Website of the Department of Health

What will it do?

The Mental Health Act 2007 makes a range of important changes to existing legislation to modernise and improve it.

It introduces a new, simplified single definition of mental disorder in the Mental Health Act 1983, removing unnecessary complexity. 

It introduces a specific new requirement that no-one can be brought or kept under detention for medical treatment under the Mental Health Act unless appropriate medical treatment is available. 

It introduces supervised treatment in the community (SCT) which will allow patients to be discharged from hospital and continue their treatment in the community. 

There is greater flexibility about which  professionals may perform certain key statutory roles under the Mental Health Act, reflecting modern NHS practices.

The revised Code of Practice to the Mental Health Act contains a set of principles to inform decisions made under the Act.

Detained patients will have the right to refuse electro-convulsive therapy (ECT).

Patients will now be able to apply themselves to the county court to have their nearest relative displaced.

Civil partners are now treated in the same way as spouses when determining who is a patient’s nearest relative. 

There will be a new regime of safeguards in the Mental Capacity Act for people deprived of their liberty in care homes or hospitals where they lack capacity to take the relevant decisions themselves, but it is considered necessary in their best interests.

Parts of the Act that come into force later are:

Statutory independent mental health advocates will be available for the first time. (April 2009)

Patients aged under 18 in hospital will be accommodated in an environment that is suitable for their age, subject to their needs.  (April 2010).

What is the single definition of Mental Disorder brought in by the Act?

“Any disorder or disability of the mind.”  The new definition is no wider than the current one, except that mental disorders considered to be “sexual deviancy” will no longer be excluded. Alcohol and drug dependence will continue to be excluded.  In addition, the Act will no longer distinguish between different categories of mental disorder, so the same criteria apply regardless of diagnosis and no-one fails to get the treatment they need because they do not happen to fall within one of these categories.  But the limitations on when certain powers can be used solely in respect of learning disability will be kept.

What is a supervised community treatment?

Supervised treatment in the community (SCT) will be available for suitable patients following a period of detention and treatment in hospital.  It will allow patients who are well enough to be discharged from hospital, as long as they continue their treatment in the community.  It will be possible to recall patients to hospital if necessary.  SCT will help patients comply with treatment and enable action to be taken to prevent harm to themselves or others and avoid relapses and readmissions to hospital.  It reflects modern service provision; patients treated in their communities according to their individual needs and circumstances.  Patients on SCT will not be subject to forcible treatment in their own homes (except in certain situations where it is an emergency and they lack capacity to consent.).  If they refuse treatment, and treatment is seen as essential, then they normally will be brought back to hospital.  Patients will not be subject to conditions other than those which are related directly to their treatment or to protecting them or others from harm.

Who is responsible for implementing the changes?

The changes provide new opportunities for mental health services locally. It is up to those services to make the best use of them.  The Mental Health Act Commission will continue to monitor the operation of the Act in hospitals until April 2009, when its functions will be taken over by the Care Quality Commission, the new integrated regulator for health and social care in England.

How can the Act provide more treatment in the community and still protect the public effectively?

People with even serious mental disorders are much more likely to pose a risk to themselves than to the public at large. It will still be possible to detain people in hospital where that is necessary because of the risk posed by their mental disorder either to themselves or other people. But it will now be possible for some of those people to be discharged onto supervised community treatment – meaning they can continue their treatment in the community, subject to the possibility of being recalled to hospital if necessary.  That will help ensure that they continue to get the treatment they need, and help break the so-called “revolving door” cycle of people being discharged from hospital, losing contact with services, and then having to be detained again as a result.

Won’t SCT simply be abused/overused?

We don’t expect it to be. It will be a matter of clinical judgement whether SCT is suitable for an individual patient.  But we will monitor its use through statistical collection and research.

Isn’t SCT simply ineffective?

No. A review of research evidence commissioned by DH (Churchill et al 2007) found that there was a lack of conclusive evidence about the effects of community treatment orders internationally. A lack of evidence should not be confused with a lack of efficacy. The lack of evidence is not surprising due to the nature of these interventions; there are many practical and methodological problems in research in this area. Interestingly the study did show that many stakeholders had positive views about CTOs. A research study into how SCT will work in England has already been commissioned.

If people have serious mental health problems, shouldn’t they just be in hospital?

People should be where they will be treated best, having regard to their individual case and circumstances.

Won’t this Act mean that more people will be locked up against their will?

The reason we have a Mental Health Act is that sometimes it is necessary to take action without people’s consent in order to protect them, or other people, from the ill-effects of their mental disorder. In fact, total detentions under the Act have remained fairly stable over several years.  The changes made by the 2007 Act are unlikely to change that. But we will monitor their impact.

What will Mental Health Advocates do?

Independent mental health advocates (IHMAs) will help patients to understand the way the Mental Health Act applies to them, and what can and cannot be done as a result. They will also help patients to understand their rights under the Act, and to support them in exercising those rights.

Who can be an advocate?

The appointment of IMHAs will be subject to regulations. It will be the responsibility of commissioners – Primary Care Trusts or Local Authorities – to engage people to act as IMHAs. 

Why can’t advocacy arrangements come into being now?

A decision was made to delay the introduction of advocacy arrangements to allow commissioners and voluntary sector organisations sufficient time to develop systems to engage suitably experienced IMHAs.

Does this mean that mental health patients will be left without advocacy until 2009?

Although there will be no statutory requirement for services to provide IMHA support before April 2009, advocacy provision is already available on a non-statutory basis from a number of agencies and we expect that these arrangements to continue.

Why didn’t you delay the provisions on supervised community treatment until advocacy arrangements were ready?

SCT is a useful treatment option for patients, clinicians and families.

It reflects and supports modern service provision - patients treated in their communities according to their individual needs and circumstances.  Delaying the introduction of SCT until advocacy arrangements were in place, would have denied patients and clinicians this useful treatment option.

When will you announce guidance/funding for advocacy?

Commissioning arrangements for IMHA services will be announced shortly.

What flexibility does the Act introduce around which professionals can perform which roles?

The Act removes rigid demarcation of professional roles and introduces a new approach which ensures that practitioners with the right skills, expertise and training can carry out important functions not currently open to them. The Approved Social Worker role will be replaced by the Approved Mental Health Professional which will be open not only to social workers but also to first level nurses whose field of practice is mental health or learning disability, occupational therapists and chartered psychologists. The Responsible Medical Officer role will be replaced by the Responsible Clinician Role, which is open to other professions as well as doctors, the same as above.

Does that mean there’s a danger that the person in charge of care may not be qualified for the job?

Not at all. The professionals undertaking the new functions of approved mental health professional, approved clinician and responsible clinician under the Act will have to be registered with their professional bodies, have undergone appropriate training and meet the relevant competencies. We expect that only experienced, senior professionals will be able to demonstrate that they meet the competencies needed to be an approved clinician.

Psychiatrists are concerned that when they are required to detain someone, the new Act will mean that they are now responsible for finding and bed and must also know where the patient is being sent, when this isn’t always possible.

The basic procedures for detaining people aren’t changing. Like now, professionals need to work with each other to do what is best for the patient. It is up to local services to put in place the systems and structures to allow them to do that.