This week is Carers Week and the theme is Building Carer Friendly Communities. To celebrate we have a guest blog from the Nearest Relatives Resources Project team. It focuses on one of the spaces that carers can find really daunting - the mental health system.
Introduction by Robert Lewis, DHSC Mental Health Social Work LeadThere can be many types of caring role and tasks individuals, families, and friends take on when supporting a loved one. These can range from relatively simple, yet essential, everyday activities - such as placing a shopping order, providing an appointment reminder, or fetching down that treasured photo album from the top shelf of the cupboard to help brighten a day – through to often physically and emotionally stressful personal care. Not that every carer would consider themselves to be a ‘carer’, rather their actions are as much acts of love and kindness as they are tasks and demands.
Often unseen, unpaid, and without thanks, carers quite simply keep the world turning for millions of us day in, day out. For those who find the person they support experiencing a significant mental health challenge, it can also mean being pulled into the complex, confusing, and often scary world of the ‘Mental Health Act assessment’. For carers, this can sometimes mean being sidelined as professionals turn their attention to views of the Nearest Relative (NR), but it can also mean being both a carer and an NR – with the latter opening up a whole range of rights and powers you may never have known existed. That is why I am delighted to introduce the work of this collaborative research project funded by the UK Research and Innovation during Carers Week.
While NRs have been a feature of mental health legislation for decades, as our colleagues point out here, good quality advice on the NR role has not always been available or the role understood by those expected to carry it out. The Nearest Relative Resource hosted by the University of Bristol is an exceptional example of what can be achieved when we listen to people’s experience and do something with it.
Please share these resources with your networks, colleagues, and those who provide support and care to their loved ones. Thank you again to Judy Laing, Gerry Nosowska, and the Nearest Relatives project team who have helped make this work a reality.
A Friendly Place for Free Information and Support - blog by Judy Laing, Gerry Nosowska Image from Resources for Nearest Relatives – Improving support for Nearest Relatives under the Mental Health ActWhy did we develop the resources?
Building these resources has been so useful and empowering, they fill in the gaps I was missing and will hopefully provide answers as well as pastoral support for others.
Nearest Relative involved in the project
The Care Quality Commission carries out an annual survey of experiences of people who use community mental health services. In their most recent survey, nearly half of the 120000 respondents said no information or support was offered to their family or carers while they were in crisis. This suggests that carers and relatives are often excluded from their loved ones' mental health care. However, they have important legal rights and deserve recognition and respect.
Relatives and carers that we spoke to in our research project told us they face a lot of challenges navigating the mental health system, especially to access information and be involved. There are often concerns about confidentiality to overcome, as well as learning to navigate through what feels like a complex and over-burdened mental health system.
A family member, who is acting as a Nearest Relative under the Mental Health Act 1983, can face further obstacles as they have additional legal rights. These include the right to be informed or consulted about a decision to admit their relative to hospital for mental health treatment. The Nearest Relative is selected by a mental health professional from a fixed hierarchical list in the Mental Health Act and is normally a family member. Nearest Relatives told us they often feel conflicted in this role as it has huge emotional impact, they don’t always know how to exercise their legal rights, and they often feel isolated and don’t know where to go for reliable support.
What is in the resources and how can you use them?
Image from Resources for Nearest Relatives – Improving support for Nearest Relatives under the Mental Health ActHow have we gone so long without a resource like this?
Carer
Our website is a trusted ‘go to’ place for Nearest Relatives and carers - and for professionals working in mental health services - to find information and advice. We worked with Nearest Relatives, mental health professionals and advisers to co-create the resources.
On the website Nearest Relatives can:
Hear from others about their experiences of the role - it helps to know there are other people in the same shoes as you, and you are not alone; Get advice and information about what the role involves and how you can exercise your legal rights; Find out more about how you can look after your own wellbeing and seek support.If you are working in mental health services you can:
Use the resources to help Nearest Relatives and carers feel that the mental health system is more accessible and less alienating; Use and share the tool for staff on how to engage with Nearest Relatives; Build these resources into the information you provide; Link directly to the resources from your website, as other organisations we are working with have done, for example Mind, Cygnet Healthcare and The Carers Trust; Use the resources at times of particular stress, for example, when there is a Mental Health Act assessment, a Mental Health Tribunal hearing, or planning for the patient’s discharge from hospital; Help carers to access trusted and reliable help through the support pages of the website.Future changes to the role and our resources
Image from Positive mental health image library | Mental Health FoundationAt the moment there is fear of the unknown.
Advisor from a helpline involved in the project
A new Mental Health Act for England and Wales was passed in December 2025 and will make several changes including to the role of Nearest Relative. In a few years, the Nearest Relative will be replaced by a Nominated Person who will be chosen by the patient (provided they have capacity to do this). This new role can be fulfilled by anyone from the patient’s support network, not necessarily a family member. The Nominated Person will have more legal rights to support their relative when they are admitted to hospital under the Mental Health Act.
What this means for Nearest Relatives and carers:
The new law brings positive changes for relative and carers by strengthening their rights to support their relative in times of mental health crisis; These changes are not happening straight away and the Nearest Relative role will carry on, probably till 2028/2029. There will be a long transition period to prepare for the new role. A lot of the detail about the Nominated Person role and related processes is not known yet and will be included in a revised Code of Practice. We will provide updates on our website about how this Code will be developed and how you can get involved with the consultation process.Our website will continue to provide trusted and reliable information about the Nearest Relative role for as long as it is needed.
We will also provide updates on the website about the transition, as we find out more detailed information about the changes and the timeline for implementation.
We will be in regular contact with the Department of Health and Social Care about the transition, and will create a new resource in the future for Nominated Persons.
Our website aims to support carers to care for their own wellbeing and to give them confidence about their rights, so they feel less daunted.
We encourage everyone to think of the website when they think of the Nearest Relative, as a friendly place for advice and support at a truly difficult time for carers.
Get in touch if you have ideas about what is needed in future as a resource to support Nominated Persons. Visit the Nearest Relatives Resources website. Read our Impact report. seen at 17:50, 11 June in Social work with adults.