These assessments show what action government has taken to carry out the United Nation’s (UN’s) recommendations, within the scope of our methodology.
They include recommendations from the UN committees associated with the human rights treaties that the UK government has signed and ratified (agreed to follow), which are:
- International Covenant on Civil and Political Rights (ICCPR)
- International Covenant on Economic, Social and Cultural Rights (ICESCR)
- International Convention on the Elimination of All Forms of Racial Discrimination (CERD)
- Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
- Convention on the Rights of Persons with Disabilities (CRPD)
- Convention on the Rights of the Child (CRC)
- Convention against Torture and Other Cruel, Inhuman or Degrading Treatment (CAT)
Overview of action taken
Substituted and supported decision-making
What we assessed in the recommendation
End all forms of substituted decision-making by updating the law and policies on mental capacity and mental health. Do this in consultation with disabled people's organisations, including those representing people from Black and ethnic minority backgrounds. Do more to improve research, collect data and establish good practices in decision-making rules.
CRPD concluding observations 2017, paragraph 31:
The Committee recommends that the State party, in close consultation with organizations of persons with disabilities, including those representing persons from black and minority ethnic groups and in line with the Committee’s general comment No. 1 (2014) on equal recognition before the law, abolish all forms of substituted decision-making concerning all spheres and areas of life by reviewing and adopting new legislation in accordance with the Convention to initiate new policies in both mental capacity and mental health laws. It urges the State party to step up efforts to foster research, data and good practices in the area of, and speed up the development of, supported decision-making regimes. It recommends that the State party ensure that asylum seekers and refugees with disabilities can exercise all rights enshrined in the Convention.
Since the recommendation was made in October 2017, the UK government has not abolished all forms of substituted decision-making. Under the Mental Capacity Act 2005, substituted decision-making is permitted in certain circumstances where an individual is deemed to lack capacity.
The UK government commissioned an independent review of the Mental Health Act 1983 (MHA) in October 2017. The review engaged with groups affected by issues related to the MHA, including people from ethnic minorities and people with learning disabilities.
Following the independent review, the UK government consulted on a white paper about reforming the Mental Health Act from January 2020 to April 2021. Individuals from black and minority ethnic groups participated in the consultation, but it is not clear whether disabled people’s organisations participated.
A draft Mental Health Bill was subsequently published, and publicly consulted on, in June 2022. However, this was not taken forward.
After updating the draft Mental Health Bill following a pre-legislative scrutiny report, the UK government introduced the bill to Parliament in November 2024. One of the stated aims of the bill is to ensure patients’ views and choices are respected. This includes introducing a new duty on Integrated Care Boards (ICBs), NHS England and local health boards (in Wales) to inform people at risk of detention of their right to make an Advance Choice Document regarding their future care and treatment and supporting them to make this document. The bill will also remove learning disabilities and autism from detention criteria. However, it will still authorise non-consensual treatment and detention in certain cases.
In March 2017, shortly before the recommendation was made, the Law Commission published its independent review of the Mental Capacity Act, which included a recommendation that a supported decision-making scheme be established. In 2018, when the UK government formally responded, they did not accept recommendations on supported decision-making.
The pre-legislative scrutiny report on the draft Mental Health Bill also contained a recommendation for the UK government to review the operation of the Mental Capacity Act to ensure it cannot be used as an alternative route to the Mental Health Act to detain people. In their response to the report, the UK government committed to clarifying the interaction between the two pieces of legislation in the Mental Health Act code of practice.
In 2021, the National Institute for Health and Care Excellence (NICE), an executive, non-departmental body funded by the Department for Health and Social Care, published guidance on supported decision-making in mental health settings. It is not clear if the Department for Health and Social Care commissioned this guidance.
Assessment up to date as of December 2024.
Treatment and detention of disabled people
What we assessed in the recommendation
Remove laws, such as the Mental Health Act 1983, and practices that allow people with disabilities to be treated badly or detained without their consent.
CRPD concluding observations 2017, paragraph 35:
The Committee recommends that the State party: (a) Repeal legislation and practices that authorize non-consensual involuntary, compulsory treatment and detention of persons with disabilities on the basis of actual or perceived impairment.
ICCPR concluding observations 2024, paragraph 37:
The Committee urges the State party to repeal legislation, including the Mental Health Act 1983, and practices that authorize non-consensual, involuntary, compulsory treatment and detention of persons with disabilities based on actual or perceived impairment. Furthermore, the State party should intensify its efforts to guarantee the provision of sufficient community-based mental health services, providing early intervention and preventative support.
