Mental Health Bill [HL]

Debate between Baroness Bennett of Manor Castle and Lord Kamall

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have attached my name to Amendment 47, in the name of the noble Baroness, Lady Tyler, and I raised this issue at Second Reading.

A powerful case has already been made for a mental health commissioner, so I am just going to make one comparison here. At the same time as this Bill has been going forward, in the other Chamber I have been dealing with the Armed Forces Commissioner Bill. An Armed Forces ombudsman was created, which in some ways has parallels with the Chief Inspector of Mental Health and the CQC. It was found that that was not effective or strong enough, and now the Government themselves are going for the Armed Forces commissioner model.

There is another parallel. One of the reasons why it is felt so strongly that there needs to be an Armed Forces commissioner model is that members of our Armed Forces do not have the same rights. They have certain responsibilities laid on them and are treated differently from other members of society, which is why they need a special advocate. The parallel with people who are potentially subject to the Mental Health Bill is obvious.

In the health space, I have been heavily involved over the years with the Patient Safety Commissioner, which was initially resisted by the Conservative Government of the time. Eventually the fight was won, and it is now seen to be a huge success. This is a model that we can see working and that is seen to be necessary.

The Government have expressed a desire to get rid of arm’s-length bodies and make decisions themselves. The Government devolve decision-making to those so-called quangos—the arm’s-length bodies—but that is not the case with the Patient Safety Commissioner; there is no parallel here. They are a person who is there as an advocate and to have oversight; they are not making decisions. I do not think the Government can shelter under that umbrella.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

Mental Health Bill [HL]

Debate between Baroness Bennett of Manor Castle and Lord Kamall

Committee stage
Monday 27th January 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I beg to move Amendment 99 in my name and to speak to my further Amendment 137; both are also in the name of my noble friend Lord Howe.

Our Amendment 99 places a duty on the police and on hospital trusts to record the number of patients not in the criminal justice system who are escorted to accident and emergency departments by the police for treatment for a mental disorder. The reason behind this amendment is that a number of people are taken into accident and emergency by the police because they exhibit behaviour that is a cause for concern, resulting from a diagnosed, or even an undiagnosed, mental disorder or learning disability. These patients are not necessarily placed under arrest, since they may not have committed any crime, but they are escorted to hospital by police.

Once in A&E, it is quite common that they could wait for six, 12 or even more hours before they see a clinician. This is obviously not an efficient use of police time; I know that my noble friend Lady May spoke to this earlier in Committee. More importantly, a police officer escorting a patient who is demonstrating challenging behaviour could exacerbate the problem. Also, a patient who arrives with or without a police officer may behave in a way that is seen as threatening by other patients, which could lead to their being arrested, as they are seen as at risk of harming themselves or others. The patient then finds themselves in the criminal justice system.

To avoid situations such as this, we are probing the Government to try to understand how often the police take patients into hospital for treatment for a possible mental disorder when they are not under arrest. This data should help us to understand how much police time is being spent accompanying these patients. This is not to take a particular view one way or the other; rather, it is to say that we need to have this information available so that we can fully assess the situation.

Our Amendment 137 states that the Care Quality Commission

“must publish a report on the efficacy of systems designed to prevent the introduction of illegal drugs into mental health units”.

Hospitals are entitled to prohibit patients from misusing drugs or alcohol on their wards, but what they can do to enforce those requirements is less clear, especially with detained patients. We accept that informally admitted patients can be asked to leave by hospital managers or even escorted off-site by security if they do not abide by a hospital’s rules on illegal drug use. However, patients detained under the Mental Health Act cannot be forced off premises for violating these rules.

The risks of illegal drugs being used in mental health units are obvious and severe. There is a possibility of those drugs interfering with prescribed medication, which could make that medication ineffective or even harmful to a patient’s physical or mental health. Further risks include the effects—such as psychosis or aggravating effects—of certain drugs, which could potentially lead patients to become more violent and cause harm to themselves or to staff. Whatever the result, the use of illicit drugs in mental health hospitals does not contribute to the treatment or therapeutic benefit of patients; I suspect that is a British understatement.

