Associate Hospital Managers (AHMs) are members of the local community with a power under section 23 of the Mental Health Act 1983 to discharge people from compulsory mental health care against medical advice. They provide scrutiny of professional decisions and, in so doing, protect patient liberty by providing review of compulsory care. Abolition of the AHMs has been contemplated on numerous occasions, most recently by the Independent Review of the Mental Health Act 1983 (December 2018), the White Paper on ‘Reforming the Mental Health Act’ (January 2021) and the Government's response (July 2021). Through an historical and contemporary consideration of the section 23 power spanning 1808–2022, this paper argues that removal of the AHMs would be detrimental to the legitimacy of the 1983 Act. This is because the abolition of the AHMs would undermine the principles of local, democratic, community oversight entailed by section 23, and found nowhere else in the Act. The Draft Mental Health Bill (June 2022) does not address these concerns.