The Mental Health Act (MHA) 1983 authorises non-consensual, involuntary compulsory treatment and detention of some people with learning disabilities where they meet the criteria for detention under the MHA. Specifically, when their learning disability is associated with ‘abnormally aggressive and seriously irresponsible conduct’. This is set out in part 1, section 1 (2A) of the MHA.
Since the recommendation was made in October 2017, the UK government has taken some action address this.
The UK government commissioned an independent review of the Mental Health Act 1983 in October 2017. Following the review, the UK government held a consultation on reforming the Mental Health Act 1983 from January 2020 to April 2021. A draft Mental Health Bill was subsequently introduced, and subject to parliamentary scrutiny, in June 2022.
A bill to reform the MHA was introduced on 6 November 2024. For those with a learning disability or autistic people, the act will be amended to place a limit of 28 days for which they can be detained unless they have a co-occurring mental health condition.
Assessment up to date as of December 2024.
Community-based mental health services
What we assessed in the recommendation
Improve mental health services, including:
by making sure there are community-based mental health services offering early help and prevention
introducing measures to destigmatise mental health issues
taking specific action for groups that are disproportionately affected by mental health conditions
ICESCR concluding observations 2025, paragraph 51:
The Committee recommends that the State Party, along with the devolved governments of Northern Ireland, Scotland and Wales: (b) Strengthen mental health services and support systems by allocating sufficient resources, strengthening community-based support, undertaking initiatives to destigmatize mental health issues and implementing targeted measures for groups disproportionately affected by mental health problems.
ICCPR concluding observations 2024, paragraph 37:
Furthermore, the State party should intensify its efforts to guarantee the provision of sufficient community-based mental health services providing early intervention and preventative support.
The ICCPR recommendation was made in March 2024 and the ICESCR recommendation was made in March 2025.
The UK government does not guarantee a level of community-based mental health services. Most mental health services are commissioned and budgeted for locally. Access and waiting time standards are in place for early intervention in psychosis services, children and young people’s eating disorder services and NHS talking therapies. A Mental health policy and services in England research briefing from the House of Commons Library outlines these provisions.
Before the recommendations were made, NHS England, a non-departmental public body, published a Patient and carer race equality framework (PCREF) in October 2023. This provides mental health services with a framework to ensure they are effectively supporting patients from ethnic minority backgrounds. This includes ensuring that boards are developing and monitoring action plans to address inequalities and ensuring there are effective feedback mechanisms for patients and carers. All NHS mental health trusts across England were expected to implement the PCREF by March 2025, after the ICCPR recommendation was made.
In July 2025, NHS England began a pilot of six ‘Neighbourhood Mental Health Hubs’, which aim to provide open walk-in access to community-based adult mental health services. The pilot is due to run until August 2026.
In November 2025, the UK government published a men’s health strategy, setting out a ten-year vision for men’s health in England. This includes a focus on challenging the social attitudes and expectations that lead to poor health and wellbeing outcomes for men, and consideration of how to prevent and tackle the biggest health problems affecting men of all ages, including mental health.
In December 2025, the Mental Health Act 2025 became law. Section 4 of the act places a duty on Integrated Care Boards (ICBs) to establish and maintain Dynamic Support Registers of those who have risk factors for detention under Part 2 of the act. The aim of this is to improve monitoring of the needs of, and support for, people who may be at risk of going into crisis and being detained under the act. The act also includes a new commissioning duty that requires ICBs and local authorities to have regard to the information on the register when exercising their commissioning functions. They are also required to seek to ensure the needs of autistic people and people with a learning disability can be met without detaining them. For example, through providing community-based services that offer early and preventative support. These duties are not yet in force.
Assessment up to date as of June 2026.
Mental Health Act reform
What we assessed in the recommendation
Urgently update the Mental Health Act in line with the 2021 White Paper. Reforms should include:
- banning the detention or placement of children with mental health issues, learning disabilities and autism in adult psychiatric units or police stations
- guaranteeing children’s right to input in decisions about their mental health care, to get therapeutic services and to get support from Independent Mental Health Advocates
- introducing rules about the length of mental health inpatient care and appropriate follow-up care to prevent unnecessary and overly long stays
CRC concluding observations 2023, paragraph 43:
The Committee recommends that the State party: Urgently reform the Mental Health Act, in line with previous commitments and the policy position set out in the 2021 White Paper, and ensure that it: (i) Explicitly prohibits the detention or placement in adult psychiatric units or police stations of children with mental health issues, learning disabilities and autism; (ii) Guarantees children’s right to be heard in decisions regarding their mental health care, to access therapeutic mental health services and to receive support from Independent Mental Health Advocates; (iii) Establishes standards for determining the duration of inpatient mental health care and for appropriate follow-up, with a view to preventing unnecessary and prolonged stays in inpatient mental health care.
