Core Revision
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Chapter 10 of 11 · Ethics, Law & Safeguarding
The Mental Health Act: sections, powers and the 2025 reforms
Learn the sections as a table of four numbers each: who applies, who recommends, how long, and what the patient can do about it.
Read this first. The Mental Health Act 2025 received Royal Assent on 18 December 2025, but almost none of its clinical provisions are in force. Only a handful of technical sections have commenced. Nothing about detention criteria, holding powers, CTOs, consent to treatment, the Nearest Relative or places of safety has changed. The Government’s indicative timetable puts the first major phase at 2027/28, with full implementation over about a decade. Answer AKT questions on 1983 Act rules.
The sections at a glance
| Section | Purpose | Who applies | Doctors | Duration | Appeal |
|---|---|---|---|---|---|
| s2 | Assessment (± treatment) | AMHP or Nearest Relative | 2, at least one s12-approved | 28 days, not renewable | Tribunal within the first 14 days |
| s3 | Treatment | AMHP or NR — NR objection blocks it | 2, at least one s12-approved | 6 months, then +6, then annually | Once per period |
| s4 | Emergency admission | AMHP or NR | 1 | 72 hours | None |
| s5(2) | Doctor’s holding power — existing inpatient only | The doctor/approved clinician in charge, or one nominated deputy | — | 72 hours | None |
| s5(4) | Nurse’s holding power | Mental health or LD nurse | — | 6 hours | None |
| s135 | Warrant to enter private premises | AMHP applies to a magistrate; constable executes with AMHP + doctor | — | 24 h (+12) | None |
| s136 | Removal from anywhere other than a private dwelling | Police constable | — | 24 h (+12) | None |
| s17A | Community Treatment Order | Responsible Clinician + AMHP | — | 6 months, +6, then annually | Once per period |
Only one of the two doctors needs to be s12-approved. The other should, if practicable, have previous acquaintance with the patient — which in practice is very often the GP. That is the GP’s statutory role in a Mental Health Act assessment, and it is worth knowing that it is a real one.
The traps that recur
- s5(2) does not work in A&E, in clinic, or in your surgery. The patient must already be an admitted inpatient. Outside that, you are relying on common law, the MCA, or the police under s136.
- s136 is 24 hours, not 72. It was reduced by the Policing and Crime Act 2017, which also extended it to anywhere except a dwelling and made a police station unusable for under-18s and near-unusable for adults.
- s2 lasts 28 days; the appeal window is 14.
- s3 renewal is 6 → 6 → 12 months, not 6 → 12 → 12.
- The NR can block a s3 but not a s2.
- s135 needs a warrant, an AMHP and a doctor. s136 needs none of those — though the constable must consult a doctor, nurse or AMHP first where practicable.
You are called to see a 40-year-old man at home. He is acutely psychotic, has barricaded the door and is refusing entry. His mother is outside and very frightened. He has no history of violence.
What is the correct route?
s136 applies anywhere other than a house, flat or room where someone is living. His own home is precisely where it does not apply.
Entry to private premises requires a s135(1) warrant, applied for by an AMHP to a magistrate and executed by a constable accompanied by an AMHP and a doctor. He can then be removed to a place of safety for up to 24 hours (extendable by 12).
In the meantime: contact the crisis team and the AMHP service urgently, and if there is an immediate threat to life the police have separate common-law and Police and Criminal Evidence Act powers of entry that do not need a warrant.
s4 lets you admit on one medical recommendation where waiting for the second would cause undesirable delay. But it does not get you through the door. You still need lawful entry — that is what s135 is for.
s5(2) applies only to a patient already admitted to hospital. It has no application in the community.
Pick an option to see the answer.
Community Treatment Orders
Available only for patients detained under s3 or an unrestricted Part 3 section. Made by the Responsible Clinician with AMHP agreement. Two mandatory conditions (attend for renewal examination; attend for SOAD examination) plus discretionary conditions that must not amount to a deprivation of liberty. Recall is for up to 72 hours, within which the RC either revokes the CTO — reviving the s3 — or releases the patient back onto it.
Section 117 aftercare
Section 117 is triggered by discharge from s3, s37, s45A, s47 or s48. It is a joint duty on the ICB and the local authority, and the services must not be charged for. It ends only when both bodies jointly agree the person no longer needs them — never for cost reasons, and not on turning 18.
s117 does not follow s2, s4, s5 or s136. That is the single most examined point about it, closely followed by the fact that it is free.
