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Mental health crisis care

Lifecycle: Implementation Care Quality Commission · College of Policing · Department of Health and Social Care · Health and Social Care Committee · Home Office · Ministry of Justice · NHS England · Public Accounts Committee · The Parliamentary and Health Service Ombudsman Last regenerated 3 weeks ago

Summary

What this is

The reform of England and Wales' mental health crisis-care regime, comprising the Mental Health Act 2025 (which amends the Mental Health Act 1983 across detention criteria, nominated persons, advance choice documents, IMHAs, learning disability/autism scope, and removes police stations and prisons as places of safety) and the operational crisis-care architecture built around the 2014 Crisis Care Concordat and the 2023 Right Care, Right Person National Partnership Agreement.

Why it matters

The regime determines when the state may detain and compulsorily treat people in mental health crisis, who responds at the front line (police vs health), and what safeguards apply — touching ~52,000 new detentions per year and an estimated £5.3bn of health/social care costs and £313m of justice-system costs over 20 years (DHSC IA, 2024/25 prices).

Current status

The Mental Health Act 2025 received Royal Assent (c. 33) following ping-pong concluding in December 2025; Commencement No. 1 Regulations brought ss. 51-52 into force on 6 April 2026, but the bulk of the Act remains uncommenced pending statutory guidance, workforce build-up and Code of Practice revision. The 2023 RCRP National Partnership Agreement continues to govern police-health interface during this transition.

What changed recently

  • 22 Apr 2026 — PQ tabled on ICB liothyronine policies — illustrative of continuing ICB-level commissioning scrutiny adjacent to the reformed s.117 aftercare duty. →
  • 7 Apr 2026 — Mental Health Act 2025 (Commencement No. 1) Regulations 2026 (SI 2026/385) commenced ss. 51 (HRA extension to certain private care providers) and 52 (review of duty to notify incidents) on 6 April 2026 — the first commencement of substantive 2025 Act provisions. →
  • 19 Mar 2026 — Health and Social Care Committee Chair publicly criticised the Government's response to the Committee's community mental health services report as 'disappointing', citing absence of national waiting-time standards. →
  • 29 Jan 2026 — CQC published 'Monitoring the Mental Health Act: 2024 to 2025' — its statutory annual report on MHA use, the last under the unreformed Act in operation for a full year. →
  • 2 Dec 2025 — HSCC published 'Government risks missing golden opportunity to transform mental health services' — calling for continued funding of six 24/7 Neighbourhood Mental Health Centres pilots. →

Key documents

Framework

  • Act

    Mental Health Act 2025 (c. 33)

    Reform Act amending MHA 1983 across detention criteria (s.5), CTOs (s.6), nominated persons (s.24, Sch 2), advance choice documents (s.44), IMHAs (s.40, Sch 3), care and treatment plans (s.21), removal of police stations and prisons as places of safety (s.48), and extension of HRA s.6(3)(b) to certain private care providers (s.51).

  • Policy Paper
    View Original ↗

    Mental Health Crisis Care Concordat (February 2014)

    Foundational multi-agency concordat (22+ signatories) establishing principles for how health, police, ambulance and social care respond to mental health crisis.

  • White Paper
    View Original ↗

    Reforming the Mental Health Act (2021 White Paper / consultation outcome)

    Government's full policy position following the Wessely Independent Review and the 2018 White Paper consultation — the policy spine the 2025 Act enacts.

  • Bill

    Mental Health Act 2025 — Keeling Schedule (October 2025)

    Keeling schedule showing all amendments to MHA 1983 as enacted — the operationally critical reference for what the post-reform statute actually says.

  • Bill

    Mental Health Bill — HL Bill 137 Commons Amendments (15 October 2025)

    Commons amendments returned to Lords inserting new MHA 1983 s.142C (HRA extension to certain private care providers under s.117 after-care, NHS-arranged in-patient treatment and Scottish equivalents), tightening s.45 advance choice document arrangements, and removing the 'constable or other authorised person' references in clause 5.

Operationalising

Scrutiny

Evidence

  • Policy Paper

    Mental Health Bill Impact Assessment (DHSC, November 2024)

    Final-stage IA quantifying the reform package at ~£5.3bn (health and social care) and £313m (justice) over 20 years, with best-estimate NPV of -£169m and a wide -£4,835m to +£3,876m range; sets out 40,000 ACDs/year, ~27,000 additional IMHA caseload, and ~1,300 fewer CTOs/year at steady state.

