New Mental Health Act reforms aim to strengthen patient rights, with legislation that came into force in December 2025 tightening the rules around detention and giving patients greater control over their care. The Mental Health Act 2025, which received Royal Assent on 18 December, amends the existing 1983 Act and introduces a series of measures designed to address long-standing criticisms that the system strips detained individuals of autonomy and dignity.
The changes come against a backdrop of rising detentions. Official data shows that in 2024–2025 there were 52,731 new detentions reported under the Mental Health Act in England, a slight increase on the previous year. Critics have long pointed to what they describe as “shameful racial inequalities” in the system, with people of Black or Black British ethnicity detained at rates four times higher than White people – a figure that has worsened from 3.5 times the year before. The rate for Black people stood at 262 per 100,000 population, compared with 66 per 100,000 for White people. Experts say these disparities reflect a “vicious cycle of inequality and mental illness”.
Mental health charity Mind had called for reform, demanding a bill that “strengthens the rights of people at their most unwell”. While the new Act does not include every recommendation from Mind and other independent bodies, the charity said it would “bring in some positive reforms”.
Reforms to the Mental Health Act
The core changes introduced by the Mental Health Act 2025 are intended to make detention a last resort and to embed patient rights at every stage. The grounds for detention under sections 2 and 3 have been tightened: detention is now lawful only if there is a demonstrable risk of “serious harm” to the individual or others, taking into account the “nature, degree and likelihood” of that harm. This replaces broader criteria that critics argued allowed too much discretion.
Other key reforms include the introduction of mandatory Care and Treatment Plans for everyone detained, giving patients a formal document outlining their treatment and recovery goals. Patients can now choose a “nominated person” to represent their interests and participate in key care decisions, replacing the previous system where a nearest relative was automatically assigned. New safeguards have been introduced for patients who have capacity but refuse treatment: clinicians must demonstrate a “compelling reason” before overriding that refusal, and a second opinion appointed doctor (SOAD) must be involved.
For autistic people and those with learning disabilities, detention under section 3 or a Community Treatment Order now requires a co-occurring psychiatric disorder that meets the detention criteria – a change intended to stop people being detained simply because of their diagnosis. Prisons and police cells will no longer be classified as “places of safety” under the Act. Community Treatment Orders, which the original reform bill had aimed to abolish, remain in place but are under scrutiny. Their use has increased sharply – by 17% in 2024–25 compared with the previous year, totalling 6,575 new orders. People of Black or Black British ethnicity are over eight times more likely to be subject to a CTO than White British people, and that group saw a 26% rise in CTOs between 2023–24 and 2024–25.
The reform process began with an Independent Review in 2018, followed by a White Paper in 2021 and a draft Mental Health Bill in 2022. The Royal College of Psychiatrists has urged the enactment of the proposals to tackle persistent racial and social inequalities. However, some MHA reviewers have noted that staff in many wards are unaware of the Patient and Carer Race Equality Framework introduced to help NHS trusts become actively anti-racist.
The detention process
For those who are sectioned – and for their families and friends – detention under the Act can be an intensely frightening experience. Steve Bown, a former mental health nurse with over 20 years of crisis-based care experience who is now a senior lecturer, described the key stages.
The process typically begins with a crisis team assessment. Someone in a mental health crisis is referred by the police, the local community or a family member. The crisis is associated with “significantly increased risk, either to themselves or others”, Bown said – which can include suicidal intent, violent or severe impulsive behaviour, episodes of psychosis or extreme mania. A crisis practitioner visits the person at home or in the community to assess whether they can maintain “reasonable standards of behaviour” or need to be detained. Bown said practitioners try their best to create a “hospital approach in the person’s home”, but that is not always possible. If there is an immediate severe risk, the crisis team makes a referral for a Mental Health Act assessment.
The next stage involves a Mental Health Act assessment team, comprising a mental health professional and two doctors, at least one of whom must be section 12 approved – meaning they can make mental health assessments. The team conducts both a medical and a social assessment, looking for less restrictive alternatives such as other care settings or strong family support. Factors considered include the nature of the condition, the chance of relapse and the severity of presentation. If all three agree that detention is necessary, an application is made. Bown said the turnaround for the assessment and application stages is typically within a day.
Once detention is agreed, the individual is brought to hospital. Police may be involved if there is high risk, but Bown has seen family members or trusted social workers walk clients in. On the ward, the admission process includes a holistic assessment by a nurse and a doctor to understand the presenting complaint and the patient’s broader psychological and social experience. A separate risk assessment looks at safety on the ward, medication management and observation levels – some patients may need checks every 15 minutes. Bown emphasised that despite the dehumanising nature of the process, there is a strong emphasis on “maintaining social function”, with escorted leave to local shops sometimes possible within the first 24 hours.
Treatment begins once the patient is settled. Bown stressed that while medication is important, talking therapies such as Cognitive Behavioural Interventions and Dialectical Behaviour Approaches are also central. Clinicians often use the CHIME model – Connectedness, Hope and Optimism, Identity, Meaning in Life, and Empowerment – to prepare patients for returning to the community. The identity element, for example, encourages the patient to develop a new identity not solely defined by their mental health diagnosis, shifting from “I am X” to “I am a person who lives with X”.
Appeals and safeguards
Patients detained under the Act have two routes of appeal. The first is to a Mental Health Act Tribunal, an independent body that can discharge someone immediately. The patient is provided with a solicitor free of charge, and the nurse looking after them must support them in the appeal process. The appeal must be made within the first two weeks of detention, with a hearing scheduled within seven working days.
The second route is an appeal to the hospital managers, which Bown described as “a little more toothless”. This tends to be a general check on whether detention is still necessary, but he said hospital managers “tend to be much more deferential to clinical opinion”. Throughout the entire process, Bown said, the real job of wards is to work “from a position of coercion towards a position of collaboration”, with the key factor being the building of a therapeutic relationship based on empathy and compassion in the initial hours.
Detailed rights include the right to an Independent Mental Health Advocate, the right to clear information about detention, the right to visitors, and free legal representation for tribunal appeals. The Human Rights Act 1998 ensures dignity and respect, although treatment can sometimes be given without consent, particularly in the first three months under section 3 or if deemed necessary for safety. The new Act also strengthens access to second opinions and enhances the role of the First-tier Tribunal (Mental Health), with children and young people’s wishes to be given greater consideration.
Official figures also reveal that detention rates are highest in the most deprived areas, where people are over 3.5 times more likely to be detained than those in the least deprived areas. Men have higher detention rates (90.1 per 100,000) than women (80.0 per 100,000), and rates decline with age, with the 18–34 age group significantly more likely to be detained than those aged 65 and over. There has also been a 77% increase in very urgent referrals to crisis services in 2024–25 compared with the year before, and reviewers note that people are becoming more unwell before they are referred for an MHA assessment, often waiting longer and arriving at hospital in a worse condition.