Mental Health Bill [HL]

Debate between Baroness Berridge and Baroness Butler-Sloss

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I entirely agree with what the noble Lord, Lord Meston, just said. The two interjections were very interesting but they do not really affect the guidance. That is crucial. The question asked by the noble Baroness, Lady Browning, as to whether you can understand it but cannot make a decision, may well affect how the person applying the guidance does so. That would be one of the issues for whoever has the uncomfortable task of making the decision.

I think the noble Baroness, Lady Tyler, is too cautious. If we go back to the Mental Capacity Act 2005, there is clear explanation and guidance in primary legislation as to how anyone who has to judge capacity is to do it. What we are talking about here—incompetence—is quite simply capacity. For some reason, which I find quite difficult, we seem to think that children under 16 have competence or do not, but over-16s have capacity or do not. It would have been far more sensible to use the same word for every person who will, in fact, be judged on whether they do or do not have capacity to make a decision of great importance, as it would be, in relation to mental health issues. I find it very odd.

However, and equally importantly, if it is in primary legislation for over-16s, why on earth would it be in guidance for under-16s? If it is good enough for over-16s, why is it not good enough for under-16s? The way the noble Lord, Lord Meston, has set this out seems admirable. It is very close to the Mental Capacity Act. I take and entirely agree with the point made by the noble Baroness, Lady Tyler, but the Government seem to have ignored children to a very large extent, although children are a very important part of this Bill. I do not blame the Minister, because she did not draft it, but she has to bring it to us. I tabled a lot of amendments about parents and people with parental responsibility because they are largely ignored; I will speak about that later. But where we are dealing with children aged under 16, it is essential that they are treated in the same way as everybody else and that has to be in the Bill—in primary legislation.

Young people have had to deal with these issues ever since Lord Denning was presiding in the Court of Appeal in Gillick, but he did not help us at that stage as to how actually to deal with it. Like the noble Lord, Lord Meston, I have also had to make decisions as to whether under-16s were giving me advice that I thought was really worthy of listening to. Children of five can give extraordinarily good explanations, though I do not expect them to give them on mental health issues. I urge the Minister: it is crucial that everyone whose capacity is a matter at issue has it treated in exactly the same way. Therefore, to put it into guidance really will not do.

I will also speak on Amendments 55 and 56. I am very concerned about children. Bear in mind, however much we treat children aged over 16 with respect and as having the capacity to make decisions, and however much we listen to them, as we should listen to all children, there are stroppy teenagers—we all know about them—who, for one reason or another, will not do what adults tell or advise them. I am very concerned, and I am not quite sure about this because I am no expert on mental health legislation, that if a 16 year-old has the right to make advance decisions and they just say, “I do not want any injections, I do not want any pills, I absolutely refuse to have any treatment”, then unless there is an ability to override them they will have capacity and cannot be ignored. One has to view advance decisions for 16 to 18 year-olds with some degree of care. I am not saying that they should not happen, but I am not happy about them being universal and without some ability for them to be overridden.

[Baroness Berridge (Con)]

My Lords, I have put my name to Amendment 147. I find myself in agreement with much that has been said. It has been a consistent recommendation to His Majesty’s Government since the independent review that there should be a statutory test of competence or capacity for those aged under 16. Of course, that means it should be in the Bill. This has been supported by the Children’s Commissioner of late and by the Children and Young People’s Mental Health Alliance.

Therefore, I was disappointed to see the code of practice solution outlined in the Minister’s policy paper that we received yesterday. As the noble and learned Baroness, Lady Butler-Sloss, outlined, in the Mental Capacity Act, which applies to over-16s, there is a functional capacity test followed by the secondary mental impairment test. I also agree with the noble Baroness, Lady Tyler, that under-16s are presumed to lack capacity, so you start from the opposite premise of the Mental Capacity Act for over-16s, who are presumed to have capacity. That puts them at an advantage: it has to be taken from them, rather than being given to under-16s.

I agree with the comments of the noble Lord, Lord Meston. Great work is being done by clinicians up and down the country to apply Gillick competence tests, but throughout my time on the Joint Committee we did not seem to know whether there was any review or assessment as to how and when it is applied in hospitals and healthcare settings up and down the country. I fail to understand the Government’s reluctance to put this test in the Bill. How is such a reluctance compatible with one of the four guiding principles—to treat the person as an individual? Perhaps the Minister could outline the reasoning for this omission.

I also want to point to the problem of relying on the code of practice made under Section 118 of the Mental Health Act. On page 13 of the code of practice, there is a very clear description of the code and its legislative function:

“Whilst the whole of the Code should be followed, please note that where ‘must’ is used, it reflects legal obligations in legislation, (including other legislation such as the Human Rights Act 1998) or case law, and must be followed. Where the Code uses the term ‘should’ then departures should be documented and recorded”.


