Reform of The Mental Health Act in England and Wales

What is the Mental Health Act White Paper?

Launched by the Department of Health and Social Care in January 2021, the White Paper builds on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018 which set out what needed to change in both law and practice in order to deliver a modern mental health service that respects the patient’s voice and empowers individuals to shape their own care and treatment. 

The College has responded to this White Paper, setting out its position on the reforms.

Our submission can be found here.

What are the key proposals included in the White Paper?

The White Paper includes 36 consultation questions and sets out the Government’s plans for:

  • New guiding principles
  • Stronger detention criteria
  • Giving patients more rights to challenge detention
  • Strengthening the patient’s right to choose
  • Improving the support for people who are detained
  • Community Treatment Orders
  • The Mental Health Act/Mental Capacity Act interface
  • Caring for patients in the criminal justice system
  • People with Intellectual Disability and Autism
  • Children and Young People
  • The experiences of people from Black, Asian and minority ethnic communities

The government is consulting on proposed changes, including:

  • introducing statutory ‘advance choice documents’ to enable people to express their wishes and preferences on their care when they are well, before the need arises for them to go into hospital
  • implementing the right for an individual to choose a nominated person who is best placed to look after their interests under the act if they aren’t able to do so themselves
  • expanding the role of independent mental health advocates to offer a greater level of support and representation to every patient detained under the act
  • piloting culturally appropriate advocates so patients from all ethnic backgrounds can be better supported to voice their individual needs
  • ensuring mental illness is the reason for detention under the act, and that neither autism nor a learning disability are grounds for detention for treatment of themselves
  • improving access to community-based mental health support, including crisis care, to prevent avoidable detentions under the act – this is already underway backed by £2.3 billion a year as part of the NHS Long Term Plan

Does the White Paper cover mental health law UK-wide?

No. The White Paper is limited to the MHA in England and Wales. Both Scotland and Northern Ireland have their own mental health legislation.

Mental health law in Scotland is covered by the Mental Health (Care and Treatment) (Scotland) Act 2003. See RCPsych in Scotland for further information.

Northern Ireland has recently introduced the Mental Capacity Act (Northern Ireland) 2016, the state’s first independent legislation to cover the legalities surrounding a lack of mental capacity.

The College in Northern Ireland is working to influence the development of the Code of Practice. See RCPsych in Northern Ireland for further information.

What is the College doing to help reform the MHA in England and Wales?

Our response to the White Paper consultation set out the College’s views on the proposed reforms. We consulted across the College and wider to reflect the views of clinicians and patients.

In March 2021, we ran a survey of members in England and Wales to find out what members thought about the proposed changes.

As well as continuing to work with DHSC on a new MHA Bill, we are working to push for adequate funding and workforce provision to allow the Government’s proposals to be implemented successfully. 

The College has worked with both the Independent Review of the Mental Health Act and the Department of Health to make sure that there is a clinical perspective being given on every topic area and that the workforce and resource implications of all recommendations were considered. Members of the Royal College of Psychiatrists were closely engaged with the Review and have worked with patients, carers and other professionals to make sure the new Act is one that works better for all.

For more details on the College's work on the Independent Review of the Mental Health Act, please see our page on this.

How can I get involved with the College's work on the MHA?

We will continue to work to make sure that changes to the Mental Health Act work for patients, carers and clinicians and want to hear from people on their thoughts on the White Paper and the MHA in general.

If you have anything you would like the College to be aware of, or if you have any evidence or experiences that will be relevant, please send them to

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