It’s finally here after years of reviews, drafts, and debates. The long-awaited Act introduces the biggest reform of Mental Health law in England and Wales since the primary statutory framework in 1983.
The Mental Health Act 2025 was passed on the 18th of December 2025 and will reform and amend key provisions of the Mental Health Act 1983. The new legislation is intended to bring outdated mental health laws into the 21st century by reducing detentions, providing more sustainable pathways to recovery, and offering a more holistic person-centred approach to mental health prevention and treatment. The hope is that it will also address racial disparity, which currently exists in the system.
The key principles of the Act are:
- Choice and autonomy: there is involvement of the person in decision-making, as well as consideration of the views of the carer/s and other interested parties.
- Least restrictive to minimise restrictions on liberty as far as consistent with the person’s wellbeing, safety for the person and others.
- Therapeutic benefit, so the effectiveness and appropriateness of treatment are considered.
- Treating the person as an individual supports dignity and considers their attributes and past experiences.
The changes will affect the entire health and care system. The key areas for organisations under the new Act should be evidencing therapeutic benefit; justification for detention and treatment; likely outcomes; and the importance of care and treatment plans. New provisions, such as community and crisis provisions, should be developed and provided to prevent detention in hospital settings. This will be important, particularly for children and people with learning disabilities and autism. There will be a need to increase the workforce to meet the increased workload and to support alternative community provision.
Implementation
Although the Act is now law, full implementation will be gradual, and the Mental health Act 1983 remains the primary legislation to be followed by practitioners. The full range of changes of the new Act are expected to be enacted over a period of up to 10 years. Some limited provisions will come into force on the 18th of February 2026 (see below), and the rest will be implemented in phases. The priority would be developing a new Code of Practice and supporting secondary legislation, followed by workforce training.
Initiation
On 18th February 2026 limited provisions will come into force and will affect people in the criminal justice system, particularly restricted patients. These changes were introduced because of a Supreme Court Judgment which held that the existing Mental Health Act did not allow conditions amounting to a Deprivation of Liberty on conditional discharge. Please take a look at the final link below.
Reforms to Detention Criteria
One of the biggest shifts in the new Act concerns when someone can be detained under the Mental Health Act. Under Sections 2 and 3, detention will require a risk of serious harm to the person or others once these provisions are commenced. Professionals will have to consider not just that harm might occur, but its nature, degree, and likelihood. There’s also a new “reasonable prospect” test, meaning there must be a real therapeutic benefit to detaining someone under Section 3 of the Act. The plan is to shorten detention periods under Section 3 from 6 months to 3 months. These changes will also apply to Community Treatment Orders (CTOs), so the focus will be on being more targeted, justified, and therapeutic, and more clinicians must agree before a CTO is made or renewed. This should reduce the use of CTOs as a default or long-term control measure. Statutory Care and Treatment Plans will also be in place for most under the Act.
Children and People with Learning Disabilities and Autism
Learning disability and autism will no longer on their own, be treated as mental disorders for the purposes of detention under the new Act. This is a significant legal change, particularly in relation to Section 3, which allows for longer-term detention for treatment. Detention under the Mental Health Act will only be lawful where a child or a person with a learning disability or autism also has a co-occurring mental health condition that requires hospital treatment. These reforms place a duty on local health commissioners and local authorities to invest in community support to reduce unnecessary hospital admissions. Local areas must also keep “at risk” registers to help identify children and people who may be nearing crisis, allowing care to be planned and delivered in the community. Overall, the focus moves away from inpatient mental health settings and towards early support and prevention. Detention should only be used where there is a clear clinical benefit, rather than because someone has a learning disability or is autistic.
Representation and Control for the Person and their Representatives
The Nominated Person.
The old Nearest Relative system will be replaced with the “Nominated Person” (NP).
Under the new Act, people will be able to choose their own “Nominated Person” (NP), someone they trust to represent their wishes if they become unwell. This is all about giving the person back choice and control, not leaving it to chance or outdated family hierarchies.
Independent Mental Health Advocates for Everyone
- Independent Mental Health Advocates (IMHAs) will now be available to informal (voluntary) patients too.
- Hospitals will have a duty to notify advocacy services when someone qualifies for advocacy, and advocates will be expected to visit, talk to the person, and support them in decision-making about their care and treatment.
- This is a vital step to ensure that every voice is heard, not just those under formal detention.
- The advocacy service will be an opt-out service rather than an opt-in service as it was before.
Advance Choice Documents: Planning Ahead
Another positive change is the introduction of Advance Choice Documents (ACDs).
This is a way for people with capacity to record their wishes and preferences before a crisis occurs. This should detail their preferences for future care and treatment, including the medications and therapies they prefer. This should also include any treatment they wish to refuse and any broader wishes they think will help, such as the environment, staff approach and support. There will be a duty to ensure people know about them, are supported to write them, and can be accessed by clinicians at the right time.
ACD’s must be considered by clinicians, although in rare, urgent circumstances, clinicians may override them under strict safeguards.
Strengthening Rights but Providing the Balance
Tribunal Hearings and the Secretary of State
There will be more frequent tribunal hearings. The Act seeks to strengthen the rights of the person and their representatives to appeal against detention, to provide easier access to second opinions from Second Opinion Appointed Doctors (SOAD), and to enhance access to the First-tier Tribunal (Mental Health). This includes an automatic tribunal review every year, and the tribunal can impose safe community conditions rather than keeping the person in hospital unnecessarily. In addition, it aims to enhance the rights of children and young people by ensuring that their wishes, as well as those of those close to them, are more central to decision-making.
There will be new powers for the Tribunal to impose stronger conditions outside hospital whilst still respecting the person’s rights.
Safeguards will still apply and the Secretary of State now has a legal power to protect the public by managing people considered to be high risk in the community, including those who may be deprived of their liberty
Place of Safety
Police stations and prisons will no longer be classed as places of safety under the Act, with a clear expectation that places of safety should be health-based.
Other Areas of Change
There will also be the following:
- In terms of criminal justice reforms, there will now be a 28-day time limit for transfers from prisons or immigration centres to a hospital. If this is not the case, it should be justified and could be legally challenged.
- The Act introduces stronger procedural safeguards before electroconvulsive therapy (ECT) can be given, especially when a person refuses it.
- The Act now states that Section 117 aftercare continues until the responsible bodies give the person written notice that they are satisfied that Section 117 aftercare is no longer needed and also changes the rules that identify which local authority is responsible for the provision of aftercare.
- The Act extends duties to private mental health providers delivering publicly arranged or funded care, ensuring consistent human rights protections for all people, regardless of who provides the service.
Conclusion
The Mental Health Act aims to give people more control over their treatment, reduce unnecessary detention, provide alternatives to hospital care within the community and improve protections for those with autism and learning disabilities, which can be seen as a step forward.
However, the worry is that these changes may not work well without major investment, and we do not know what the unintended consequences are for people with learning disabilities and autism under the Mental Health Act.
For further information, please see:
https://www.legislation.gov.uk/ukpga/2025/33/enacted
https://www.gov.uk/government/news/mental-health-bill-receives-royal-assent-revolutionising-care
Reformed Mental Health Act Royal Assent – what it means, how SCIE can help
Mental Health Bill: memorandum on European Convention on Human Rights (ECHR) – GOV.UK
tri.x online policy and procedure manuals are developed and supported by a team of industry leaders for local authority and independent sectors. The manuals cover children and adult; social care, safeguarding partnership/boards, supported accommodation, children’s homes, adoption and fostering. Find out how we can help you strengthen compliance, consistency, and best practice across your organisation.