It then refers to explanatory paragraphs and continues:

“Where the Code gives guidance using the terms ‘may’, ‘can’ or ‘could’ then the guidance in the Code is to be followed wherever possible”.


In the Minister’s policy statements, there is often the use of “will”, which, as far as I understand, is a “must”. Bearing in mind what I just read, unless something is in the Bill then even putting this test into the Bill will mean that it is only, at the very best, a “should” and can be departed from. Obviously, that applies across all of the places in which the Minister relies on the defence of, “We’re going to put it in a code”. I note that it is a code that we have not seen and will be consulted on only after the passing of the legislation.

Dealing again with the amendment, it is important to determine capacity and, as Mind has said in its excellent briefing, the question of whether a person has capacity or competence to make the relevant decision is fundamental to the operation of key rights and safeguards. To build on the point from the noble Lord, Lord Meston, as I understand it the Bill contains 13 references to competence. It deals with such important matters as the appointment of their nominated person and, if you are under the age of 16, your freedom to choose someone other than the person with parental responsibility depends on your having competence. There is also the ability to refuse medication. To deal with the point made, I think, by the noble Lord, Lord Stevens, who was concerned about leakage across, this is a very particular piece of legislation with such coercive power, as I am sure he is aware, that the case for putting the test in the Bill to open up those safeguards for young people is very important.

The Government’s response to the consultation stated:

“We are committed to ensuring that children and young people benefit from the reforms we plan to introduce”.


Will the Minister therefore explain again how the lack of a statutory test is consistent with maximising that choice and autonomy?

Mental Health Bill [HL]

Debate between Baroness Berridge and Baroness Butler-Sloss

Tuesday 14th January 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I declare an interest as an honorary fellow of the Royal College of Psychiatrists, but without any qualifications, unlike the noble Baroness, Lady Murphy. For the reasons that have already been given, I entirely agree with the whole group of amendments, which have been proposed so much better than I could do—so I do not propose to say any more.

[Baroness Berridge (Con)]

In supporting Amendment 1, I am delighted that the noble Baroness, Lady Tyler, began Committee with this focus on the impact of the Mental Health Act on racialised communities, because that is where this whole journey began, with the noble Baroness, Lady May, when she was Prime Minister, announcing it in that context—and then, of course, it became a wider reform of the whole Act.

I served on your Lordships’ Joint Committee with the other place, scrutinising the Bill. In the course of that, I became aware of the relative strengths of civil society among some of the groups. There were excellent civil society groups speaking on behalf of people with learning disabilities and autism; they were highly professional and articulate. We had one evidence session on the effect of the Mental Health Act on racialised communities, but I saw that the strength of civil society and of media coverage in that area was less—so I am sympathetic to Amendment 1, which would give a profile to one of the main issues under the legislation.

On whether the table should be in the Bill to be in the code or in the Bill sitting as primary legislation, I have sympathy for that proposition. We have learned that the code of practice merely reflects primary legislation. I am aware, of course, that the independent review came up with those four principles, and this fifth one was not part of that. I expect to hear the Minister say that it is already in the Equality Act, so we do not need to put it in the Bill—but I am persuaded of the merits of the amendment. During the whole process of an independent review, a White Paper, a response to a White Paper, a draft Bill, a Joint Committee and now the Bill before your Lordships’ Committee, it has become clear to me that many of the changes that ethnic minority communities need to see are in practice. They are in resources and training—people would not look to the Bill and see their needs as the first or an important priority in it. I would be grateful if the Minister would take seriously this consideration of putting this equity principle in the table and putting it in the Bill, full stop, and not within the code.

Illegal Migration Bill

Debate between Baroness Berridge and Baroness Butler-Sloss

Report stage
Monday 3rd July 2023 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I declare that I was President of the Family Division and tried endless care cases involving local authorities. I am extremely concerned about Clauses 15 and 16 and their interrelation with the Children Acts, particularly the Children Act 1989. As the noble Lord, Lord Scriven, has already pointed out, the Secretary of State does not have parental responsibility for children.

I pointed this out to the Minister several times in Committee. So far, and I do not mean to be impolite, I am not sure that either he or—more importantly—the Home Office have put their minds to the implications of parental responsibility. I have not seen a copy of the letter that apparently was sent. It would have been helpful if I had seen it before I came to this House, because since I have been here I am afraid that I have not been looking at my emails.

