Mental Health Bill [HL]

Debate between Baroness Murphy and Lord Scriven

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I shall speak to Amendments 54A and 54B in my name, which are on a very narrow part of the treatment plan for individuals. Before I do that, let me say that I support the amendments in this group, particularly the general thrust of what been said; that is, that the automatic medical model must no longer be the default position and a much more social model must be added on to the medical model so that they complement each other.

Having said that, I listened very carefully to the noble Baroness, Lady Fox, but found it very difficult to understand what was required. She argued against the use of medication but then argued against quite a lot of the non-medicated issues. Her intervention was a bit confusing in terms of understanding what the importance was.

My amendments are predominantly about Clause 18, which is about the use of ECT. The clause allows for the emergency use of ECT based on a second medical opinion. The element I wish to speak to is the very wide Henry VIII power that the Government wish to give themselves in regulations to do away with the second medical opinion in an emergency. The Bill says:

“The appropriate national authority may by regulations amend this Act to provide for circumstances in which functions of a second opinion appointed doctor in relation to treatment falling within section 62ZA(1) may or must be carried out instead by the approved clinician in charge of the treatment in question”.


New Section 62ZB(3) then says:

“Regulations under this section may make … (a) provision subject to specified exceptions; (b) different provision for different cases; (c) transitional, consequential, incidental or supplemental provision”.


That is quite a wide Henry VIII power.

To prove that I really am Billy No-Mates and do not get out often on a cold night, I read the wonderful 10th report of this Session from the Delegated Powers and Regulatory Reform Committee, which makes exactly the same points but in more eloquent language. This is a very wide Henry VIII power, and the committee does not really understand why the Government are seeking—even though it is through the affirmative procedure—such wide powers in such broad language.

The committee said that it would expect the power to be drafted with significant limitations and a framework for when it could be used. My amendment seeks to do exactly that. It would not prevent the clinician in change from using ECT in an emergency case without referring to a second practitioner in certain circumstances, but the regulations would be within a framework laid out in Amendment 54B, that

“the treatment is immediately necessary to save the patient’s life … obtaining a second opinion would cause a delay that places the patient at a significant and imminent risk of death or serious physical harm, and … the treatment is reversible”.

The regulations would have to be written so that

“Any amendment made under subsection (1) must specify the exceptional nature of the circumstances in which the second opinion may be dispensed with”.


A report to Parliament on subsection (1) dispensations would also have to be made.

I believe, from reading the wise words of the Delegated Powers and Regulatory Reform Committee in its report, that it is important that the regulations have a framework, so that the Minister still has flexibility but is constrained by what is in the Bill. That is why I have spoken to this amendment.

[Baroness Murphy (CB)]

My Lords, I feel I must poke my nose in on these of amendments, even though I do not have an amendment. I support the noble Earl, Lord Howe, and his various amendments. I particularly like the amendment that would require children and their families to be asked the month after how it all went.

We are hearing described the appalling nature of many mental health services. It is not just children’s services. Although they may be a very good example, as many of them are not fit for purpose, we would get the same complaints and the same appalling state of affairs if we went around other mental health services across the country. It is heartbreaking. I truly believe that services have deteriorated since I practised in hospitals. People, including my former colleagues who are still practising, say that services are completely disorganised and not fit for purpose. We have known for 50 years that the social model of care was an appropriate model, and that you need psychological and social psychotherapeutic interventions, as well as any drugs that might be helpful. They are not going on because there is no availability anywhere.

We have known since at least the 1960s that patients with schizophrenia, for example, can benefit by being taught, one-to-one, about how to interact with people when they are recovering from an episode. That never happens, because we do not employ teachers in the NHS—we just do not do it. We do not employ the right sort of people and we do not have the right sort of facilities. When people are employed, there are so few of them that it is simply impossible to do what is necessary. I am not defending this, because there are some very good units—I am sure that there are some very good children’s and young people’s units—but they are not the norm anymore, and that is a very sad state of affairs.

Sadly, legislation through mental health Bills will not, unfortunately, solve the problem. What we are talking about is not only a fundamental change of culture and getting on with all the things that we know should be done; there needs to be investment and a totally different approach to mental health. All the things that we know should be done cannot be delivered by mental health legislation alone. I say that because we are trying to shove too much into the Bill and hoping for the best, but I do not think that it will work.

Later in the debate on these amendments, noble Lords moved away from talking about people who were very unwell and who need in-patient care to talking about this vast mass of people who are diagnosed with conditions where they cannot work. That is a whole new ball game. I agree with almost every word that the noble Baroness, Lady Fox, said, because there is no doubt that there is a massive overdiagnosis of things that are called “mental disorder”, when they are in fact distress and need a different sort of approach.

A young friend of mine—a gentleman who is now in his final years training as a maxillofacial surgeon—had a period of great distress because of family circumstances. He sat down on his own one evening and went to a website, “Diagnose yourself”. He rang me and said, “I’ve been diagnosed as having ADHD”. I cannot imagine anybody who is less likely to have ADHD than this young man, who is the most socially competent young man I know. This morning, my husband and I had a go on the website together—he did one test and I did another—and we both came up with the same result: “You probably have ADHD”. Well, maybe I am, folks, but I am not going to go on the Ritalin yet. There are a lot of websites that are utter rubbish and encourage people to pay money to see psychotherapists and other counsellors to see what the matter is with them, so that other people can put money in their pockets for doing not much.

