Mental Health Bill (England and Wales) receives Royal Assent

The Mental Health Bill was passed at the end of 2025, with the new Mental Health Act receiving Royal Assent on 18 December.

Starting with the Wessely review, it is the result of years of hard work from professionals, policy makers, patients and carers. The College’s response to this can be found here.

Background

In October 2017, Theresa May set up an Independent Review of the Mental Health Act to tackle 'the injustice and stigma associated with mental health'. The UK Department of Health and Social Care published a White Paper in 2021, building on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018 and a Draft Bill followed in 2022. The Joint Committee on the Draft Mental Health Bill was established to provide pre-legislative scrutiny and published its final report in January 2023. The UK Conservative Government did not ultimately bring forward a Bill before the 2024 General Election; the UK Labour Government announced that it would bring forward such a Bill in its first King’s Speech. Following passage through the UK Parliament, the Bill received Royal Assent in December 2026.

Summary of changes in the new Mental Health Act

Amending detention criteria

The Bill revises the criteria for detention under the MHA, providing new criteria which requires clear evidence of the risk of serious harm before detention can occur.

Section 2 (admission for assessment) and Section 3 (admission for treatment) criteria now include tests for whether harm ‘may be caused’ and the ‘likelihood’ of the harm.

Learning disabilities and autism

The Bill removes, for the purposes of Part 2 of the Act, people with a learning disability and autistic people from the scope of the conditions for which a person can be detained for compulsory treatment under section 3.

It also places care and treatment reviews (C(E)TRs) on a statutory footing, ensuring these patients are only admitted to hospital when necessary.

The Bill establishes a register of people with learning disabilities or autism who are at risk of detention, to help prevent unnecessary hospitalizations by improving community care services.

Advance choice documents (ACDs)

Health bodies will be required to inform patients about advance choice documents, which record the patient’s care preferences when they have capacity. Clinicians must consider these documents when providing treatment.

This is not a statutory right as recommended by the Joint Committee, but rather the Bill introduces duties on Integrated Care Boards (ICBs), NHS England and Local Health Boards (Wales) to make arrangements so that people at risk of detention are informed of their ability to make an Advance Choice Document, and (if they accept) supported to make one.

From 'nearest relative' to 'nominated person'

The Bill introduces a nominated person (NP) who can be chosen by the patient (if they have the capacity). The NP replaces the nearest relative and will have similar rights and powers, but with some additional responsibilities, such as being consulted on care plans and treatment decisions.

Compulsory medical treatment

New safeguards are introduced regarding consent to treatment, including a clinical checklist for clinicians, who must consider patients' wishes, involve them in decision-making, and consult those close to the patient.

If a patient refuses medication, and has capacity to do so, treatment cannot proceed unless there is a compelling reason, certified by a second-opinion doctor (SOAD).

The Bill also reduces the requirement for a SOAD certification of medication from three months to two months and introduces additional safeguards for those refusing electroconvulsive therapy (ECT).

Community Treatment Orders (CTOs)

The Bill revises the criteria for the use of Community Treatment Orders (CTOs) in line with the new detention criteria.

The Bill requires a written agreement from the community clinician for a CTO to be implemented and allows the mental health tribunal to recommend that the responsible clinician reconsiders whether a particular CTO condition is necessary.

Statutory care and treatment plans

A new statutory care and treatment plan will be required for detained patients, with regular reviews by responsible clinicians to ensure the treatment remains appropriate.

Independent Mental Health Advocates (IMHAs)

The Bill extends the right to an IMHA to informal patients and introduces an opt-out system where hospitals must notify advocacy services about qualifying patients. This aims to increase the uptake of IMHAs.

These changes apply in England only.

Mental health tribunals and detention periods

The Bill expands access to mental health tribunals, allowing patients to apply sooner than under the current system. Section 2 patients can apply to the tribunal within 21 days of detention (rather than 14)); section 3 patients can apply within three months (rather than six months);

Automatic referrals to the tribunal will occur after three months and then every 12 months.

This means more frequent reviews and assessments of the patient’s detention.

Discharge process

Before discharging a patient, the responsible clinician must consult with a professional involved in the patient’s treatment to ensure the discharge is appropriate and safe.

Principles in the code of practice

The Independent Review’s principles (choice and autonomy, least restriction, therapeutic benefit, and individuality) will be embedded in the MHA’s codes of practice, applying to both England and Wales.

Section 117 aftercare

The Bill introduces new rules on ordinary residence for Section 117 aftercare services, ensuring that the placing authority is responsible for providing aftercare, even when a patient is placed out of area.

