominated person”. Sch 2 MHA 2025 contains amendments of the Mental Health Act 1983 which—
- (a)make provision about the appointment of a nominated person for a patient,
- (b)transfer to nominated persons functions currently conferred on patients’ nearest relatives, and
- (c)confer functions on nominated persons for certain patients concerned in criminal proceedings.
Where the patient is 16 or over, the nominated person must be 16 or over; where the patient is under 16, the nominated person must be 18 or over. This is the first criterion of eligibility. The second criterion of eligibility is that the person is not disqualified by reason of a court order terminating their previous appointment as a nominated person. Various formalities, including appointment by an instrument in writing signed by the patient and a witness and a signed statement by the nominated person and by a witness, are also required.
(8) Reduced detention periods (s29 MHA 2025)
The old 6-month period of detention for treatment under s20 has been replaced by a three month period. However, a patient placed under guardianship in pursuance of a guardianship application may still be kept under guardianship for 6 months.
(9) New deprivation of liberty safeguards (s35 MHA 2025)
A necessity condition has been inserted for the imposition of conditions on a conditional discharge where those conditions amount to a deprivation of liberty; they may only be imposed if necessary for the protection of another from serious harm.
(10) Promoting independent mental health advocates (Sch 3, ss40-44 MHA 2025)
Schedule MHA 3 contains amendments relating to independent mental health advocates, including amendments which:
- provide for informal patients to qualify for help from independent mental health advocates;
- impose duties on hospital managers and others to notify providers of advocacy services about qualifying patients;
- impose duties on providers of advocacy services to arrange for certain patients to be interviewed to find out whether they want to use those services.
ss40-44 also contain amendments, relating to the provision of information, including about complaints, and advance choice documents.
Other amendments
This article does not give a comprehensive overview of all the amendments introduced. However, some other potentially notable amendments include:
- The provision for a greater role for community clinicians, through ss22-23 MHA 2025
- Greater consultation requirements on discharge: see s34 MHA 2025
- The grant of a power to Tribunals to recommend the provision of s117 after-care services to a patient: see s45 MHA 2025
- Explicit recognition of the circumstances in which a registered care provider will be regarded as exercising functions of a public nature such as to engage the HRA 1998: see s51 MHA 2025
Statistics on the Mental Health Act are published annually, usually in or around the September of each year, covering the previous April-March. It will be interesting to see whether there are any identifiable trends flowing from these changes in the next few sets of data, and if so, whether they indicate that the aims of the reforms have been achieved.