Consultations

Stakeholders

Grouped by role with evidence. Long groups scroll inside their column.

Sponsoring department 3

  • Department of Health and Social Care
    Bill sponsor; published the November 2024 Impact Assessment; lead on Code of Practice and statutory guidance under the 2025 Act
  • Ministry of Justice
    Co-sponsor on Part III restricted patients, MHT and prison transfer provisions; signatory to the IA covering £313m of justice-system costs over 20 years
  • Home Office → src
    Co-signatory to the 2023 Right Care, Right Person National Partnership Agreement defining the police-health crisis-response threshold

Sponsoring minister 7

  • Baroness Merron
    Then Parliamentary Under-Secretary of State for Patient Safety, Women's Health and Mental Health (treat as historical for current status); Lords Bill minister — wrote multiple peers' letters during Lords Committee on CTOs, IMHAs and devolved powers
  • Wes Streeting → src
    Then Secretary of State for Health and Social Care (treat as historical for current status; the department is now led by James Murray as Secretary of State for Health and Social Care); issued HCWS66 on the CQC s.48 review of Nottinghamshire Healthcare in September 2024
  • Stephen Kinnock
    Commons Bill minister during Public Bill Committee — wrote follow-up letters to MPs on devolved powers, IMHA concerns, tribunal powers, capacity and readmission data (June–July 2025)
  • Zubir Ahmed → src
    Parliamentary Under-Secretary of State at DHSC who signed the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026 (SI 2026/495) on 29 April 2026
  • Victoria Atkins → src
    Then Secretary of State for Health and Social Care (treat as historical for current status; the department is now led by James Murray as Secretary of State for Health and Social Care); commissioned the CQC s.48 review of Nottinghamshire Healthcare in January 2024 and reported via HCWS391 in March 20
  • Lord Markham → src
    Then Parliamentary Under-Secretary of State, DHSC (Lords) (treat as historical for current status); issued HLWS388 on the CQC s.48 review of Nottinghamshire Healthcare in March 2024
  • Sajid Javid → src
    Then Secretary of State for Health and Social Care who made HLWS185 publishing the MHA reform consultation response in July 2021 — the policy moment that crystallised the 2025 Act package

Lead committee 3

  • Health and Social Care Committee → src
    Lead Commons scrutiny committee; published its 'golden opportunity' report on community mental health (Dec 2025) and the Chair publicly criticised the Government response (Mar 2026)
  • Public Accounts Committee → src
    Took evidence from DHSC and NHSE on mental health services (PAC report, July 2023) — fiscal/delivery scrutiny baseline
  • Delegated Powers and Regulatory Reform Committee (Lords)
    Published 18th Report scrutinising delegated powers in the Mental Health Bill (March 2025)

Regulator / delivery programme 6

  • Care Quality Commission → src
    Statutory monitor of MHA use (annual 'Monitoring the Mental Health Act' reports); conducted the s.48 review of Nottinghamshire Healthcare; submitted written evidence to PBC (MHB27)
  • NHS England → src
    Operational lead for ICB commissioning of crisis pathways; co-signatory to RCRP NPA; co-producing guidance on multi-agency urgent mental health interface
  • National Police Chiefs' Council → src
    Co-signatory to RCRP NPA; producing the operational toolkit on RCRP threshold decisions with the College of Policing
  • College of Policing → src
    Co-developer of the RCRP national toolkit and legal guidance on police thresholds for mental health response
  • Association of Police and Crime Commissioners → src
    Co-signatory to RCRP NPA via its mental health lead PCC
  • Parliamentary and Health Service Ombudsman
    Submitted written evidence to PBC (MHB30) on complaints and accountability under the reformed Act

