The Mental Health Act 2025 summarised

The Mental Health Act 2025 received Royal Assent on 18 December 2025. It makes significant changes to the Mental Health Act 1983 (MHA) and aims to strengthen the voice of the patient and ensure that detention is only used when, and as long as, necessary.   

The following is a summary of the key provisions in the 2025 act.  

Amending the detention criteria

The 2025 act amends the criteria for detention under part 2 of the MHA and renewals. The aims are to provide greater clarity as to the level of risk that a person must present in order to be detained and limit the detention of patients with a learning disability and autistic people.

First, a “serious harm” test is inserted into the criteria for detention under sections 2 and 3. It must be shown that serious harm may be caused to the health or safety of the patient or another person, unless the patient is detained (or receives medical treatment in the case of section 3 detention).

Second, there must be consideration of the “nature, degree and likelihood” of the harm. For both section 2 and 3 detentions, this means that decision makers must consider the type and severity of the harm and the likelihood of this occurring.

Third, for section 3 detention, “appropriate treatment” must be available. This is defined as treatment which has a reasonable prospect of alleviating or preventing the worsening of the disorder or one or more of its symptoms or manifestation, and which is appropriate in the patient’s case.

Finally, it will no longer be possible to detain people with a learning disability or autistic people under section 3 unless they have a co-occurring “psychiatric disorder” that warrants hospital treatment. This exclusion does not apply to part 3 patients (those concerned with criminal proceedings).

Replacing the nearest relative with the nominated person

The 2025 act replaces the nearest relative with a new statutory role, the nominated person (NP).

The NP can be selected by the patient at any time when they have capacity or competence to do so. The nomination must be witnessed by a health or care professional, who must confirm a number of matters, including that there is no reason to think that the patient lacks the relevant capacity or competence or that undue influence and fraud has been used.

The NP continues to represent the patient even if that patient subsequently becomes unwell and no longer has the relevant capacity or competence. If the patient lacks capacity or competence to nominate, and has not made a nomination, an approved mental health professional (AMHP) may appoint a NP for the patient.   

The NP has the same rights and powers as nearest relatives have now. In addition, the NP would have new rights to be consulted about statutory care and treatment plans and transfers between hospitals, and to object to the use of a community treatment order (CTO).

Currently, when a nearest relative exercises their powers inappropriately or unreasonably, the main option is often seeking an order from the county court to remove or displace them from their role. The 2025 act changes this to enable the NP to be temporarily overruled when they exercise certain powers (such as objecting to section 3 admission). This is intended to ensure that, where appropriate, the NP can continue to have a role in the patient’s care and treatment. The county court retains the power to terminate the appointment of a NP either permanently or for a specified time.

Regulating compulsory medical treatment

The 2025 act makes several reforms to part 4 of the MHA, which regulates when treatment can be imposed on detained patients. The amendments seek to promote patient choice and autonomy.

A duty is placed on treating clinicians to consider certain matters and take a number of steps when deciding whether to administer medical treatment to a patient. These include considering the patient’s wishes and feelings, assisting patients to participate in treatment decisions and consulting those close to the patient.   

New safeguards are introduced for patients refusing medication, either with capacity or competence at the time, or in a valid and applicable advance decision, or where the treatment is in conflict with a decision made by a donee of lasting power of attorney, a deputy or the Court of Protection. In these circumstances, the treatment cannot be given unless there is a “compelling reason” to give the treatment and a second opinion approved doctor (SOAD) has provided certification. A compelling reason means that no other forms of treatment are available or that alternatives are available, but the patient has not consented (or they would conflict with an advance decision or a decision by a donee, a deputy or the Court of Protection).

Currently, the MHA provides that medication can only be provided to a patient beyond three months if certification is provided by a SOAD or the approved clinician. The 2025 act shortens this to two months. This applies in cases where the patient consents, or lacks capacity or competence to consent and there is no conflict with any advance decision or a decision by a donee or deputy or the Court of Protection.

