The Control of Patients in Mental Health Law: Does the Mental Health Act 2025 Adequately Protect Patients?

Introduction

For over four decades, the Mental Health Act 1983 governed the treatment of individuals with mental disorders in the UK. Although amended in 2007, the Act attracted criticism for outdated detention criteria and insufficient regard for patient autonomy. Following the Independent Review of 2018, Parliament enacted the Mental Health Act 2025, which received Royal Assent in late 2025.[2] The 2025 Act seeks to modernise mental health law by giving patients more choice and protecting their dignity. [3]

This article will analyse the faults of the previous mental health laws in the UK and the changes and improvements implemented by the Mental Health Act 2025. I will argue that the Act represents an important shift in legislation to ensure control and detention are proportionate to protect the liberty of patients whilst managing the risk of the potential harm brought by the patient and others around them, but whether it can adequately protect individuals will ultimately depend on its practical implementation.

Criticisms of the Previous Mental Health Laws in the UK Governing Control of Patients

The Mental Health Act 1983 structured compulsory detention through broad discretionary thresholds. Under s.2, an individual could be detained for assessment where suffering from a mental disorder of a nature or degree warranting detention and where this was necessary in the interests of their health or safety or for the protection of others. [4] Under s 3, detention for treatment could be authorised on similar grounds for a longer period. These provisions focused on managing risk, without much consideration of the autonomy and liberty of patients. [5]

Bartlett and Sandland analysed the role of care in multiple places, such as hospitals, community care, prisons, and asylums. [6] They explained that the control of patients could be seen in restraint and seclusion. On discussing restraint, they pointed out that ‘control’ is the more accurate description as opposed to ‘management’.[7] They observed that there was a lack of definition for ‘restraint’ in the MHA 1983, which made the level of restraint permissible unclear.[8] It was clarified in Pountney v Griffiths that hospital staff had powers of control over all mentally disordered patients, though the nature and duration of control will vary based on the patient.[9] Later in Herczegfalvy v Austria, it was held that any use of restraint had to satisfy the test of ‘medical necessity’.[10] Concerningly, it was held in this case that the restriction of a patient through handcuffing, feeding by force, strapping him to his bed, and having a belt strapped around his ankles was necessary since the patient was on a hunger strike and resisting treatment.[11] While Bartlett and Sandland concluded that the mode of restraint used was becoming clearer through surveys, it can be seen that the line between controlling patients and abuse remained unclear.

On discussing seclusion, Bartlett and Sandland argued that the court’s interpretation of what was proportionate regarding ‘seclusion of patients’ was inconsistent and occasionally too strict. For instance, in R v Ashworth Hospital, ex p Munjaz, the House of Lords upheldrestrictive seclusion practices and deferred to professional judgment and held that there was no breach of the right to personal freedom under Art 5 ECHR because the seclusion was not imposed as a punishment.[12][13] Whilst it was held in the later case of S v Airedale NHS Trust that seclusion of a patient for 12 days in a non-secure hospital under poor conditions was unjustified and disproportionate,[14] Barlett and Sandland noted the court’s reluctance in acknowledging the potential breaches of the prohibition of torture and the right to respect for private and family life under Art 3 and 8 of the ECHR, and that there has yet to be a limit on the use of seclusion.[15] The control of patients through detention was often broad and not properly defined, leading to an overwhelming number of examples where patients were restricted in harsh manners.

Assessing the Key Reforms in the Mental Health Act 2025 and their Adequacy

S.5 of the Mental Health Act 2025 brings one of the key reforms of the Act. This section reforms the grounds for detention set out in the MHA 1983. It introduces a higher threshold requiring that detention be justified by a risk of ‘serious harm’ to the health or safety of the patient or others.[16] The Explanatory Notes explain that this reform is designed to clarify the criteria for detention so that powers are used only where there is a clear and evidenced risk of serious harm.[17] Whilst there is no clear definition for ‘serious harm’ given, it is forecasted that the Code of Practice will provide further guidance.[18] This threshold replaces the broad and more discretionary “health or safety” formulation under the previous regime, which will ensure proportionality.

Moreover, s.29 of the MHA 2025 reforms the temporal structure of detention by reducing the initial period of treatment detention under s.3 from six months to three months.[19] The Explanatory Notes suggest that this change is intended to ensure that the patient’s detention is subject to more frequent review and renewal.[20] By shortening the initial period, the Act limits the duration of compulsory treatment before reassessment is required. This reform strengthens the proportionality of detention. Under the previous regime, individuals could remain detained for extended periods without mandatory reconsideration. The revised framework ensures regular scrutiny and frequent renewal decisions, in line with the principles of least restriction and therapeutic benefit.

