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The Mental Health Act (1983) regulates compulsory detention and treatment of people with a mental disorder in England and Wales. The UK Government has published a draft Mental Health Bill to amend the legislation. The proposed changes focus on increasing patient autonomy and reducing assessment and detention under the Act. This is in response to a range of issues, notably the the rising rates of detention under the Act and its disproportionate use against people from ethnic minority backgrounds.  

The Government commissioned an Independent Review of the Mental Health Act, which reported in 2018. Its recommendations centred on four principles: choice and autonomy; least restriction; therapeutic benefit; and the person as an individual. 

A Joint Committee on the Draft Mental Health Bill was established in July 2022 to scrutinise the draft Bill. The Committee published a report with its recommendations to Government in January 2023. 

Further information on the White Paper that preceded the Draft Bill, the consultation and the draft Bill is available in the Commons Library briefing on Reforming the Mental Health Act. 

This POSTnote is focused on patient choice and autonomy, and covers adults aged over 18. It complements other recent POSTnotes focussed on other aspects of proposals to update the legislation: Mental Health Act Reform – Race and Ethnic Inequalities and Mental Health Act Reform – Impacts on Children and Young People. As healthcare policy is devolved, the reforms described here apply only to England and Wales.  

Key points 

  • The Mental Health Act 1983 has been criticised as being overly restrictive, with inadequate scope for patient choice and autonomy.  
  • The Government’s Draft Mental Health Bill proposes reforms to improve patient choice. A joint parliamentary committee report on the draft Bill recommended further changes to enhance choice, including a statutory duty to offer patients advance choice documents. Reports to date suggest that advance care planning could offer some benefits, but uptake can be low. 
  • Proposals to replace the Nearest Relative who has certain powers under the Act, with a Nominated Person of the patient’s choosing, have been widely welcomed. There are questions about operationalisation and safeguarding. 
  • Alongside the reforms, the Government is piloting ‘culturally appropriate advocacy’, which preliminary findings suggest could help advocates better support patients from ethnic minority backgrounds. 
  • The draft Bill removes learning disabilities and autism as grounds for detention under Section 3 of the Act. Stakeholders have raised concerns about unintended diversion to more restrictive pathways, such as the criminal justice system.A range of stakeholders share the view that careful implementation is needed to maximise the benefits of proposed reforms. 
  • The Government has not announced when the Bill will be introduced. 


POST is grateful to Dr Howard Ryland for researching this briefing, to the Oxford Policy Engagement Network Fellowship and the Department of Psychiatry, University of Oxford for funding his parliamentary fellowship, and to all contributors and reviewers. For further information on this subject, please contact the co-author, Dr Sarah Bunn. 

POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer-reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

  • Members of the POST Board* 
  • British Association of Social Workers* 
  • British Psychological Society* 
  • Dr Arun Chopra, Mental Welfare Commission for Scotland*
  • Alison Cobb, Mind* 
  • Department of Health and Social Care*  
  • Dr Zoë Fritz, University of Cambridge 
  • Professor Claire Henderson, King’s College London*  
  • Stephen Hinchley, VoiceAbility*  
  • Stephen Jones, Royal College of Nursing*  
  • Dr Patrick Keown, Newcastle University  
  • Professor Judith Laing, University of Bristol*  
  • Dr Richard Latham, East London NHS Foundation Trust* 
  • Professor Bryn Lloyd-Evans, NIHR Mental Health Policy Research Unit, University College London 
  • Professor Rose McCabe, City University* 
  • NHS England*
  • Dr Gareth Owen, King’s College London and Royal College of Psychiatrists*
  • Alex Ruck Keene KC, 39 Essex Chambers and King’s College London* 
  • Dr Lucy Stephenson, King’s College London* 
  • Professor Kevin Stone, University of Warwick 
  • Professor Sarah Vicary, Open University
  • Dr Susan Walker, University College London  
  • Professor Sir Simon Wessely, Chair of the Independent Review of the Mental Health Act 

*denotes people and organisations who acted as external reviewers of the briefing. 


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