Mental Health Bill [HL]

Debate between Baroness Keeley and Baroness Tyler of Enfield

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I will speak to Amendment 62 in this group, which is in my name, and I will try to be as brief as possible. This group is all about the statutory care and treatment plans, and I very much welcome them. They are a very positive part of this legislation and should help patients achieve recovery and hopefully discharge from mental health in-patient units as quickly as possible.

My amendment seeks to ensure that individuals who are turning 18 during a care and treatment plan have their plans reviewed to ensure that there is continuity of care when transitioning from child to adult services. I spoke earlier about the tricky issue of transitioning from child to adult services. It is important for three reasons. Young people aged 16 to 25 experience high rates of mental health problems but are less likely to access the support they need; young people often experience tricky transitions, meaning that too often they fall through the gaps—we have heard so many stories about in this Chamber in the past; and, again as we have said earlier today, young people really should have a say in their care and treatment.

We know that there is a high level of mental health need among young people in the 16 to 25 age group and that it is going up. I have no wish to return to the earlier debate about whether that rise is real, but the numbers according to NHS Digital are very much on the increase. So, while 16 to 25 year-olds are experiencing high levels of need, they are often having real difficulties accessing support. It is sometimes talked about as the treatment gap, which is what the noble Lord, Lord Stevens, talked about earlier on, and it is far wider here than for other age groups.

These poor transitions between CAMHS and adult services are generally the problem because, after someone reaches their 18th birthday—which is the upper limit for CAMHS—young people too often face a real cliff edge when trying to access mental health support. They are no longer in the age range for CAMHS and simultaneously may not reach the threshold for adult services. Effectively, it leaves young people in limbo, with no access to the mental health support they require.

There is a range of reasons for these challenges, including poor information and, very importantly, a difference in treatment models. While children’s services are generally seen as more nurturing, with a focus on treating developmental and emotional disorders, adult services in contrast focus on treating severe and enduring mental illness, meaning that young people with these diagnoses are less likely to be accepted. Just as I have mentioned, the high thresholds for support often result in young people being told that they are not ill enough for the services they need, so unfortunately things get worse and they end up being detained. Without that support during transition, young people can experience all sorts of worsening symptoms and other life outcomes. That is the rationale behind my Amendment 62.

I will mention another couple of amendments in this group that have my strong support. Amendment 64, in the name of the noble Baroness, Lady Keeley, from whom we have still to hear, really emphasises the critical importance of ensuring that, where young carers are involved in a family situation, they are identified, particularly by adult mental health practitioners, who may not have them in mind first and foremost, that people proactively look for them, and then that the young carers—who are often hidden, with their needs only identified when there is a crisis—are supported. That amendment has my full support.

Lastly, I support Amendment 59, in the name of the noble Lord, Lord Davies. At this point—because I have not done it yet—I refer to my interests in the register, both as a member of the Financial Inclusion Commission and president of the Money Advice Trust. I absolutely support what the noble Lord said about the importance of these plans, including matters to do with finance. The links between money problems and mental health are now well proven and this legislation should reflect them. The Bill provides a once-in-a-generation opportunity to ensure that people’s holistic needs, including finances, are considered as a key part of supporting recovery from a mental health crisis.

[Baroness Keeley (Lab)]

My Lords, I rise to explain the significance of Amendment 64 in my name, which aims to cover the situation of both young carers and young children in a family where a care and treatment plan is being prepared for their parent. I thank the Carers Trust for suggesting this amendment and providing a briefing on this issue. I also thank the noble Lord, Lord Young of Cookham, for his support for the amendment and, of course, the noble Baroness, Lady Tyler, who has just spoken of her support for it.

Briefly, the amendment adds the requirement that a practitioner preparing or reviewing a care and treatment plan must ask whether there are children in the family and take actions to respond if the children need help or protection from harm. This amendment would, as I said, cover young carers, but it would also cover young children where there may be safeguarding concerns—a topic which the Child Safeguarding Practice Review Panel highlighted as a theme in its latest annual report.

