Associations between nearest relative change frequency and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study

The Mental Health Act (1983/2007) authorises health professionals to detain (“section”) patients against their will if they pose a danger to themselves or others in England and Wales. Under the Mental Health Act, a nearest relative (NR) has legal powers to request a mental health assessment, request a patient’s discharge, object to sectioning (in some cases), and receive information regarding a patient’s detention. They act as a legal safeguard to protect a person’s rights when they are acutely unwell.

Some patients under the Mental Health Act 1983 frequently change their nearest relative more than others. Common reasons for changing an NR include the current person being abusive, objecting to necessary treatment, acting against the patient’s best interests, the NR has failed to exercise their powers with proper regard to the patient’s welfare, or the patient desires someone more supportive.

We want to investigate if frequent nearest relative change is associated with worse health outcomes for the patient.   Using routinely collected mental health records from 2007 to 2025, we will evaluate whether frequent changes in a patient’s nearest relative in  1 year (under the MHA 1983 framework) predict later outcomes such as re-admission, re-detention, crisis/liaison contacts, service use, treatment resistance measured by medication changes, and death.