Reform of the Mental Health Act

The 1983 Mental Health Act is widely regarded to be outdated. Its proposed replacement is currently undergoing its final stages in the House of Commons, having been introduced there in April earlier this year. This demand for change suggests a rise in modern clinical and moral standards relative to past decades, shifting towards a greater emphasis on patient autonomy. 

The bill is poised to modernise and implement recommendations made by the 2018 Wessely Independent Review. This review was initially commissioned by ex-Prime Minister Theresa May in response to the increased number of patients subject to detentions under the Act. According to the NHS website, 52,358 new detentions were recorded across England in 2023. The national total is likely even higher. The bill is also a response to testimonies given by those subject to care under the act. This displays how the medical sphere is now becoming increasingly responsive to patient experiences, having greater control over how they are managed in a contemporary landscape. 

The reformed bill will not just stop at limiting confinements, either. Other recommendations included replacing the ‘nearest relative’ system with a ‘nominated person’ to be chosen specifically by the patient. The implementation of a narrower detention criteria and an end to the use of police cells as ‘places of safety’ has also been suggested. Finally, the Bill proposes extending Human Rights Act protections to those receiving services from private providers, ensuring they are safeguarded against mismanagement.

It is easy to generalise this piece of medical legislation as ‘modern’ or a ‘breakthrough’. However, it is important to appreciate that this bill is part of a wider trend, built off of the errors and gains of past acts. Before the 1983 Act, there was the 1959 Mental Health Act. This abolished the distinction between psychiatric and general hospitals, amongst other things, improving the standards of patient care within the then fairly new NHS system. This repealed past legislation: the Lunacy and Mental Treatment Acts and Mental Deficiency Acts. This changed the way people with learning disabilities were legally categorised, no longer officially using pejorative terms such as ‘feeble-minded’. This conveyor-belt of updating mental health legislation is a consistent pattern across the 20th century.

Mental health legislation is greatly influenced by the culture of the time, suggesting that the current bill in Parliament will likely be subject to further change in the future. Past acts were also once considered modernising and ‘up-to-date’, yet time has seen the public call for them to be amended. Even the driving force behind the investigation himself, Professor Wessely, has identified the central role of time and cultural change. He was quoted saying that “the Mental Health Act (1983) was written when people with a mental health problem was something to be afraid of … but the way we think about mental health and illness has changed dramatically, so now they are more likely to be seen as people to be helped”. Human autonomy is now given far greater value, where in the past it was overlooked in favour of convenience, order and government control both in the medical and societal spheres.

What this means for aspiring medics

The reform of the Mental Health Act highlights key lessons for future doctors. It underscores the growing importance of patient autonomy, ethical practice, and legal awareness in medical care. Aspiring medics should recognise that delivering effective care is not just about clinical knowledge but also about understanding patients’ rights, cultural context, and evolving societal expectations. Being aware of legislation like this demonstrates a commitment to responsible, reflective, and patient-centred practice, qualities medical schools value highly.

Potential interview questions

  • Why do you think mental health legislation needs to change over time?
  • Why is patient autonomy important, and how would you uphold it in practice?
  • Can you give an example of a situation where a doctor’s legal and ethical responsibilities might conflict, and how you would handle it?