That is the different end of the spectrum. When we are thinking about these things, we have to think about what the patient has. Is it something that can be diagnosed—heaven knows that colleagues here were very keen that we should have a diagnosis—or something at the other end of the spectrum? With the Mental Health Bill, we are talking about when you can detain people, take away their rights and say, “We are detaining you”, to treat them, and protect them from wrong treatment, bad doctoring and bad staff. That is what the Mental Health Act is for.

But I am afraid that it is not to do with any of this other stuff. We have to think through what really has to be in the Bill to protect the patients and the staff and what cannot go in there because it is not relevant to these issues.

Mental Health Bill [HL]

Debate between Baroness Murphy and Lord Scriven

Committee stage
Monday 20th January 2025 Lords Chamber

[Lord Scriven (LD)]

I just wonder where this £81 million per annum comes from. I think that there is a total cost of £99 million over the period, but I am not sure where the £81 million comes from.

[Baroness Murphy (CB)]

It is taken directly from the Government’s impact assessment on the Bill to local authorities, with these particular resources for IMHAs.

--- Later in debate ---

[Baroness Murphy (CB)]

I apologise. Obviously, I was looking at another figure from a different bit of the impact assessment.

[Lord Scriven (LD)]

I think the noble Baroness, Lady Murphy, added up all the years and got to the final cost, and then described it as an annual cost. I think it was a genuine mistake.

Mental Health Bill [HL]

Debate between Baroness Murphy and Lord Scriven

Tuesday 14th January 2025 Lords Chamber

[Baroness Murphy (CB)]

What does the noble Lord think will happen to the people in the gap?

[Lord Scriven (LD)]

As I said, the noble Baroness, Lady Bennett, pointed out what happens internationally, in Trieste in Italy, for example, and I therefore suggest that good international comparisons and practice could be enacted in legislation to ensure that the needs of as many people as possible are met in the community, rather than them being held in detention because the provision is not there. That is exactly what will happen unless this gap is dealt with by looking at what is required rather than looking at the gap and continuing detention.

[Lord Hardie (CB)]

My Lords, I apologise that I did not speak at Second Reading, but I have been listening to this interesting debate and it seems to me that Clause 5 is introducing the concept of detention in extreme cases, where there is a risk of serious harm to the health or safety of the patient or another person unless the patient is detained. That is the reason for the detention: to protect the patient from serious harm to himself or herself, or to protect others from serious harm.

As I read the amendment from the noble Baroness, Lady Browning, it simply seeks to suggest, or to put on the statute book, that someone suffering from autism or a learning disability would not satisfy the test in Clause 5. But the amendment permits the admission to hospital of someone with a learning disability for the purpose of assessing whether he or she has a mental disorder. I am not sure that this amendment by the noble Baroness, Lady Browning, would result in people slipping through the net.

[Baroness Murphy (CB)]

I wrote the amendment in a terrible hurry as a compromise amendment when I could not table the amendment that I really wished to table, which was seeking to get back to having clarity about the diagnostic criteria. I apologise if that was not the provision that the noble Lord wanted in the Bill—I am not sure that I want it very much either. I do not have any great devotion to the proposed new clause; it was just a way of trying to address this leaving of the gap. We used to do that, by the way. After the 1983 Act, noble Lords will remember that we dropped alcohol addictions and drug misuse from the Act, saying that we could not detain people for those reasons alone. What happened was that there was total neglect for the next 20 years until voluntary organisations and local authorities got moving and said, “This won’t do—we must do something”.

Noble Lords should remember that that is what happens. If you leave somebody out of protective legislation, they will not be included; they will be neglected and they will end up in prison. That is what Sir Simon Wessely thought and it is what the noble Baroness, Lady Berridge, has been talking about. I can guarantee that nobody will be interested in autistic meltdowns if there is no way in which to intervene to save a family from having that person with them, seven days a week and 24 hours a day, during the period of this terrible disturbance.

Community services are great. I urge noble Lords to visit Trieste, as it has brilliant services in a tiny area; it is one of the very few in Italy, and it continues to work very well. It is cited all over the world, and that is very good. But this is Britain, with 80 million people and massively underfunded services, and it ain’t going to happen. I want to know what will happen to those people noble Lords would like to see neglected until such time as the Government produce some alternative provision.

[Lord Scriven (LD)]

I do not think that I or anybody else who has a different opinion from the noble Baroness wants to see those people being neglected. We have a different view. The issue I have with her stance is that the evidence is that putting people with learning disabilities and autism in a psychiatric hospital—and that is where they will go if there is no provision, because that is where they go at present—is damaging. It is not the correct provision. I believe that what she is arguing for—to continue the neglect of provision by putting them somewhere—is significantly not in their best interests and causes damage.