Consent to treatment (Part 4)
- s63 — treatment for mental disorder under the direction of the approved clinician needs no consent
- s58 — after three months of medication for mental disorder in the current detention you need a certificate: Form T2 (the approved clinician certifies capacity and consent) or Form T3 (a SOAD certifies the treatment is appropriate where the patient refuses or lacks capacity)
- s58A (ECT) — ECT cannot be given under s58A to a capacitous patient who refuses (the only route in that situation is s62 urgent treatment, below). An incapacitous adult needs a SOAD certificate and no conflicting advance decision, attorney, deputy or court order. Any under-18 needs a SOAD certificate, even if informal and consenting
- s62 — urgent treatment disapplies these where immediately necessary to save life, prevent serious deterioration, alleviate serious suffering, or prevent dangerous behaviour. For ECT only the first two limbs apply
SOADs are appointed by the Care Quality Commission, not by the trust. Part 4 does not apply to patients held under s4, s5, s135, s136 or guardianship.
The Nearest Relative
Not “next of kin” — a statutory list, in order: spouse or civil partner (including a cohabitee of six months or more), son or daughter, father or mother, brother or sister, grandparent, grandchild, uncle or aunt, nephew or niece. The elder of two equals wins, whole blood beats half blood, and a relative the patient lives with or is cared for by is preferred.
The NR can: request an AMHP assessment; apply for s2, s3 or guardianship; object to a s3, which blocks it; and order discharge on 72 hours’ written notice — which the RC can block with a barring report. Displacement is by the county court under s29.
An 84-year-old woman with dementia and no psychiatric history is in hospital with a fractured hip. She lacks capacity to consent to admission, is not objecting, and needs to stay on the ward for rehabilitation. The ward is locked and she is under constant observation.
Which framework?
She is in hospital for treatment of a physical disorder and is not objecting. The MHA is for detention for assessment or treatment of mental disorder.
Treatment proceeds under the MCA in her best interests. Whether the arrangements amount to a deprivation of liberty requiring DoLS is now a multifactorial question following the June 2026 Supreme Court judgment ([2026] UKSC 16) — and the fact that she is not objecting and may be validly consenting weighs against it. Under the old acid test this was an automatic DoLS application; it no longer is. See Chapter 3.
The MCA replaced the common law for adults lacking capacity. Necessity survives only for genuine emergencies before the Act can be applied.
A relative has no power to consent for an adult unless they hold a registered health and welfare LPA or a deputyship.
Pick an option to see the answer.
What the 2025 Act will change — eventually
Worth knowing as future context, and worth not answering exam questions with yet:
- New “serious harm” detention criteria, adding likelihood of harm to nature and degree
- Therapeutic benefit written into “appropriate medical treatment”
- Learning disability and autism removed as grounds for s3 detention unless a co-occurring psychiatric disorder meets the criteria — and this will not commence until community services are judged sufficient
- The Nominated Person replaces the Nearest Relative, chosen by the patient
- Statutory care and treatment plans and advance choice documents
- Police stations and prisons abolished as places of safety
- Shorter s3 periods (3 months, then 3, then 6, then annually) and a longer s2 appeal window of 21 days
- Opt-out IMHA for detained patients, extended to informal patients
Self-testA GP is asked to be the second doctor in a Mental Health Act assessment for a long-standing patient. She is not s12-approved. Can she do it?
Yes, provided the other doctor is s12-approved — only one of the two must be. Indeed she is the preferred second doctor: the Act asks that, where practicable, one doctor has previous acquaintance with the patient, and a GP who knows them well is exactly who that means.
The two examinations must be no more than five days apart, and conflict-of-interest rules apply — for example the two doctors should not, in specified circumstances, be from the same team.
Self-testWhich is the more restrictive framework, the MHA or the MCA? And why does the answer matter?
Neither, straightforwardly — and that is the point. The MHA authorises detention and, crucially, treatment for mental disorder without consent in a patient who objects. The MCA can authorise deprivation of liberty but cannot be used to impose treatment on someone who is objecting and meets MHA criteria.
It matters because the MHA carries stronger safeguards attached to that greater power: tribunals, IMHAs, SOAD certification, and s117 aftercare. Using DoLS to avoid “sectioning” someone who is objecting is not the kinder option — it is unlawful, and it strips them of those protections.
Written and checked by NHS GPs. Last reviewed 24 August 2026. UK law and guidance change — always follow current local policy and your defence organisation’s advice in a real case.
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