Furthermore, S.30 enhances procedural safeguards by amending s.66 of the MHA 1983 and expanding access to the Mental Health Tribunal. Patients detained under section 2 now have 21 days in which to apply for discharge, and those detained under section 3 may apply after three months rather than six.[21] These amendments allow patients to challenge their detention and to ensure timely access to independent review. This reform is particularly significant when considered alongside the reduced detention periods introduced in s.29. Earlier tribunal access ensures that deprivation of liberty is subject to independent scrutiny at a more proportionate stage. This strengthens compliance with Article 5(4) of the European Convention on Human Rights, which requires the right to a speedy review of detention to ensure its lawfulness.[22]

The Mental Health Act 2025 introduces meaningful structural reforms to detention criteria, detention duration, and access to Mental Health Tribunals. However, whether thesereforms provide adequate protection will depend greatly on their enforceability and practical impact. The reform of detention criteria under s.5 appears to significantly strengthen substantive protection. By replacing the broader “health or safety” formulation with a requirement of risk of serious harm to the person or others, Parliament has raised the legal threshold for deprivation of liberty. The British Institute of Human Rights appreciated the new threshold to potentially be a positive change in the law, but pointed out that whether this positive effect is achieved will depend largely on the way it is implemented in practice.[23] As for s.30, which strengthens the right to challenge detention by providing more frequent and earlier access to the Mental Health Tribunal, Mind disagreed that the timeframes for applying for tribunal review were too long, especially in the context of being deprived of liberty. [24] They proposed that a suitable period would be 12 months, instead of the 2-year-period contained in the MHA 2025. The Joint Committee on Human Rights pointed out that the Government should review the Bill to ensure further clarity, and that there should be coordination with other authorities, e.g. the Mental Health Tribunal, to ensure effective implementation of the Bill.[25] Reynolds, Mental Health Practice Lead at the Social Care Institute for Excellence, wrote that past patients welcomed the changes brought by the MHA 2025, and that with sufficient funding, resources, and support, the Act would likely bring greater autonomy for patients through reduced detentions.[26] The amendments suggested in the MHA 2025 are bringing positive shifts to mental health law, such as ensuring detention of patients is proportionate and subject to review by relevant authorities. However, as suggested by professionals, the practical effect of the Act will depend heavily on resource allocation and the implementation of the provisions in the following years.

Conclusion

Whilst the previous Mental Health Acts focused on preventive detention justified through appeals to health, safety, and public protection, they violated the autonomy of patients and dismissed proportionality. The Mental Health Act 2025 seeks to respond to these criticisms by narrowing detention criteria and ensuring patients’ voices are heard. These reforms ensure that detention must be proportionately justified. However, statutory reform alone cannot guarantee substantive protection. The adequacy of the MHA 2025 ultimately depends on whether there is successful implementation of the Act, with sufficient resources and funding.

References

[1] Mental Health Act 2007.

[2] Department of Health and Social Care, ‘Mental Health Bill receives Royal Assent, revolutionising care’ (GOV.UK, 18 December 2025) <https://www.gov.uk/government/news/mental-health-bill-receives-royal-assent-revolutionising-care.> accessed 21 Feb 2026.

[3] Department of Health and Social Care, ‘Mental Health Bill 2025’ (GOV.UK, 14 November 2024) <https://www.gov.uk/government/collections/mental-health-bill-2025#:~:text=Contents&text=The%20Mental%20Health%20Bill%20received,found%20on%20the%20Parliament%20website.> accessed 21 Feb 2026.

[4] MHA 1973 s 2.

[5] ibid. s 3.

[6] Peter Bartlett and Ralph Sandland, Mental Health Law: Policy and Practice (4th edn, OUP 2014) Ch 2.

[7] Ibid. p 84-85.

[8] Ibid. p 85.

[9] Pountney v Griffiths [1976] AC 314 (HL) (per Lord Edmund-Davies).

[10] Herczegfalvy v Austria (1992) 15 EHRR 347.

[11] ibid.

[12] R v Ashworth Hospital, ex p Munjaz [2005] UKHL 58.

[13] European Convention on Human Rights Art 5.

[14] S v Airedale NHS Trust [2003] EWCA Civ 1036 para 81.

[15] Bartlett and Sandland (n 7) p 96-97.

[16] Mental Health Act 2025 s 5.

[17] Mental Health Bill [HL] Explanatory Notes para 77.

[18] ibid.

[19] MHA 2025 s 29.

[20] Mental Health Bill [HL] Explanatory Notes para 202.

[21] MHA 2025 s 30.

[22] ECHR Art 5(4).

[23] British Institute of Human Rights, Written Evidence Submitted by the British Institute of Human Rights (MHB0012) <https://committees.parliament.uk/writtenevidence/135397/pdf/>.

[24] Mind, Written Evidence Submitted by Mind (MHB0008) <https://committees.parliament.uk/writtenevidence/135297/pdf/> accessed 22 Feb 2026.

[25] Joint Committee on Human Rights, Legislative Scrutiny: Mental Health Bill (HC 601 / HL Paper 126) [26] Zoe Reynolds, ‘How are the changes to the Mental Health Act 2025 landing, and how can SCIE support?’ (SCIE, 11 Feb 2026) < https://www.scie.org.uk/how-are-the-changes-to-the-mental-health-act-2025-landing-and-how-can-scie-support/#:~:text=Key%20findings,Keeping%20up%20to%20date> accessed 22 Feb 2026.

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