In 2017 the Government ordered an independent review of the Mental Health Act and following the review Professor Sir Simon Wesley delivered a landmark report on a number of reforms and changes which needed to be made to ensure that the Mental Health Act is up to date.

Over 3 years and a pandemic later on January 13th 2021, the Government announced that it would be moving forward in reforming the Mental Health Act.

The reforms proposed will bring a number of big changes to the Act and its aims are to deliver a modern mental health service that respects the patient. For this reason, there were four main principles which were taken into consideration when reviewing the original Mental Health Act. These principles are; choice and autonomy, the least restrictive option, therapeutic benefit and focusing on the patient as an individual. It was with these principles and the opinions and voices of professionals and service users that the reforms were thought of.

A Change in Criteria?

In terms of the actual reforms there are a number which are being proposed. Firstly, they wish to revise and clarify the detention criteria for some sections, including altering the requirement of being a risk to having a substantial likelihood of significant harm. They are also altering the therapeutic benefit part of the criteria and the new reformed criteria must demonstrate that the purpose of care and treatment is to bring about a therapeutic benefit, that the care cannot be delivered without detention and that appropriate care and treatment are available.

Review of Detention

Another proposed change is to increase the frequency in which detention is renewed, it was a common theme during the review that service users felt that the eligibility periods and section periods can be too long and as a result they were being detained longer than is necessary. It is proposed that for patients under section three that their detention is to be reviewed by the Hospital Managers three times within the first year, an increase from the current two times.

Hospital Managers Hearings

Hospital Managers Hearing were discussed at length when discussing for the Mental Health Act. As mentioned above the plan is to increase access to a Hospital Managers hearing however the review heard mixed views on the effectiveness of the Manger’s panel. The Government are therefore wishing to use the public consultation prior to taking a final decision on whether or not to remove the Hospital Managers Hearing.

Mental Health Tribunals

In terms of access to the Mental Health Tribunal the reforms have proposed an increase in section two eligibility period from fourteen days to twenty-one days. In terms of section three, patients would have three opportunities to appeal to the tribunal in the first twelve months instead of two.

The number of automatic tribunals are also hoped to be increased. It was recognised that an automatic tribunal which is put in place if a patient has not made their own application is an important part of the Act. Although an increase in automatic tribunal would ensure that detentions are consistently reviewed it would also have to be balanced with the increase in demand which the other reforms will put on the Tribunals service. The reforms also hope to extend the role which the Tribunal has giving it the powers to consider applications for discharge, to grant leave, to transfer patient and to direct services in the community.

Another proposed change would be to remove the automatic referral to the tribunal when a CTO is revoked as usually by the time the Tribunal sits the patient is back into the community or has been reverted onto a section three.

Challenging a Treatment Decision at the Tribunal?

As well as the standard right to appeal a patient’s detention at the Tribunal the proposed reforms are also suggesting that a patient will have the ability to challenge their treatment under the act. However, prior to being able to proceed to a Tribunal hearing a Judge will sit alone and carry out a preliminary review of the case. If the Judge grants permission to appeal, then there would be a full hearing. 

A Patients right to Choose and Refuse Treatment

Another proposed change is to increase the right choice by the patient this includes; Advance choice documents, care and treatment plans will become a legal requirement for all patients, part 4 will be revised allowing for consent and refusal of medical treatment and the enhanced role of the Mental Health Tribunal.

Support for those Detained

The new reforms will also seek to replace the Nearest Relative with a new role of a Nominated Person where the patient would be able to pick the person. It is hoped with this new change there would be greater support for the patient. 

A Move Forward?

Although the Government are moving forward in the reforms it is not a done deal yet, the White paper is now open to public consultation and to professionals to discuss the impact of the reforms and whether there are any other amendments. There are a number of other key proposals and changes which have been put forward and the whole document and details on how to have your say can be found at

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