Modernising the Mental Health Act: increasing choice, reducing compulsion

6 December 2018

In October 2017, Prime Minister Theresa May announced an Independent Review of the Mental Health Act 1983. The Act gave the state powers to detain, assess and treat people with severe mental health problems. May said the review would consider the context of rising rates of people being detained under the Act and its disproportionate use to detain people from black and minority ethnic groups.

The Review was chaired by Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists and reported on 6 December 2018. The report findings made clear that the Mental Health Act needed significant reform.


The review’s 154 recommendations were organised according to four principles to ensure:

  • patient choice and autonomy
  • the least restrictive use of the Act
  • therapeutic benefit to patients, so they could be discharged from the Act
  • the treatment of patients as individuals.

Government response

On the day of the review’s publication, the government confirmed it would accept at least the following two of the review’s recommendations to establish:

  • statutory ‘advance choice’ documents in which people express their preferences for care and treatment, so that these would carry more legal weight than they previously had
  • a new role of Nominated Person enabling people to choose which relative would be involved in decisions about their care and have the power to act on their behalf, rather than this relative being allocated to them from a list.

Theresa May committed to new mental health legislation and later confirmed that the government would publish a white paper on reforming the Act in response to the Review before the end of 2019.

The following Prime Minister, Boris Johnson, repeated the same commitment to publish a white paper and then reform the Mental Health Act in the Queen’s Speech on 14 October 2019 and again in the Queen’s Speech on 19 December 2019.


Wessely S.
Modernising the Mental Health Act: Increasing choice, reducing compulsion.
UK government; 2018.

Department of Health and Social Care.
Prime Minister announces review to tackle detention of those with mental ill health.
UK government; 2017.

Department of Health and Social Care.
Government commits to reform the Mental Health Act.
UK government; 2018.

Prime Minister’s Office.
Queen’s Speech December 2019.
UK government; 2019.

Prime Minister’s Office.
Queen’s Speech October 2019.
UK government; 2019.