The 2025 act gives additional safeguards to patients who do not consent to urgent electro-convulsive therapy (ECT). In order to give such treatment, a SOAD must first issue a certificate within a time period prescribed in regulations. This applies in cases where the patient has capacity to consent, or lacks capacity or competence to consent and there is no conflict with any advance decision or a decision by a donee or deputy or the Court of Protection.

Also, the 2025 act removes the power to give urgent treatment to patients with the relevant capacity or competence on the basis that it is considered necessary to alleviate serious suffering, as is currently permitted under section 62. This is sometimes referred to as the ‘right to choose to suffer’.

Reforming community treatment orders (CTOs)

The 2025 act revises the criteria for the use of CTOs in line with changes to the detention criteria (see above).

First, CTOs may only be used if there is a risk of “serious harm” to the health and safety of the patient or others. Second, consideration must have been given to the “nature, degree and likelihood” of the harm. Third, “appropriate treatment” must be available. Finally, a person cannot be made subject to a CTO solely on the basis of their learning disability or autism.

The CTO must also be agreed in writing by the community clinician. The mental health tribunal is given the power to recommend that the responsible clinician reconsiders whether a particular CTO condition is necessary.

Learning disability and autism: improving support

As well as excluding certain people with a learning disability and autistic people from long-term detention and CTOs (see above), the 2025 act also introduces two new provisions aimed at improving inpatient and community support for people with a learning disability and autistic people.

First, care (education) and treatment reviews (C(E)TRs) are placed on a statutory footing. The responsible NHS commissioning body must ensure that C(E)TRs are held when a child or young person with a learning disability or autism is detained under the MHA. Certain bodies (such as the responsible clinician, integrated care boards (ICBs) and local authority) are then required to have regard to recommendations made by the C(E)TR.

Second, ICBs are required to establish and maintain a register of people with a learning disability and autistic people who are at risk of detention under the MHA (known as a ‘dynamic support register’). ICBs and local authorities must have regard to the register and the needs of the local ‘at risk’ population, when carrying out certain commissioning duties.

These changes apply in England only.

Introducing statutory care and treatment plans 

The 2025 act introduces statutory care and treatment plans for detained patients (and those subject to CTOs and guardianship), except those under short-term detention powers.

Responsible clinicians are placed under a duty to prepare and regularly review the plan, and regulations will be used to set out the contents of the plan.

These changes apply in England only.

Access to independent mental health advocates (IMHAs)

IMHAs are specially trained advocates who represent and support patients detained under the MHA.

The 2025 act extends the right to an IMHA to informal patients. It also introduces an ‘opt-out’ system, whereby hospital managers and others are required to notify advocacy services about qualifying patients and those services must then arrange for an IMHA to visit and interview the patient to find out if they wish to receive help from an advocate. The aim is to increase the uptake of IMHAs.

These changes apply in England only.

Shortening detention periods

The 2025 act shortens the period that a patient may be kept in detention for treatment. 

The initial detention period is reduced from six months to three months. This can be renewed for a further three months (reduced from six months) and then for six months (reduced from one year).

These changes mean the patient’s initial detention will expire sooner, and if the detention is to continue, it must be reviewed and renewed more frequently.

Access to mental health tribunals

The 2025 act provides that patients have greater access to the tribunal. Specifically:

• section 2 patients can apply to the tribunal within 21 days of detention (rather than 14 days currently);
• section 3 patients can apply within three months (rather than six months currently); and
• automatic referrals to the tribunal take place - in cases where the patient has not exercised their right to apply - three months from the date on which the patient was first detained and then ever 12 months.

Discharge process safeguards

The 2025 act provides that before a patient is discharged from detention, the responsible clinician must consult someone professionally concerned with the patient’s treatment.

This is intended to ensure that patients are not discharged inappropriately where they may be a risk to themselves or others. There are similar safeguards introduced in respect of the decision to discharge guardianship.

