It’s been almost a decade since the then Prime Minister Theresa May stated that the Mental Health Act in England and Wales needed to be rewritten and later appointed Sir Simon Wessely to conduct a review of what needed to change. Mrs May described the way the Act works as a ‘burning injustice’, both because of the increasing use of detention and the disproportionately coercive treatment of racialised communities.
Now, at the end of 2025, the Government’s bill to modernise the Mental Health Act is on the brink of getting Royal Assent – going from being a bill, to being an Act of Parliament. But that is far from being the end of the story. For in real life, the story of Mental Health Act reform hasn’t even started, and it could be another decade before it’s fully implemented – if at all. Last year, the number of uses of the Act rose again after falling the year before, and the extent of racial inequity grew even wider.
The Mental Health Bill is not a whole new Act to repeal and replace the one that was enacted in 1983 – and which itself was largely an update of legislation from the 1950s. It’s a set of changes – some of them quite extensive, others less so – to the 1983 Act, which will remain in force but with a new set of updates. In other words, it’s the same legal framework but with some significant changes to the rules and some extra features designed to make the system fairer and more respectful for those subject to it. It’s not radical or completely new, but in sum, the changes in the Bill could make the Act work a lot better for the people it’s there to serve.
It’s important to note that once the Bill gets Royal Assent, nothing is going to change very quickly. Because many of the changes need preparation and resources to be implemented, the Government has said that it will ‘switch on’ different parts of the Bill at different times over the next decade. Literally, a timescale of another ten years from now.
Now that we know what the final Bill contains, it’s reasonable to go back to the purpose of the process and ask: will it mean fewer people are subject to compulsory powers, and will it stop the disproportionate use of those powers? In both cases, we don’t know, but the best answer we have for now is, maybe.
There are some measures in the Bill that could reduce the use of compulsion, or at least keep it within tighter boundaries. A clearer set of conditions for the use of the Act (including community treatment orders) and requirements for a care and treatment plan, coupled with greater access to advance decisions and advocacy, could help to stop people being detained or kept on CTOs for longer than is absolutely necessary, and actually be beneficial therapeutically.
The exclusion of people who are autistic or have a learning disability but no mental illness from some sections of the Act is a very big change, but switching this on can only happen when there are sufficient services outside hospital to meet people’s needs. That will need sustained investment, in support that simply does not exist in most places today.
There is little, if anything, in the Bill that specifically addresses racial inequity in its operation. It is possible that the changes noted above will reduce levels of subjectivity in the ways decisions are made, with the potential to curb some of the disproportionality facing racialised communities today. Efforts to insert specific requirements to address systemic racism were rejected by Parliament. So in practice, the difference will be made elsewhere, most notably by the Patient and Carer Race Equality Framework, as long as that is fully, faithfully and sustainably implemented.
Another widely held ambition for the Bill is that it gives people more of a say in how they are treated, and to be treated with greater dignity. Here, there is more reason to be hopeful. Many of the changes in the Bill are designed to give people the chance to make choices in advance about how they will be treated when unwell, and to be better supported while subject to the Act in knowing and asserting their rights. There’s also a very welcome limit on prison to hospital transfers of 28 days, which should end the unacceptably long waits for a bed that too many people are enduring today. As above, though, all of these provisions will only come into force when there are the resources to make them possible. How long will we have to wait for those, we don’t know. And how these will be applied equitably to children and young people remains unclear.
The Government also signalled, late on in the legislative process, that it would consult on the use of police powers under Sections 135 and 136 of the Mental Health Act. This follows moves from the House of Lords to extend these powers to other professions – for example social workers or paramedics. Such a shift would have worrying ramifications, so it is welcome that the Government has sought to consider this matter more deeply. But it creates more uncertainty for the future, and potentially more changes to come.
Mental Health Act reform is a long process. By the time this legislation is properly in place, it may already feel outdated and in need of renewal. All the more reason, then, to get on with it. All the more reason to implement the agreed legislative changes in full, with the necessary resources in place to give them the best chance of working as intended. And all the more reason to make wider changes to our mental health services so that more people get the help they need more quickly, rather than having to wait until they reach a crisis and need urgent care.
The Mental Health Act gives the state unique powers to detain citizens for their health. Its use can save lives, and its safeguards provide people with protection of their rights when they need them most. But too often, it feels punitive and can be traumatic. And for Black communities in particular, its use is connected to painful experiences of oppression and violence. The job of changing the Act is not done. It’s barely started. But with an updated legal framework in place, it’s time to make it work.
