Nearest Relative and Nominated Person Under the Mental Health Act

When someone is detained under the Mental Health Act 1983, the law gives a family member a special role called the nearest relative. It is a different thing from next of kin, and many staff and families confuse the two. The Mental Health Act 2025 will replace the nearest relative with a “nominated person” chosen by the patient, but the change is not yet in force. This guide explains how the role works now, what is changing and what frontline staff should do. It applies in England and Wales.

Who is the nearest relative today?

The nearest relative is decided by a list in section 26 of the Act, not by the patient’s wishes. The order is:

1. Husband, wife or civil partner
2. Son or daughter
3. Father or mother
4. Brother or sister
5. Grandparent
6. Grandchild
7. Uncle or aunt
8. Nephew or niece

Within each group, relatives of the whole blood are preferred to half-blood relatives, and the elder is preferred to the younger. A person who is not a relative but has lived with the patient for at least five years is treated as a relative, although they rank lowest and cannot be the nearest relative if the patient has a spouse or civil partner. The result is that the person who holds the role may be someone the patient does not trust, or does not speak to.

What does the nearest relative do?

The role carries real legal powers. In summary, the nearest relative:

• Must usually be consulted by an approved mental health professional (AMHP) before an application is made for admission for treatment under section 3, unless this is impracticable or would involve unreasonable delay.
• Can object to, and so halt, a section 3 application.
• Can apply for the patient to be admitted.
• Can order the patient’s discharge by written notice. For a patient detained for assessment, the hospital managers do not act on the notice unless it is given at least 72 hours (excluding weekends and public holidays) before the patient would otherwise cease to be liable to detention.

Why is it being replaced?

Commentators describe the current provisions as out of date. The person cannot choose who represents them, working out who the nearest relative is can be legally complex, and the law pays no attention to the relative’s suitability or the patient’s wishes. In some cases a relative who has been abusive or is estranged ends up holding legal powers over the patient.

How will the nominated person work?

Under the 2025 Act, the patient chooses. Based on law firm commentary on the reforms:

• A person with capacity can appoint their own nominated person at any time, ideally before they become unwell, by a written and witnessed document. They can end it by appointing someone else or giving signed notice.
• If the patient lacks capacity, an AMHP can appoint someone from those eligible, taking the patient’s wishes into account. For adults, people appointed under a lasting power of attorney or court deputies come first. Different rules apply for 16 and 17-year-olds and for children under 16.
• The nominated person gets wider rights to be consulted on care and treatment plans, community treatment order discharge, renewal of section 3 and transfers.
• An AMHP can override the nominated person’s objection to a section 3 admission if detention is necessary to prevent dangerous behaviour.

For more on the wider reforms, see our overview of the Mental Health Act 2025 key changes.

When will the change happen?

Implementation is being phased. One law firm commentary says the nominated person provisions are not likely to start until 2028 or 2029, with the Code of Practice, regulations and forms drafted during 2026 and 2027. Dates can change, so check GOV.UK for the latest position. Until then, the nearest relative rules continue to apply.

What should frontline staff do now?

1. Know who the nearest relative is. It should be recorded in the patient’s file and checked, not assumed.
2. Do not confuse it with next of kin. Next of kin has no legal powers under the Act, and the nearest relative is a statutory role.
3. Tell patients about the role. Explain who it is and what they can do, in plain language, and note any concerns the patient raises.
4. Pass on any notice. If a nearest relative gives written notice of discharge, hand it to the responsible clinician or manager immediately, because time limits apply.
5. Take concerns seriously. If a patient says their nearest relative is unsafe or unsuitable, raise it with the AMHP or manager, because there is a route to apply to a court to displace them.

How it links to aftercare and capacity

Mental health law and capacity law overlap in daily practice. Our guide to section 117 aftercare explains the support people receive after certain detentions, and our guide to Mental Capacity Act and DoLS training covers the framework for people who lack capacity.

Frequently asked questions

Is next of kin the same as nearest relative?

No. Nearest relative is a legal role set by the Mental Health Act with specific powers. Next of kin has no legal authority.

Can a patient choose their nearest relative now?

Not under the current Act. That is the main change the nominated person will bring.

Is the nominated person in force?

Not yet. It is expected to be phased in over several years.

Key takeaways

• The nearest relative is set by a legal list and has powers, including to object to a section 3 admission and to order discharge.
• The nominated person will let patients choose their own representative.
• Until the change is in force, current rules apply.

To keep your knowledge current, explore our healthcare CPD courses.

Sources

• legislation.gov.uk: Mental Health Act 1983, functions of relatives of patients
• DAC Beachcroft: Spotlight on upcoming Mental Health Act changes, the nominated person