Module 1 of 2 · 50 minutes
The Act, the timetable and the new detention test
By the end of this module you will be able to
- State when the Act received Royal Assent and why commencement is phased
- Say what applies on the ward today
- Name the four principles the Code of Practice must reflect
- Explain the serious harm test and the therapeutic benefit test
- Explain what changes for people with a learning disability or who are autistic
Watch: Emma and George talk it through
4 minutes. Captions are on, and the same conversation is written out in full below. The voices are computer generated.
Emma George, the new Mental Health Act. I've seen a dozen posters, three training days and two rumours. Is it law yet?
George It's law, but it isn't all in force. That distinction is the first thing to get clear. Royal Assent was 18 December 2025. That made it an Act. It didn't switch the provisions on.
Emma So when does it start?
George In pieces. A small number of provisions are already in force. Most have to be commenced by regulations, and the plan is phases over potentially ten years. The statutory Code of Practice has to be drafted, consulted on and published first. Workforce training is planned for 2026 and 2027, and the first major phase is expected from 2027.
Emma What do I do on the ward on Monday?
George Keep working to the 1983 Act as it stands until your trust tells you a provision is in force. Don't change practice because of what the 2025 Act will provide. That's the single most useful sentence in this course.
Emma Right. What's it actually trying to do?
George Four principles, taken from the independent review in 2018. Choice and autonomy. Least restriction. Therapeutic benefit. And the person as an individual. The Code of Practice has to reflect them.
Emma Principles are easy to write. Do they change anything?
George They explain the rest. Choice is why people can plan ahead. Least restriction is why a restriction needs justifying. Therapeutic benefit is why detention has to be for treatment that has a real prospect of helping. And the individual is why culture, history and preferences matter.
Emma The part everyone asks about is who can be detained.
George Under sections 2 and 3, there has to be a risk of serious harm, to their own health or safety or someone else's. And the decision maker has to consider the nature, the degree and the likelihood of it. So possible harm isn't enough any more.
Emma And section 3 specifically?
George There has to be real therapeutic benefit. The treatment available must have a reasonable prospect of alleviating the disorder, or stopping it getting worse, or easing symptoms. Treatment that can't offer that isn't a basis for compulsion.
Emma I'm a nurse, though. I don't detain anyone.
George No, that's for approved mental health professionals and doctors. But what you observe and write is what those decisions and the later reviews are built from. If the test asks about nature, degree and likelihood of harm, a vague note is no use to anybody.
Emma What does a good note look like?
George Specific behaviour, specific risk, specific response to treatment, in your own words and timed. Not agitated and unsettled all day. What they did, what you saw, what you did about it, what happened.
Emma What about learning disability and autism? I've heard that's big.
George It is. Once those provisions commence, a person can't be detained for treatment under section 3, or put on a community treatment order, just because they have a learning disability or are autistic. They'd also need a psychiatric disorder that meets the criteria.
Emma So where do they go?
George That's the point of the other half. Statutory Care and Treatment Reviews for detained children and young people. And integrated care boards have to keep a register of people at risk of admission, so support can be arranged in the community before a crisis.
Emma Anything I can do now?
George Start asking, for anyone with a learning disability or autism, what support in the community would make admission unnecessary. And read your trust's commencement plan when it arrives, rather than a poster.
The written material
Royal Assent is not the same as in force
The Mental Health Act 2025 received Royal Assent on 18 December 2025. That made it law, but it did not switch its provisions on. Most of them have to be brought into force by commencement regulations, and the government has said the full programme will run in phases over potentially ten years.
A small number of provisions have already been brought into force. The new statutory Code of Practice has to be drafted, consulted on and published, which is expected to take around the first couple of years. Workforce training is planned for 2026 and 2027, and the first major phase of reforms is expected from 2027.
Four principles
The Act requires the Code of Practice to reflect four principles taken from the independent review of 2018: choice and autonomy, least restriction, therapeutic benefit, and the person as an individual.
They are not decoration. They are the reason for most of what follows. Choice means the person's views count, and they can plan ahead. Least restriction means a restriction has to be justified against the alternative. Therapeutic benefit means detention is for treatment that has a real prospect of helping. The person as an individual means their culture, history and preferences are part of the picture.
The new test for detention
Under sections 2 and 3, a person can be detained only if there is a risk of serious harm to their own health or safety or to someone else's. The decision maker must consider the nature, the degree and the likelihood of that harm, so it is no longer enough that harm is merely possible.
For section 3, there must also be a real therapeutic benefit. The treatment available must have a reasonable prospect of alleviating the person's mental disorder, or preventing it getting worse, or one or more of its symptoms or manifestations. Treatment that cannot offer that is not a basis for compulsion.
Nurses do not make the legal decision to detain, which rests with approved mental health professionals and doctors. But your observations and your records are what those decisions and the later reviews are built from. Record behaviour, risk and response to treatment specifically and in your own words, because the test now asks about the nature, degree and likelihood of harm.
People with a learning disability or who are autistic
Once the relevant provisions are commenced, a person with a learning disability or who is autistic will no longer be able to be detained for treatment under section 3, or placed on a community treatment order, unless they also have a psychiatric disorder that meets the detention criteria. Learning disability and autism themselves are no longer enough.
The Act also puts statutory Care and Treatment Reviews in place for detained children and young people with these conditions, and requires integrated care boards to keep a register of people at risk of admission so that support can be arranged in the community before a crisis.
Knowledge check
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The learning itself stays free and open. You are reading all of it right now without an account.
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