Since the recommendation was made in June 2023, the UK government has taken some action to reform the Mental Health Act 1983 in line with the recommendation.
A draft Mental Health Bill was introduced in June 2022, before the recommendation was made, to reform the Mental Health Act. However, the bill was not passed before Parliament was dissolved in May 2024.
Following further updates in response to a pre-legislative scrutiny report, the UK government introduced a new draft Mental Health Bill to Parliament in November 2024.
Whilst the draft bill as published on 6 November 2024 makes no changes regarding the circumstances that children can be placed in adult wards, it will make changes to state that police stations are not permitted as ‘places of safety’, and are therefore unsuitable places to detain people awaiting assessment and treatment. It will also make changes that aim to better guarantee all children’s access to Independent Mental Health Advocates and place greater limits and scrutiny on the use of mental health detention.
Assessment up to date as of December 2024.
Electroconvulsive therapy
What we assessed in the recommendation
Ban the use of electroconvulsive therapy without consent and put safeguards in place that are based on the human rights model and not only medical criteria.
CRPD concluding observations 2017, paragraph 37:
The Committee recommends that the State party: (d) Prohibit any use of non-consensual electroconvulsive therapy on the basis of any form of impairment, in all regions, ensure that safeguards are based on the human rights model and are not limited to medical criteria, and work through appropriate authorities to ensure monitoring of this development, particularly in Northern Ireland.
Electroconvulsive therapy (ECT) can be given to patients without consent in certain situations. This is authorised by the Mental Health Act 1983.
According to the Mental Capacity Act Code of Practice (page 64), patients can make an advance decision to refuse electroconvulsive therapy in any future treatment they receive. This decision is legally binding. An attorney acting on the part of someone who lacks capacity can also refuse ECT on their behalf. In both cases, ECT can still be given in specific emergency situations set out in the Mental Health Act 1983.
There are safeguards in place for the use of ECT when patients are detained under the Mental Health Act 1983. Before this treatment can be given without consent, a patient’s doctor must seek a second opinion from an independent doctor. The independent doctor must then confer with two other people involved in the patient’s care. They must confer with a nurse and one other person who must not be a medical practitioner, such as a social worker. The independent doctor must certify that the person doesn’t understand the treatment and that the treatment is appropriate. They must also certify that the treatment does not conflict with a decision by an attorney or deputy appointed by the Court of Protection.
In November 2024, the UK government introduced a Mental Health Bill to parliament. The bill proposes changes aimed at improving safeguards against ECT without consent.
The NICE guidelines on the use of ECT say it should only be used for two specific conditions: when all other treatments have not worked or when the illness may be life-threatening.
ECT can also be given under the Mental Capacity Act 2005 if a patient lacks capacity, depending on the circumstances. The Mental Capacity Act Code of Practice says, in these situations, a ‘decision maker’ can determine that ECT should be given if it is in the patient’s best interests. The decision maker is typically the consultant in charge of the patient’s care (page 64). However, it also explains that there are exceptions to the ‘best interests’ principle. For example, any advance decision to refuse a specific treatment should be respected (page 67, paragraph 5.4).
For people who qualify for additional safeguards (under section 37 of the Mental Capacity Act), an Independent Mental Capacity Advocate (IMCA) must be instructed when considering serious medical treatments like electroconvulsive therapy. According to the Mental Capacity Act Code of Practice, the IMCA must be instructed to try to determine what the patient’s wishes would likely be if they had capacity (pages 192 and 185).
Assessment up to date as of December 2024.
Major Conditions Strategy
What we assessed in the recommendation
Ensure that the Major Conditions Strategy includes infants, children and young people’s health, and prioritises their mental health.
CRC concluding observations 2023, paragraph 43:
The Committee recommends that the State party: (b) Ensure that the Major Conditions Strategy includes infants, children and young people’s health, and prioritises the mental health of infants, children and young people.
Since the recommendation was made in June 2023, the UK government has not published the Major Conditions Strategy. The UK government updated the Strategic Framework Document for the Major Conditions Strategy in August 2023. However, there is no evidence that these updates related to ensuring that the strategy includes infants, children and young people’s health or prioritises their health.
Assessment up to date as of December 2024.
Page updates
Published:
29 January 2025
Last updated:
27 August 2026