Much of the information and literature on substance misuse in in-patient mental health settings seems to be out of date. The major studies that we looked at were conducted in the early 2000s; these included a paper published by the Psychiatric Bulletin in 2000. I am happy to be corrected if there is more up-to-date data, but it seems that we do not have enough adequate and up-to-date data available concerning the prevalence of illegal drugs in mental health units. Can the Minister tell us whether the department has up-to-date figures? If not, does it have any intention of collecting these figures? Once again, this would help us to understand the scale of the problem.

Whether or not we are fully aware of the prevalence of illegal drugs in mental health units, there must be adequate safeguards in place to ensure that their use is as limited as possible. This amendment probes the Government for some answers on how they are trying to achieve this. By requiring the CQC to publish an annual report on this matter, we hope that a fuller picture could emerge, which would, we hope, inform the development of procedures and processes to reduce the harms related to illicit drug use. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I shall speak to Amendment 151 in this group, which is in my name. It is a slightly diverse group, in that the noble Lord, Lord Kamall, has just set out his two amendments, which are very focused on specific areas, while mine is a very general one. However, they fall under the grouping as provided to us by the Whips; they are about monitoring and reporting, so there is some kind of sense here.

I start with the words of the noble Baroness, Lady Tyler, who in the previous group said that, without proper resources, this Bill is not going to work at all. That is what this amendment aims to address. I think the reason why it was regarded as within the scope of the Bill without any wrestling from me is that, specifically, the aim of this Bill is to have fewer people sectioned and fewer people under compulsory treatment orders. It aims to reshape and have earlier interventions, so that we do not see problems get so bad that we get to that point.

Mental Health Bill [HL]

Debate between Baroness Bennett of Manor Castle and Lord Kamall

Committee stage
Tuesday 14th January 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for her rich and full response, and indeed all noble Lords who have taken part in this important debate. It has been long but that has been quite necessary. I thank the Minister particularly for responding directly to my question about the UN Convention on the Rights of Persons with Disabilities. I do not agree with her response but I appreciate that she engaged fully with it, so I thank her for that.

I will not go through and summarise all the contributions, but I just want to make two points, which are perhaps specifically directed to the noble Lord, Lord Kamall, and the noble Baroness, Lady Murphy. A phrase which has been missing from our whole debate is the “social model of disability”. That is the idea that society is discriminatory, and that people are disabled by the barriers in society, not by their difference. That position was endorsed by the Government Equalities Office in 2014, and so far as I know, that still holds, and it is preferred by most disability charities.

I invite noble Lords to consider another phrase in this healthcare space, which is “parity of esteem”. I think that when we come to the social model of disability and physical disabilities, most people have now accepted that if there are only steps and not a ramp, that is a failure of society, not the failure of the person in the wheelchair. However, we have not heard in this debate an acknowledgement of the same parity of esteem—the same approach to mental disability as we have accepted towards physical disability—and we should consider and think about that.

In that context, just to pick up a couple of points from the Minister, she talked about how people with autism or learning difficulties can be detained for aggressive or irresponsible conduct. The Trieste model—if I can call it that—which is being adopted by many countries around the world, asks: “Can we intervene before that point and ask what has provoked that person? Can we intervene before we need to detain someone?” That needs to be very carefully considered.

The other point that the Minister addressed, which I confronted myself with, asking why I did not table the broader amendment that I might have done, is what happens when people get to the point of being a danger to themselves or—I stress that this is extraordinarily rare—a danger to others as a result of a mental disorder. Again, how did people get to that point, and should there not be services and support and community wraparound in the Trieste style? I do not think that any nation or area is saying that it has totally got to that point, but surely we should be aiming at that.

[Lord Kamall (Con)]

The noble Baroness referred to the Trieste model, and I thought that led to quite a deal of interest from noble Lords across the House. Could she share some details on the Trieste model with other noble Lords but especially the Minister and the department, so we can all start learning those lessons?

[Baroness Bennett of Manor Castle (GP)]

I should absolutely stress at this point that I am not an expert, but I will certainly do my best to secure as much information as possible and share it with all noble Lords. The Minister may also have access to resources that may not be available to me. Reflecting on the intervention of the noble Lord, Lord Kamall, perhaps we could even arrange some kind of discussion—it might be useful—and perhaps even hear some testimony, because that would really inform our consideration of the Bill. But in the meantime, I beg leave to withdraw the amendment.