What changes on the ward: voice, plans, timings and places of safety

Emma George, last time was the headline. Now give me the stuff I'll actually meet on shift. Start with the nominated person.

George It replaces the nearest relative. Under the old rules the nearest relative came from a list in the Act, so the right to be consulted could land on an estranged parent or someone the patient had cut off.

Emma I've seen that go badly.

George Everyone has. Now, if the person has capacity, they choose, and the choice carries on even if they later lose capacity. If they haven't chosen and can't, an approved mental health professional can appoint one. And the nominated person gets new consultation rights and can object to a community treatment order.

Emma What do I do about it before it's in force?

George Ask early, while someone's well enough to answer. Who would you want us to speak to? Record the answer, and where it came from.

Emma What about advocacy?

George Independent mental health advocacy extends to informal patients, on an opt-out basis. The service has to contact qualifying patients to offer support instead of waiting to be asked. Your job is making sure patients know the advocate exists and can reach them.

Emma And care plans?

George They become statutory. For people detained, on a community treatment order or under guardianship, the responsible clinician must prepare a plan and review it regularly. It's where the four principles stop being words.

Emma I've heard about advance decisions too.

George Advance choice documents. Healthcare bodies must help people record their wishes and feelings and decisions about future care. Professionals must have regard to them, but they aren't absolutely binding. They're the clearest way someone can still be heard when they're unwell.

Emma Detention periods. I never remember these.

George Nobody does, so here's the shape. First section 3 detention goes from six months to three. Renewable for three more. Then six months at a time instead of twelve. More renewals means more reviews, and more occasions where you need to show detention is still justified.

Emma And tribunals?

George Section 2 patients can apply within 21 days instead of 14. Section 3 within three months instead of six. And there's automatic referral three months after initial detention, then every twelve months.

Emma Community treatment orders?

George They'll need the same serious harm criteria and appropriate treatment as detention, plus written agreement from the community clinician. And the tribunal can recommend reconsidering specific conditions, so every condition has to be one you can explain.

Emma Section 136. The police cells.

George Police cells come out of the definition of a place of safety under sections 135 and 136. Prisons can no longer be a place of safety for people in contact with criminal justice. Local arrangements for people in crisis will have to change, and the government has agreed to consult on emergency police powers.

Emma So what do I do now? Concretely.

George Don't change practice early. Do prepare. Find your trust's commencement plan. Check your recording habits. Ask people early who they'd want consulted and about their advance wishes. Make sure advocates are reachable. And read the Act's Explanatory Notes, which are free and clear. Including instead of this course, if there's a conflict.

Emma Including instead of this course?

George Always. If anything I've said differs from your trust's guidance, or the statutory Code once it's published, follow them and tell us so we can fix it. A summary is a way in, not the authority.