If you or someone you care about is receiving treatment under the Mental Health Act, you might have come across the terms Nearest Relative and Nominated Person. These roles are very important because they affect who has certain legal rights and responsibilities in decisions about your care and treatment.
This article will explain what the Nearest Relative is, what a Nominated Person is, and how these roles differ. It will also help you understand why these roles matter to you, whether you are a patient, a family member, or someone supporting a loved one.
What Is the Nearest Relative?
Under the current Mental Health Act in England and Wales, when someone is detained or admitted to hospital for mental health treatment, the law automatically identifies a Nearest Relative (NR). The Nearest Relative is a person who has specific legal powers and duties in relation to the patient’s care.
How Is the Nearest Relative Chosen?
The law has a strict list, called a hierarchy, that decides who the Nearest Relative is. This list is set out in section 26 of the Mental Health Act. It usually looks like this:
- Husband, wife or civil partner
- Father or mother
- Son or daughter
- Brother or sister
- Grandparent
- Grandchild
- Uncle or aunt
- Nephew or niece
The first person on the list who is willing and able to act becomes the Nearest Relative.
What Powers Does the Nearest Relative Have?
The Nearest Relative has important legal powers, including:
- The right to be told if the patient is going to be detained or admitted under the Mental Health Act.
- The right to object to the patient’s detention (except in emergencies).
- The power to apply to discharge the patient from hospital.
- The right to request certain reviews of the detention.
- The duty to be consulted about certain decisions affecting the patient.
These powers give the Nearest Relative a significant role in protecting the patient’s rights.
What Is the Nominated Person?
The idea of a Nominated Person (NP) is a newer concept that has been proposed but is not yet law. It comes from the Independent Mental Health Act Review, which published a report in December 2018 recommending changes to how representation for patients is handled.
Why Introduce a Nominated Person?
The current system of Nearest Relative has some problems:
- You cannot simply choose who your Nearest Relative is. It is decided automatically by the law based on family relationships.
- Sometimes the person the law chooses may not be the person the patient trusts or wants to represent them.
- The list is rigid and does not reflect modern family structures or close friendships.
- It can be distressing for patients to lose control over who has influence on their care.
The Nominated Person proposal aims to give patients more control. Under this system, patients would be able to choose their own Nominated Person—someone they trust to support them and make decisions on their behalf.
What Powers Would a Nominated Person Have?
The Nominated Person would have powers similar to those of the Nearest Relative, including:
- Being informed about the patient’s detention or admission.
- The right to object to detention.
- The power to request discharge.
- The ability to be involved in treatment decisions.
The main difference is that the patient chooses the Nominated Person, rather than the law deciding based on a fixed list.
Why Does This Matter to You?
If you are a patient, having the right person acting on your behalf can make a huge difference. It can mean feeling more supported, having someone you trust involved in decisions, and having your views respected.
If you are a family member or friend, understanding these roles helps you know what rights you have and what you can do to support your loved one.
The Challenges With the Current Nearest Relative System
While the Nearest Relative has many important powers, there are some challenges in practice:
1. The Hierarchy Can Feel Inflexible
The law assumes that family members closest in blood or marriage should be involved. But that is not always the case. Families can be complicated. Sometimes a close friend, partner, or more distant relative may be the person the patient trusts the most. Yet the law does not allow that person to be the Nearest Relative unless they fit the strict list.
2. The Nearest Relative May Not Want to Act
Sometimes, the person the law identifies may not want to be the Nearest Relative or may be unable to act. This can delay decisions or cause confusion.
3. The Nearest Relative May Not Act in the Patient’s Best Interest
Although the Nearest Relative is supposed to act to protect the patient, sometimes there can be conflicts or disagreements. The patient may feel the Nearest Relative does not understand their wishes.
4. Patients Have No Choice Unless They Go to Court
If a patient wants a different person to act as their Nearest Relative, they must apply to the County Court. This is often a difficult, expensive, and stressful process, which many patients cannot or do not want to pursue.
What Are the Benefits of Having a Nominated Person?
The Independent Mental Health Act Review recommended the introduction of the Nominated Person to address these issues:
1. Greater Patient Choice and Autonomy
You should have the right to choose who represents you. This respects your wishes and supports your dignity.
2. Flexibility for Different Family and Social Situations
The Nominated Person could be a close friend, partner, or someone else you trust—not just a relative.
3. Better Support for Patients
Having someone you know and trust involved can help you feel safer and more understood.
4. Interim Nominated Person for Those Without Capacity
For patients who do not yet have the capacity to choose a Nominated Person, there would be an Interim Nominated Person appointed temporarily. This ensures someone can act in your interest until you regain capacity to decide.
What Does the Future Look Like?
At the moment, the idea of the Nominated Person is still just a recommendation. The government has not yet decided whether to change the law to introduce it. Even if they do decide to proceed, the process of making changes to the Mental Health Act could take years.
Until then, the Nearest Relative system remains in place. It is important to know your rights and understand how the current system works, so you can act if needed.
What Can You Do Now?
If You Are a Patient:
- Find out who your Nearest Relative is. You can ask the hospital or your care team.
- If you do not want your Nearest Relative to have these powers, consider if it is possible to apply to the County Court to change this.
- Talk to your care team or advocate about your wishes and who you want involved.
- If you lack capacity, the care team should involve your Nearest Relative or any appointed representatives in decisions about your care.
If You Are a Family Member or Friend:
- Understand your role if you are the Nearest Relative or Nominated Person.
- Be aware of the powers and responsibilities you hold.
- Support the patient by respecting their wishes and helping them to understand their rights.
- If you are concerned about the current arrangement, you can seek advice or support from mental health advocacy services.
Important Terms to Remember
| Term | Meaning |
| Nearest Relative (NR) | The person automatically chosen by law to have certain powers under the Mental Health Act. |
| Nominated Person (NP) | A person chosen by the patient to act on their behalf with similar powers to the NR (proposed). |
| Interim Nominated Person | Temporary appointed person to act for a patient who has not chosen a NP and lacks capacity. |
| Section 26 List | The statutory list that sets out the order of who qualifies as Nearest Relative. |
| Mental Health Act | The law that governs how people with mental health conditions are treated and detained. |
| Capacity | The ability of a person to make their own decisions about care and treatment. |
Final Thoughts
The relationship between the Nearest Relative and the patient’s rights is complex and very important. While the Nearest Relative currently has significant powers, the law can sometimes feel unfair or out of date. The proposal for a Nominated Person aims to give you more control over who supports you and speaks up for you when you need help.
If you are involved in mental health care, either as a patient or carer, it is essential to understand these roles so that you can make informed decisions. Being aware of your rights helps you to advocate for yourself or your loved ones, and to ensure the best possible support is in place.
If you want more information or support, you can contact:
- Your local mental health advocacy service.
- The hospital or community mental health team.
- Mental health charities such as Mind or Rethink Mental Illness.
- A solicitor specialising in mental health law.
Remember, you have the right to be involved in your care and to have someone you trust by your side.
