In January 2021 the Government published the Reforming the Mental Health Act White Paper, to update legislation following the 2018 independent review of the Mental Health Act (1983). This legislation sets out when an individual can be detained in hospital and treated for a mental health disorder, sometimes against their wishes. According to NHS Digital data the number of children (aged 16-17 years) detained under the Mental Health Act (expressed as a crude rate per 100,000 population) increased from 57.5 per 100,000 in 2016/17 to 62.5 per 100,000 in 2019/20. Published official data does not make it clear whether the inequalities related to ethnicity and socio-economic status reported in relation to the overall use of the Act are seen in all age groups in the population (children and adults). While the 2021 White Paper is focussed mainly on adults, there is little detail on how proposed changes would work in practice for under 18s. Several areas of proposed reform have implications for children, relating to patient choice, autonomy and the use of a nominated person who can act as an advocate. There are differences in how children aged under 16 are deemed to have the competence to exercise autonomy and make advance choices about their care compared with older children and adults, which has been raised by stakeholders as an area that requires careful consideration.

This POSTnote will summarise recent trends in the use of the Mental Health Act on children, highlight data on inequalities and the research analysing associated factors. It will examine the proposed legislative reforms, the likely impacts on children, their families and the health professionals working with them. It will also summarise the complex interaction with the Mental Capacity Act (2005), which sets out legal provisions for people aged over 16 who are unable to make decisions for themselves.

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