Revolutionising Care for the Next Generation

The 2025 Mental Health Act doesn’t just modernize adult care; it creates a specific, protective ring around children and young people. Historically, minors in the mental health system have been a “hidden” population, often subject to the same rules as adults despite having vastly different developmental needs.

The new Act addresses this head-on with a series of targeted reforms designed to ensure that no child is “lost” in the system.

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1. The Right to be Heard: Choice and Competence

For the first time, the law explicitly strengthens the requirement to make a child’s wishes and feelings central to their care.

• Decision-Making Tests: The Act introduces a clearer statutory test for children under 16 to determine their “competence” to make specific treatment decisions.
• Child-Centric Nominated Persons: Unlike the old “Nearest Relative” rules, the new Nominated Person (NP) system allows young people (who have the competence to do so) to choose who represents them. For those under 16 who may lack competence, the Act specifies a strict hierarchy—prioritizing those with parental responsibility or special guardians—to ensure a trusted advocate is always in place.

2. Ending Inappropriate Placements

One of the biggest “scandals” in youth mental health has been the placement of children on adult wards or in facilities hundreds of miles from home due to bed shortages.

• Age-Appropriate Settings: The Act reinforces the duty to place children in age-appropriate settings. Hospitals must now notify the Care Quality Commission (CQC) immediately if a child is placed on an adult ward.
• Maintaining Connections: New statutory guidance mandates that care plans must include provisions for daily contact with family. The goal is to treat the child within their social ecosystem, not in isolation.

3. Support for “Children of Parents with Mental Illness” (COPMI)

In a landmark 2025 amendment, the Act now recognizes the vulnerability of children whose parents are being detained.

• Mandatory Identification: Professionals are now legally obliged to identify if a detained patient is a parent.
• Young Carer Support: If a child is acting as a carer for a parent in crisis, the Act mandates an automatic referral for a Young Carer’s Assessment to ensure the child’s own education and wellbeing don’t suffer.

4. Specialized Care for Neurodivergent Youth

The removal of “autism” and “learning disabilities” as grounds for long-term detention (Section 3) is a game-changer for young people.

• Dynamic Risk Registers: Integrated Care Boards (ICBs) now have a statutory duty to keep “at-risk” registers. This allows for early intervention in the community, preventing the “crisis-to-ward” pipeline that has historically seen neurodivergent teens spend years in secure units.
• CETRs (Care, Education, and Treatment Reviews): These reviews are now a statutory requirement for any autistic child or child with a learning disability who is at risk of admission, ensuring that education and social care are at the table alongside health.

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Summary of Key Protections

Protection	Old System (1983 Act)	New System (2025 Act)
Advocacy	Often “opt-in” and hard to access	“Opt-out”; advocates must visit and support minors automatically
Placement	Children often “boarded” on adult wards	Stronger prohibitions and mandatory CQC notification
Family Role	“Nearest Relative” was fixed by law	Child can choose a Nominated Person (if competent)
Neurodiversity	Autism could be a sole reason for Section 3	Autism excluded from Section 3 (unless co-occurring illness)

The Long Road Ahead

While the legal framework is now in place, the Children’s Commissioner and advocacy groups like Rethink have warned that these rights are only as good as the funding behind them. For a 14-year-old in crisis, a “right to community care” means very little if the local community team has a two-year waiting list.

The next decade will be a test of whether the government can build the “Neighbourhood Health Service” required to keep these young people out of hospitals and in their classrooms.