The Care Quality Commission’s Monitoring the Mental Health Act in 2024/25 has provided a detailed account of how the Mental Health Act is currently experienced by people detained under it, their families, and the staff responsible for delivering care.
Published shortly after the amended Mental Health Act received Royal Assent, the report provides an important snapshot of the conditions into which reform will be introduced and the risks of assuming that legislative change alone will be enough.
Based on 635 monitoring visits during 2024/25, alongside interviews with more than 3,600 patients and hundreds of carers and advocates, the report draws together qualitative insight and national data to describe a system under sustained pressure. Its findings reinforce a consistent theme from recent years: demand is rising, capacity is constrained, and the gap between what the law expects and what services can reliably deliver is widening.
Rising demand, limited capacity
The CQC reports that demand for secondary mental health services continued to grow throughout the year, with an average of almost 454,000 new referrals each month. Reviewers repeatedly found that people are becoming more unwell before they are assessed under the Act and are often waiting longer for assessments once requested. The result is that admissions frequently occur at a point of greater acuity, making care more complex and recovery slower.
These pressures are compounded by limited inpatient capacity. Average mental health bed occupancy remained at around 90% across 2024/25, above the recommended threshold for safe and effective care. High occupancy drives higher admission thresholds, delayed discharges and prolonged stays in environments that are not always therapeutic. The report documents continued breaches of the legal time limit in health-based places of safety, with some people held for days while awaiting an inpatient bed.
The knock-on effects are felt across the system. Inappropriate out-of-area placements remain high, with 5,649 such placements started during the year, an increase on 2023/24. CQC reiterated the well-established harms associated with being treated far from home, including isolation from family and advocates, disruption to continuity of care, and increased difficulty coordinating discharge and follow-up support.
Workforce pressure, safety and experience
Workforce shortages sit at the centre of many of these challenges. As of March 2025, around 9% of posts in NHS mental health trusts were unfilled. CQC describes how staffing gaps, high sickness absence and reliance on temporary staff affect both safety and experience on wards. While many patients spoke positively about staff commitment and compassion, low staffing levels often limited access to therapeutic activities, leave, outdoor space and even basic facilities. In some wards, patients reported feeling unsafe due to the lack of staff presence.
CQC’s complaints data adds further texture to this picture. Nearly half of the complaints received in 2024/25 included concerns about staff attitudes, ranging from poor communication to behaviour perceived as dismissive or disrespectful. These findings sit alongside positive examples of wards where strong therapeutic relationships helped create safer, more supportive environments, underscoring the variability in experience across services.
Concerns about quality and safety extend beyond staffing. The report highlighted ongoing issues with restrictive practices, including an increase in the average number of restrictive interventions reported each month. Autistic people and people with a learning disability are disproportionately affected, particularly those in long-term segregation. Findings from Independent Care (Education) and Treatment Reviews show that personalised adjustments are not always assessed or embedded, limiting people’s ability to move out of highly restrictive settings.
Inequality and unmet need
Inequality remains one of the most troubling and persistent themes. In 2024/25, people of Black or Black British ethnicity were over eight times more likely than White British people to be subject to a community treatment order, and nearly four times more likely to be detained under the Act. CQC also reported that people living in the most deprived areas were 3.6 times more likely to be detained than those in the least deprived areas.
Children and young people face particular challenges in accessing mental health care. The number of under-18s awaiting first contact following referral to NHS mental health services increased by 20% between 2023/24 and 2024/25, with median waiting times rising by 65% from 175 days to 288 days. A lack of specialist inpatient environments means children are often placed in inappropriate settings, including adult wards (117 notifications in 2024/25) or general paediatric wards where staff may lack mental health expertise. Concerningly, children and young people under 18 experienced the highest rates of restrictive interventions of all age groups, with rates per 1,000 bed days more than doubling over the last two years.
The report pointed to the Patient and Carer Race Equality Framework (PCREF) as a key mechanism for addressing these disparities. However, awareness remains low. During monitoring visits in early 2025, staff in more than three-quarters of services reported that they had not heard of PCREF, and only a small minority had received any training or support on its use.
The Second Opinion Appointed Doctor (SOAD) service, which provides crucial independent oversight of treatment for detained patients, continues to face significant pressures. CQC received 15,999 requests in 2024/25 (the highest since 2019/20) with average waiting times for patients on community treatment orders reaching 94 days. Concerningly, Black or Black British patients waited 30 days longer than White British patients for CTO assessments, adding to existing racial inequalities in the system.
Without sustained attention to implementation, frameworks designed to tackle inequality risk remaining aspirational rather than transformative.
Looking ahead, the CQC is clear that the amended Mental Health Act offers an opportunity to strengthen rights, safeguards and patient voice, but warns that implementation will be complex and lengthy. The report anticipates increased demand for key safeguards such as Second Opinion Appointed Doctors, as well as broader changes to practice that will require workforce growth, improved infrastructure and stronger coordination across services.
From legislative intent to lived experience
Taken together, the findings underline a central message: the success of Mental Health Act reform will be determined not by legislative intent, but by the system’s ability to translate that intent into everyday practice. Beds, staff, environments, data, and leadership are not peripheral to reform. They are the means through which rights are realised or denied.
As implementation begins in earnest, the CQC’s report provides an essential baseline. It shows where pressures are most acute, where inequalities persist, and where investment and focus will be needed if the amended Act is to deliver on its promise for the people it is meant to protect.
Top 10 takeaways
- Demand is overwhelming capacity: Nearly 454,000 monthly referrals to mental health services, with people becoming more unwell before assessment and admission, leading to more complex care needs and longer recovery times.
- Beds remain critically scarce: Average occupancy at 90% (above the safe 85% threshold), driving 5,649 inappropriate out-of-area placements and forcing people to wait in unsuitable environments like A&E departments for days.
- Workforce crisis undermines care: 9% of mental health trust posts unfilled, leading to over-reliance on agency staff who often lack specialist skills, reducing therapeutic relationships and leaving patients feeling unsafe.
- Racial inequalities persist and worsen: Black or Black British people are over 8 times more likely to be subject to community treatment orders and nearly 4 times more likely to be detained, with a 26% increase in CTOs for this group in one year.
- Anti-racism framework largely unknown: Despite being mandatory, 77% of services had not heard of the Patient and Carer Race Equality Framework (PCREF), and only 8% of staff had received training on it.
- Restrictive practices are increasing: Monthly restrictive interventions rose 24% (from 13,240 to 16,462), with children and young people experiencing the highest rates—more than doubling over two years.
- Children face a worsening crisis: Under-18s waiting for mental health services increased 20%, with median wait times up 65% to 288 days, and many inappropriately placed on adult wards due to lack of specialist facilities.
- Deprivation compounds disadvantage: People in the most deprived areas are 3.6 times more likely to be detained and more likely to experience out-of-area placements, longer stays, and delayed access to care.
- Discharge planning fails too many: Lack of step-down facilities, community support, and coordination between services keeps people in hospital longer than necessary and increases risk of readmission.
- Legislative reform needs resources to succeed: While the amended Mental Health Act 2025 offers improved rights and safeguards, implementation over 10 years will require substantial investment in beds, staff, infrastructure, and community services to translate intent into practice.
