Reforming the Mental Health Act: Independent review to draft bill

This briefing sets out the process of reforming the Mental Health Act 1983, up to but not including the Mental Health Bill [HL] 2024-25. It covers the 2018 independent review, 2021 white paper, 2022 draft bill and pre-legislative scrutiny. The Library has published a separate briefing on the Mental Health Bill [HL] 2024-25.

The Mental Health Act 1983 applies in England and Wales only There are separate statutory provisions covering Scotland and Northern Ireland.

This briefing uses the term ‘patient(s)’ to mirror the language used in legislation and to distinguish between people who are in a mental health hospital (and people subject to community treatment orders) and people who are engaging with primary or secondary mental health services in the community.

Mental Health Bill [HL] 2025

The Mental Health Bill [HL] (Bill 225 2024-25) is a government bill.  It was introduced in the House of Lords on 6 November 2024 and completed its Lords stages on 23 April 2025. The bill was introduced in the House of Commons on 24 April 2025 and will have its second reading on 19 May 2025. The bill would extend to England and Wales only (apart from the general clauses at the end of the bill that would extend across the UK).

For information on the bill, including Lords stages and amendments, see the Library’s briefing on the Mental Health Bill [HL] 2024-25.

Draft Mental Health Bill (2022) and pre-legislative scrutiny

In June 2022, the Conservative government published a draft Mental Health Bill. It contained proposed amendments to the Mental Health Act 1983, including:

• redefining “mental disorder” so autistic people and people with a learning disability could not be detained for treatment under section 3 of the act without a coexisting psychiatric disorder
• raising the threshold for detention and reviewing the need for detention more frequently
• replacing the nearest relative with a nominated person, chosen by the patient
• placing care and treatment plans on a statutory footing for detained patients
• expanding access to advocacy services
• removing prisons and police cells as places of safety
• introducing a statutory 28-day time limit for transfer from prison to hospital

A joint select committee scrutinised the draft bill from July to December 2022 and published its report in January 2023. The committee said it supported reforming the act, but the government should strengthen the bill to address rising detention rates and racial inequalities.

Examples of recommendations made by the committee included:

• introducing a new statutory Mental Health Commissioner role
• abolishing community treatment orders (CTOs) for most patients
• introducing statutory advance choice documents (ACDs).

Government response to scrutiny of the draft Mental Health Bill

The Conservative government published its response to the joint committee’s report on 21 March 2024. It said it would consider some of the committee’s recommendations in preparing the bill but did not agree with all of the recommendations. For example, the government did not agree with creating a Mental Health Commissioner role or introducing a statutory right to request an ACD.

A mental health bill was not introduced by the previous government before the General Election 2024.

Background to the reforms: independent review and white paper

Independent review of the Mental Health Act (2018)

In 2017, the government announced an independent review of the Mental Health Act 1983, in response to concerns about the use of the act.

The terms of reference of the independent review set out that the review should consider:

• the rising rates of detention under the act
• the disproportionate numbers of people from Black and minority ethnic groups in the detained population
• concerns that some processes in the act are out of step with a modern mental health system

The independent review team, led by Professor Sir Simon Wessely, published its final report, Modernising the Mental Health Act: Increasing choice, reducing compulsion, in December 2018. The review made over 150 recommendations, including changes to the law to make it easier for patients to participate in decisions about their care, to restore their dignity and recognise the importance of human rights in mental health care. The government accepted most of the recommendations and incorporated them in a subsequent white paper.

White Paper on Reforming the Mental Health Act (2021)

The previous government published its white paper, Reforming the Mental Health Act, in January 2021.

Proposals in the white paper included tightening admission criteria and raising the threshold for compulsory detention. There were also proposals designed to reduce the use of the act for persons with a learning disability and autistic people.

The government consulted on the white paper proposals from January to April 2021 and published its response to the consultation in August 2021. Respondents were broadly supportive of the proposals. The government said it would continue to work with stakeholders to refine the proposals, to make final policy decisions and develop the draft bill.