The local authority is, under the Children Act, the only corporate parent and no one else can be. If the local authority goes to the court and seeks a care order under Section 31 of the Children Act 1989, there will be a court order requiring the local authority to keep the child and place the child in appropriate accommodation. I ask the Minister: has the Home Office has reflected on what Clause 16 is saying—that the Home Secretary can take a child away from local authority accommodation and put that child somewhere else? Is it intended that this Bill is to override the Children Acts and create a new situation where parental responsibility is of no significance if the Home Secretary considers that a child should be dealt with by the Home Office and not a local authority?

This is a very serious legal situation for children. Although there may not be all that number of younger children, there are certainly some. Even a child of 16 is entitled to the care of a local authority. I just wonder whether the Government have thought through the implications of this. I do not believe that this matter will be taken to a vote, which I am rather sad about in a way, because I would like the Government to put their minds to the existing law—which, I have to tell noble Lords, a Conservative Government passed in 1989, and I was one of those who played a part in the legislation. I am extremely sad to see these two clauses.

[Baroness Berridge (Con)]

My Lords, I have added my name to Amendment 87. Like the noble Lord, Lord Scriven, I do not support the other amendments, which would get rid of these clauses entirely.

I had hoped not to have to put my name to that amendment, particularly as I hoped there would be a government amendment because of the clarification by the Family Division of the High Court during Committee on 9 June, in a case brought by Article 39, which was trying to make missing unaccompanied asylum-seeking children wards of court. It is interesting to note in that case that the lead submissions from the Government were not from my noble friend the Minister’s department but from the Department for Education, which holds the responsibility for the Children Act.

I have a simple question to my noble friend the Minister. As a Conservative, I believe it is important that every child has a parent. While the children are accommodated by the Home Office when they initially come into the country, who has parental responsibility? From my reading of the Bill—I am grateful to the noble and learned Baroness, Lady Butler-Sloss—we are changing a fundamental principle in our law and children may not have a parent, without due consideration of the consequences. It might just be for two days, two weeks or four weeks, but it is really important.

I can foresee, even on my cursory glance at this, at least three cracks in that foundation. First, if a child who is being accommodated in these hotels or hostels ends up at A&E and needs an operation but there is no parent to consent to that surgery—so to do that surgery would be an assault—then precious NHS time would be spent contacting the Home Office and not caring for patients.

The second healthcare situation is that children can be detained under the Mental Health Act. That Act gives important powers, duties and safeguards to the statutory nearest relative—and there is a list of those. Again, if a child is under a care order, under the Mental Health Act the corporate parent is the nearest relative. If the child has no parent and is detained in a secure mental health unit, who will be the nearest relative? Again, precious NHS resources will be, in my view, ill-used.

The most worrying crack—which I hope I am wrong about; I remind noble Lords that I am not a criminal lawyer, and I have done my best when looking at this piece of legislation—is that, when child protection functions under Parts 4 and 5 of the Children Act, such as Section 31, are exercised, there is then a very important exemption for local authorities or public authorities from criminal liability under Section 7 of the corporate manslaughter Act 2007. I would be grateful to hear my noble friend the Minister’s view on that statute. It defines senior management. That perhaps includes the board, civil servants in the department, as well as Ministers and, potentially, the Secretary of State. Giving evidence to public inquiries and appearing before Select Committees is commonplace for civil servants; what is not commonplace is being called as a witness to a Crown Court trial for such a prosecution of the corporate body, the Home Office, which is included under Schedule 1 to the corporate manslaughter Act. If there were to be a change of Government next year, it might be the right honourable Member for Pontefract going to the trial, and it would not be good enough for her to say, “We had only been in office for two weeks before the child fell out of the hotel window”.

Covid-19: Early Years Sector

Debate between Baroness Berridge and Baroness Butler-Sloss

Wednesday 20th January 2021 Lords Chamber

[Baroness Berridge (Con)]

My Lords, it is quite clear that with the effects of the pandemic on children and young people, family structure and wider community groups have been essential in providing support, along with our ensuring that children have access to school—when it is possible for them to be in school. As I reiterate, the Secretary of State for Education is prioritising children’s policies.

[Baroness Butler-Sloss (CB) [V]]

My Lords, are the Government giving sufficient financial support to CAMHS—child and adolescent mental health services—for young children, many of whom have urgent mental health problems?

[Baroness Berridge (Con)]

My Lords, as a result of the NHS plan, £2.3 billion is being invested in mental health services, and 345,000 individuals should be additionally supported within CAMHS by 2023-24. In relation to schools, mental health issues have been prioritised within guidance. We are still rolling out mental health support teams in secondary schools and have made specific links between mental health issues in the Keeping Children Safe in Education updated guidance, as it can often be a symptom of a safeguarding issue, not just a mental health problem.