Advanced Choice Documents: The Feasibility of Completing These With Adults Who Have Intellectual Disability at Risk of Detention Under the Mental Health Act to an Assessment and Treatment Unit

ABSTRACT Background A new Mental Health Act for England and Wales, which amends the Mental Health Act (1983), has been given royal assent by the UK parliament (Mental Health Act 2025). The Act introduces Advance Choice Documents so that those at risk of admission can set out their wishes and preferences in advance. However, the person must have the capacity or competence to make the statement. This poses a challenge to the rights of some people who have intellectual disability who may not have the capacity or competence to do so. This then contradicts the aims of the Act, which are to reduce health inequalities and increase patient autonomy. Method This study explored the feasibility of completing Advance Choice Documents with a cohort of 20 adults with intellectual disability who have been detained under the Mental Health Act and admitted to an assessment and treatment unit. Data were extracted from the patient record system, and the communication skills of each participant were assessed. The study also looked at the pre‐admission trigger points for the completion of an Advance Choice Document. Findings The study found that few could complete such a document, and for many, there was little time prior to admission to complete the document. It is recommended that, to ensure inclusion of people who have intellectual disability, new guidance on participation provided in the Act be followed, and this be emphasised in the new Code of Practice.