The mental health tribunal is also given the power to recommend that the responsible after-care bodies make plans and can reconvene to reconsider a case.

Places of safety

The Bill removes police cells from the definition of places of safety under sections 135 and 136, ensuring that police cells are no longer used for people with severe mental health needs awaiting assessment.

Patients in the Criminal Justice System

The Bill introduces a statutory time limit for transferring prisoners with mental health disorders to hospital (within 28 days).

It also provides the mental health tribunal with the power to authorise deprivations of liberty to restricted patients conditionally discharged to the community.

Timelines to implementation

The Act will be implemented in phases and it may take 10 years to fully come into force.

The code of practice for England will be introduced within 1 year. The criminal justice system changes will be prioritised. Other aspects will take far longer. The UK Government will be producing more detailed timelines.

The work to implement the Act begins now with training.

College Influencing on MHA: A summary of work since 2017

In October 2017, Theresa May set up an Independent Review of the Mental Health Act to tackle 'the injustice and stigma associated with mental health'. The College played a key part in this work and contributed to a large number of the recommendations including on inequalities and the development of PCREF.

Our influencing of this Review and our engagement with it was guided buy a College-wide survey of members and their views were widely reflected in the recommendations published by the Review.

Since this, the UK Department of Health and Social Care published a White Paper in 2021, building on the recommendations made by Sir Simon Wessely’s Independent Review of the Mental Health Act in 2018 and a Draft Bill followed in 2022. The College provided a detailed reply to the White Paper produced by a cross-college working group. This was once again guided by an all-member survey. RCPsych in Wales was also part of a reference group set up to support the Welsh Government in reaching a policy position for Wales in response to the recommendations in the White Paper.

Given the potential impacts of the Bill on the workforce and to support policy makers prepare for successful implementation of the reforms, the College commissioned The Strategy Unit to provide an independent assessment of the impact of the proposed changes on the psychiatric workforce. This was with the aim of better understanding how many additional psychiatrists would be required to deliver the reforms in the proposed year of implementation, and 10 years later.

The Joint Committee on the Draft Mental Health Bill was established to provide pre-legislative scrutiny and published its final report in January 2023. We provided submissions to this as well as oral evidence and were pleased with the results that looked likely to improve the Bill substantially.

After the General Election of 2024, the UK Government published a Draft Mental Health Bill which progressed through the Houses of Parliament. Little of the Joint Committee’s recommendations remained but the College sought to continually influence, briefing peers and MPs and tabling amendments aiming to improve the Bill and reduce some potential unintended consequences.

The College led on writing and publishing a joint statement with eight other health professional bodies to object to proposed reforms to the Mental Health Act that would delegate police powers to health professionals. This was highly influential in persuading the UK Government to drop these proposed reforms. There is an ongoing consultation on this that College will be engaging in. The College will also be seeking to influence the Code of Practice. 

Work by RCPsych in Wales

Scrutiny of the Mental Health Bill in Wales took place through the legislative consent procedure, which allows devolved legislatures (in this case, the Senedd) to examine UK Government legislation that affects devolved areas.

RCPsych Wales’ evidence directly informed Senedd Committee reports and recommendations, including in relation to:

• ensuring an adequate mental health workforce and building future capacity
• revisions to detention criteria
• Advance Choice Documents
• Community Treatment Orders
• support for people with learning disabilities and autism.

Senedd Members (MSs) voted unanimously to grant legislative consent to the Bill on 7 October. View RCPsych Wales’ response to the vote.

Implementation in Wales

Work on preparing for implementation has already commenced in Wales.

In November 2025, RCPsych Wales was asked by the Welsh Government to model the impact of the reforms on the psychiatric workforce. We presented these findings to the Mental Health Legislation Implementation Board in early December.

In addition to work to ensure a sustainable and supported workforce, RCPsych Wales will also be supporting the Welsh Government to develop a revised Code of Practice for Wales.

RCPsych Wales is focused on ensuring that the Bill’s implementation is tailored to Wales’ distinct policy and legislative landscape, including its interaction with the Mental Health (Wales) Measure 2010 and future reforms thereto. We are also keen to work with partners to pursue innovative approaches and to see the Welsh Government invest in a world-leading national approach to digitising the Mental Health Act.

We will provide further guidance for members as detailed implementation plans develop. We are pleased that the Minister for Mental Health and Wellbeing, Sarah Murphy MS, has confirmed that the Welsh Government will be guided by lived experience and stakeholder input throughout this process.

The Welsh Government has estimated that total implementation costs in Wales will be £425 million across health, housing and social care.

Further information can be found on the College’s web page on MHA reform as well as on the RCPsych in Wales web page.