Note: This article was first published by Charity Finance on 1 July 2026
The Mental Health Act 2025 brings significant reform of mental health legislation in England and Wales, impacting all those involved in the commissioning or delivery of mental health services. Implementation is expected to be phased over the next 10 years, with a focus on tighter safeguards around detention, strengthened patient rights, and improved therapeutic outcomes. Nevertheless, it remains to be seen whether these legal changes will translate into practical improvements.
Charities are increasingly critical to the safety and accessibility of mental health care, whether that is via providing information, advocacy, care, support, supplemental therapeutic provisions, or in some areas, direct inpatient provision. Charities working in partnership with NHS or independent mental health services will face significant operational and strategic implications from these reforms.
Currently, implementation dates for most of the reforms are unconfirmed, with a draft Code of Practice expected in late 2026 or early 2027. However, charities should begin planning now for these major changes.
Inpatient care
The Act makes changes designed to increase the legal threshold for detaining patients in hospital. This is by including a requirement for there to be "serious harm" to the patient or others if they are not detained and by requiring those making applications for detention to demonstrate that detention would be appropriate given the "nature, degree, and likelihood of harm" that may otherwise result.
Linked with this, the reforms also exclude autism and learning disability as standalone grounds for detention in hospital under section 3 and consequent Community Treatment Orders (CTOs). This has been a high-profile change which will undoubtedly be significant, once implemented.
The policy drivers for these changes are laudable, as they seek to prevent those with learning disability and autism being detained in hospital for long periods and to ensure detention only occurs in cases where risk cannot be managed any other way. However, in practice, it is often the lack of suitable community placements that results in prolonged hospital admissions, rather than the application of the detention criteria themselves.
For those who will no longer be detained under the Act, demand for community support is likely to increase, putting further pressure on already stretched community services, including those delivered by the third sector, especially for individuals with learning disabilities and autism.
The Act also introduces stricter safeguards for treatment without consent, including a greater role for second opinion appointed doctors and a requirement that treatment has a “reasonable prospect” of alleviating the disorder or preventing deterioration. This is likely to put a greater onus, and administrative burden, on clinicians to justify treatment choices. There may also be an increased role for advocacy organisations, including charities, in scrutinising treatment thresholds and procedural compliance under the Act.
In the community
The Act also introduces targeted reforms to community provisions.
The framework for CTOs is being strengthened, with narrower criteria aligned to section 3 and a new requirement to appoint a community consultant for all CTO patients. This clinician must be consulted before a CTO begins and on any proposed or amended conditions, helping to formalise the benefits of liaison between inpatient and community teams before discharge on a CTO. Nominated persons (replacing nearest relatives) will also have rights to be consulted and to object.
Separately, aftercare arrangements under section 117 will be reformed to align the position concerning responsible local authorities with that of integrated care boards (ICBs). Those who have engaged with the challenge of identifying the correct responsible body for section 117 purposes are likely to find that after a potentially challenging transitional period, this alignment should simplify the arrangements for section 117 patients, with joint commissioners now more likely to be in the same region and therefore more familiar with joint working. The hope is that this will reduce delays and disputes for aftercare funding arrangements, thereby allowing greater focus on the provision of person centred aftercare in the community.
Whilst many of these changes are likely to primarily impact the statutory bodies responsible for patients in a particular locality, it is important to keep in mind that transition to the new provisions as the Act is implemented will involve significant upheaval for the entire sector. The requisite administrative changes - for example, new policies, procedures, forms and training materials - will require significant time and resource. There will also be a knock-on impact for those working alongside the statutory bodies, as focus and resource will be directed towards facilitating smooth transition to compliance with the new legislation, potentially impacting investment and engagement with other projects.
Rolling reform
Whilst the Act contains a multitude of changes driven by a policy emphasis on enhanced patient rights, its practical impact will depend heavily on how it is implemented (chiefly via the incoming Code of Practice) and resourced in practice.
For charities, the reforms present both challenges and opportunities. A push towards fewer patients in hospital will undoubtedly increase demand on community provisions and, in any event, transition to the new legislative framework is going to involve significant upheaval across the sector.
As ever, sustainable funding for charities that provide or support mental health services will be paramount. With phased implementation on the horizon, early engagement, forward planning, and flexibility will be essential to ensure organisations are not only compliant, but well positioned to support individuals effectively within a rapidly evolving mental health landscape.