As the noble Baroness, Lady Tyler, just touched on, young carers are so often hidden, and often their needs are identified only when there is a crisis. Even then, the extent of their caring role and the impact it has on the child’s development may not be recognised quickly or fully assessed. This amendment would help to ensure earlier identification of children who might be in need of information, support or protection from potential harm. It would mean staff asking the right questions early on to ensure that the right information is recorded and actions taken. It would help with adequate signposting of information and a chance to offer appropriate support to avoid a crisis or manage it appropriately.

The amendment also mirrors the new wording in the Working Together to Safeguard Children statutory guidance, which covers adult social practitioners:

“When staff are providing services to adults, they should ask whether there are children in the family and take actions to respond if the children need help or protection from harm. Additional parenting support could be particularly needed where the adults have mental health problems”.


There is evidence that having a parent with a mental health problem is one of the biggest risk factors for a first episode of major depressive disorder in children and adolescents.

This is not inevitable. Research suggests that intervention can enhance parenting skills in households affected by parental depression, and it can change the way that children cope. In turn, this can reduce the risk of children internalising problems that may threaten their life chances. The amendment is designed to enhance the ability of agencies working individually and together to identify and respond to the safeguarding needs of families. It is about supporting the challenging work of finding out what is happening to children and anticipating risks and harm, of knowing when action is needed. In most cases, children receive the support, help and protection they need, but sometimes children are seriously harmed or, worse, they can die because of neglect.

Policy initiatives in recent years have called for a wider family focus on safeguarding children so that all staff recognise that meeting the needs of family members who may put children at risk benefits the child, the adult and the family as a whole. This amendment would support those efforts. The amendment is in keeping with guidance from the Social Care Institute for Excellence to “Think child, think parent, think family”, to ensure that the child is heard and their needs are met.

The Carers Trust believes that the amendment would unlock additional support from mental health professionals to work with parents and children to enable the child to have age-appropriate understanding of what is happening to their parent and information about what services are available for them in their situation and how they can access them.

To illustrate the need for the amendment, I have two short case studies. Aidan was four when his mother was first sectioned under the Mental Health Act. Throughout his childhood, Aidan’s mother was regularly sectioned and would sometimes be in hospital for a number of months. There were many occasions when the police were involved because his mother had disappeared, which was particularly scary for Aidan. In his words:

“To me, you only ever saw the police if you’d done something wrong, so I remember when they turned up at our house, I thought mum was in trouble”.


Seeing his mother being taken into hospital on a regular basis meant that Aidan had lots of questions and worries. In his words again:

“There were so many times where I wondered whether mum would ever come home. I knew she’d been sectioned but I had no idea what that actually meant or if she would ever get better”.


Staff at the hospital who were treating Aidan’s mother would regularly see him visiting. Despite this, none of the staff there told Aidan or his father about support that might be available or asked whether Aidan might need any help. It was only when Aidan was 12 and his attendance dropped at school that he was identified as a young carer.

The second case is Vamp’s story. This is a pseudonym chosen by her family. The case study is taken from a recently published child safeguarding practice review which found that a 13 year-old girl died as a result of taking drugs sold to her in a park. It was identified that her mother had had a period of serious mental illness, and that illness was identified as the catalyst for things deteriorating for the young person. Tragically, two years on, the young person had died. This is taken from the relevant extract from the child safeguarding practice review:

“Vamp’s mother did not feel that her daughter had been a young carer … as the mental illness was short term. However, Vamp’s sister described the situation as being so difficult for both. When their mother was discharged home from hospital, it was only Vamp and her mother at home. Vamp’s sister was only a young adult, and with her own baby to care for. She … said she felt that no one checked in on their mother. Vamp’s sister … said that professionals expected her mother to manage to parent Vamp, which she was not able to do alone, she needed professional help”.


This is a simple but important amendment to protect young carers. I urge my noble friend the Minister to consider it, and I commend the amendment to the House.