Draft framework. This is CQC's draft for mental health care, issued for feedback. It is not the framework your service is inspected and rated against today.
Current position. The existing published framework remains in force while CQC tests and evaluates the proposed approach.
Last reviewed. 23 July 2026.
This page is the mental health companion to our main explainer, CQC's proposed 2026 assessment framework. Read that first for what is changing across all four sectors. Here we cover what the mental health draft asks that the others do not, and it is the largest set of differences of any sector.
The legal backdrop, stated carefully
Mental health services carry a statutory layer the other sectors do not. The operative law is the Mental Health Act 1983, now reformed by the Mental Health Act 2025, which received Royal Assent on 18 December 2025 and is being brought into force in stages. The CQC draft's reference to "Mental Health Act 2025 implementation" is a reference to that phased commencement.
We are not reproducing duty text or commencement dates here, because those are being staged and must be read from the current legislation rather than a draft framework. Treat the Act itself, at legislation.gov.uk, as the source of truth for what is in force, and this page as an account of what the CQC assessment draft expects.
Where mental health is distinctive
Restrictive practice is a first-class domain
No other draft goes this far. Under Managing risks during care and treatment, the mental health draft names restrictive practice including seclusion, segregation and physical and chemical restraint, blanket restrictions, de-escalation, therapeutic observations, sexual safety risk assessment, crisis planning and lone working.
Under Well-led, it names oversight and reduction of restrictive practice as a governance responsibility, and use-of-force monitoring. Use-of-force governance rests on the Mental Health Units (Use of Force) Act 2018. The draft expects a service not only to record restraint but to show it is reducing it.
Mental Health Act oversight as governance
Under Governance, the draft names robust Mental Health Act oversight, naming reviewers, Second Opinion Appointed Doctors, trends and Mental Health Act fact sheets, and clear statutory compliance including Mental Health Act 2025 implementation. Under Safeguarding, it names Deprivation of Liberty Safeguards and the Liberty Protection Safeguards. Consent runs through lawful, rights-based decisions and independent advocacy.
This is the heart of the sector difference: the draft treats the lawful basis for detention and treatment as a quality question, not only a legal one.
Trauma-informed, and honest about disparity
Under Safety culture, the draft names a trauma-informed, psychologically safe culture, safety data broken down by protected equality characteristics, and Learning from Lives and Deaths, the LeDeR programme. Under Equity in experience it names addressing disproportionate detention. Under Strategic direction it names an anti-racism focus.
The draft asks a service to know whether its restrictive practice and its detention fall unequally on particular groups, and to act on it. Data stratified by equality characteristics is core evidence, not an add-on.
Physical health is a mental health duty
Under Safe delivery of treatments and medicines, the draft names physical health monitoring for the initiation and maintenance of treatment, and monitoring of high-dose antipsychotics, alongside non-pharmacological strategies for anxiety and agitation and treatment under the Mental Health Act compliant with the Code of Practice. Assessing needs names physical health needs and drug and alcohol dependence.
The draft expects a mental health service to hold the person's physical health, not to treat it as someone else's job.
Crisis, continuity and out-of-area
Under Timely and equitable access, the draft names access to crisis provision, out-of-hours arrangements and out-of-area placements. Under systems and transitions it names named care coordinators or key workers and proactive post-discharge follow-up. The period after discharge, and the placement far from home, are named risks the draft expects a service to manage.
The environment itself
Under Safe environments, the draft names anti-ligature, therapeutic and sensory-appropriate environments, contactless patient monitoring, same-sex provision and shared sleeping arrangements. The physical environment of a mental health unit is assessed as a safety control in its own right.
What to do now
The mental health draft is the widest of the four, so prioritise. The two areas that most define this sector, and most reward preparation now, are restrictive practice, showing not just recording but reduction, and Mental Health Act governance, showing that detention and treatment are lawful, reviewed and equitably applied.
Both are testable today, against the current framework and the current law, with evidence you should already hold. Regulation 13 safeguarding and the recording of mental capacity and deprivation of liberty are statutory anchors that do not move with the assessment framework.
Do not rebuild governance around draft wording, and do not treat any commencement date as settled until you have read it from the Act. And do not buy compliance with a framework CQC is still testing. That includes us.
Related guidance
- Start here: CQC's proposed 2026 assessment framework
- Primary law: Mental Health Act 2025 (legislation.gov.uk)
- Regulation explainer: Regulation 13 safeguarding
- Regulation explainer: mental capacity and deprivation of liberty recording
- Standard: right support, right care, right culture
- Regulation explainer: Regulation 17 good governance
- Library: sample policies
Sources
- CQC, draft mental health care assessment framework, 19 March 2026. Sector-specific scope items above are taken from this document.
- Mental Health Act 2025, Royal Assent 18 December 2025, chapter 33 (legislation.gov.uk).
- Mental Health Units (Use of Force) Act 2018.
- CQC, Better regulation, better care, Summary of Consultation Responses, February 2026.
Sector-distinctive scope is our analysis of the draft, not a formal CQC publication. Statutory references are to legislation as enacted; commencement of the 2025 Act is staged and should be read from the current legislation. Where this page says what the draft is likely to mean in practice, that is our reading as an ex-CQC inspector, not CQC guidance.