Principles to inform decisions

The 2025 act amends section 118 of the MHA so that the statement of principles in the MHA code of practice must include the four principles developed by the 2017-18 Independent Review of the Mental Health Act, whose recommendations laid the basis for the reforms.

Those principles are: choice and autonomy, least restriction, therapeutic benefit, and the person as an individual. This will apply to the codes of practice in England and in Wales.

Section 117 after-care

The 2025 act amends section 117 of the MHA to provide that the responsible after-care bodies must give written notice to a patient in order to discharge them from after-care services.

It also changes the rules that identify which local authority is responsible for the provision after-care services, by applying new ‘deeming provisions’. In broad terms, these mean that when a person is placed out of area, they will remain ordinarily resident in the area of the placing authority. So, for example, where a person living in local authority A is placed into a care home in the area of local authority B, local authority A will remain responsible for providing or arranging their after-care.

The mental health tribunal is also given the power to recommend that the responsible after-care bodies make plans for the provision of after-care services. The tribunal can reconvene to reconsider a case if any such recommendation is not complied with.

Advance choice documents

The 2025 Act places duties on NHS bodies - such as ICBs and local health boards in Wales – to make appropriate arrangements to provide information about, and help people create, advance choice documents.

These are written records of a person’s wishes and feelings, and decisions about their future care and treatment if they were to be assessed and/or admitted to hospital or detained under the MHA.

They are created when the person is well and has the relevant capacity or competence, and apply when the person lacks the relevant capacity or competence. Mental health professionals must have regard to these documents (but not necessarily follow them) when providing care and treatment under the MHA.

Extending the Human Rights Act

The 2025 act provides that registered private care providers are to be regarded as public authorities for the purposes of the Human Rights Act 1998 when providing care and treatment to informal NHS mental health hospital inpatients and under section 117 of the MHA (and its equivalent in Scotland).

Consequently, a private care provider would be required to act compatibly with the European Convention on Human Rights (ECHR) articles set out in the Human Rights Act.

This change is a response to the High Court decision in Sammut v Next Steps Mental Healthcare Ltd [2024] EWHC 2265 (KB), which held that Human Rights Act claims could not proceed against a private residential care provider that had been commissioned and funded by a local authority and an NHS body under section 117, as its functions were entirely private.

Places of safety and police powers

The 2025 act removes police cells from the definition of “places of safety” for the purposes of sections 135 and 136.

This change is in response to evidence that police cells are not suitable environments for people with a severe mental health need awaiting assessment and treatment. The 2025 act also ends the use of prison as a place of safety for people in contact with the criminal justice system.   

During the passage of the bill, the government agreed to launch a consultation into emergency police powers. This will look at the powers available to different professionals in different situations and settings, in particular but not limited to sections 135 and 136.

Patients involved in criminal proceedings

The 2025 act aims to speed up the transfer of mentally disordered prisoners to hospitals by introducing a statutory time limit. The relevant health and justice agencies are required to seek to ensure that a transfer takes place within 28 days.

When restricted patients are being conditionally discharged, there will be a new power to allow deprivation of liberty in the community. This can be used irrespective of the patient’s capacity to consent to the restrictions. The government has said this will apply in a small number of high-risk cases where the patient is no longer benefiting from hospital detention, but the conditions are necessary to protect the public from serious harm.

This is a response to the Supreme Court decision in MM v Secretary of State for Justice [2018] UKSC 60, which held that conditional discharge does permit the deprivation of liberty of a conditionally discharged patient.

Implementing the 2025 act

The 2025 act does not come into force immediately. The government has said it will be implemented in phases when “system capacity and funding allow” and it may take up to 10 years to fully come into force.  

The first priority is the introduction of the code of practice and secondary legislation, which will take a year. Training of the existing workforce will take place in 2026-27 and commencement of the “first major phase of reforms” in 2027.

Tim Spencer-Lane is a lawyer specialising in adult social care, mental capacity and mental health and legal editor of Community Care Inform.