Witnesses & evidence-givers 12

  • Royal College of Psychiatrists
    Submitted written evidence to PBC (MHB70) and a further submission on learning disability and autism reforms; Concordat signatory
  • Mind
    Submitted written evidence (MHB35) and a further submission to PBC; Concordat signatory; consistent civil-society voice for patient-rights reform
  • NHS Confederation
    Submitted written evidence to PBC (MHB31); its BME Leadership Network submitted MHB74 on racial disparities
  • Mental Health Foundation
    Submitted written evidence to PBC (MHB50); Concordat third-sector signatory
  • The Law Society
    Submitted written evidence to PBC (MHB23) on legal aid, MHT capacity and procedural safeguards
  • NHS Race and Health Observatory
    Submitted written evidence to PBC (MHB65) on racial disparities in detention and CTOs
  • Approved Mental Health Professional Leads Network
    Submitted written evidence to PBC (MHB08) — front-line AMHP perspective on the practical mechanics of the reformed assessment regime
  • Royal College of Nursing
    Submitted written evidence to PBC (MHB64) on workforce capacity and training implications
  • Local Government Association
    Submitted written evidence to PBC (MHB62) on s.117 aftercare funding and local authority duties
  • Professor Alex Ruck Keene KC (Hon)
    Leading mental capacity barrister; submitted written evidence to PBC (MHB13) on capacity, interface with Mental Capacity Act, and deprivation-of-liberty conditional discharge
  • Michael Brown OBE
    Mental health and policing specialist ('Mental Health Cop'); submitted PBC evidence (MHB01) on s.135/136 reform and RCRP interface
  • Imkaan
    Submitted PBC evidence (MHB26) on intersectional impacts on Black, Asian and minoritised women

Civil society 2

  • Race Equality Partnership for Sheffield
    Submitted PBC evidence (MHB78) — local-level race-equality scrutiny of detention practice
  • Thrive LDN
    Submitted PBC evidence (MHB71) on London-wide crisis pathway and prevention

Political commitments

What parties and ministers have promised — manifesto pledges, King's Speech announcements, ministerial statements. Each card shows what was said, by whom, and when, with a link to the original source.

  • commitment Ministerial statement Labour · 2024 · Care Quality Commission Section 48 Review of Nottinghamshire Healthcare NHS Fou…

    Government recommitted to delivering MHA reform via the introduced Bill in November 2024

    Why linked: Wes Streeting's first WMS on the file (Sept 2024) on the Nottinghamshire CQC s.48 review framed the reform agenda the Government inherited and chose to take forward.

    Source: Care Quality Commission Section 48 Review of Nottinghamshire Healthcare NHS Foundation Tr… · Original ↗
  • commitment Ministerial statement Conservative · 2021 · Mental Health Act reform consultation response

    Conservative Government published the MHA reform consultation response committing to legislate

    Why linked: Sajid Javid's HLWS185 (July 2021) is the formal cross-government commitment to the reform package the 2025 Act enacts.

    Source: Mental Health Act reform consultation response · Original ↗

Open questions & gaps

Known gaps in the evidence base and what's still pending.

Pending in the lifecycle

  • Publication of draft statutory guidance under the Mental Health Act 2025 (PQ 34557 of 28 April 2026 asked when this will appear).
  • Commencement timetable for the remaining substantive provisions of the 2025 Act (only ss. 51-52 in force as of 6 April 2026).
  • Revision of the MHA Code of Practice under the reformed principles (s.1, s.2).
  • Government decision on continued funding for the six 24/7 Neighbourhood Mental Health Centre pilots beyond the initial phase.

Beyond the corpus

  • MISSING A consolidated Government response to the Lords DPRRC 18th Report (March 2025) addressing the delegated powers in the Bill — not present as a separate event in the corpus. — DPRRC reports conventionally receive a Government response before Lords Report stage; the file is closed by Royal Assent but the response is not in the events list.
  • MISSING A published implementation/workforce delivery plan to underpin the IA's £132m training estimate and the additional 27,000 IMHA caseload assumption. — The IA flags workforce capacity as the main delivery risk but no separate plan has been published into the corpus.
  • MISSING The first CQC Monitoring the Mental Health Act report covering a post-commencement period. — Only ss. 51-52 commenced on 6 April 2026; the next CQC monitoring report (covering 2025-26) will still pre-date most reforms in operation.

Confidence gaps

  • Whether the post-commencement perimeter for 'place of safety' (s.48 removing police stations and prisons) will be commenced in a single tranche or phased.
  • Whether the new statutory advance choice document duty (s.44, amended by Commons Amendments 7–10) will be commenced before or alongside the IMHA expansion.
  • Funding certainty for the s.117 aftercare expansion implied by the IA's £396m local-authority cost estimate.