The nearest relatives of mental patients play an important role. They refer them informally or formally (by making an application for their admission) to hospital; they are consulted about applications for admission for treatment under s 3 of the Mental Health Act (made by Approved Mental Health Professionals); they can order, subject to a medical veto, the discharge of some compulsorily detained patients; they make applications to the Mental Health Review Tribunal, etc. However, choosing which is the nearest relative for this purpose is not open to even a competent mental patient but has to be selected from a prescribed list under s 26 of the Mental Health Act 1983 though a patient can initiate proceedings to displace their statutory “nearest relative”. This has resulted in court cases, most recently JT v United Kingdom  1 FLR 909. Further, when an application for treatment under s 3 of the Mental Health Act 1983 is made by an Approved Mental Health Professional, s 11(4) of the Act requires that applicant, first, to consult with the patient’s nearest relative. This issue arose in TW v Enfield LBC  EWCA Civ. 362. This paper considers and comments on these and other issues and identifies two unsatisfactory features of the law and makes recommendations for reform.