Mental Health Bill [HL]

Baroness Tyler of Enfield Excerpts

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.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, Amendments 65 and 133, in my name and that of my noble friend Lord Scriven, are both about tackling racial injustices in the operation of the Act. I am sympathetic to the amendments that we have just heard about from the noble Baroness, Lady Whitaker, who set them out eloquently. I also strongly support Amendment 138, in the name of the noble Lord, Lord Kamall.

As I have said in previous debates, a primary driver of the review of the Mental Health Act was the shocking racial injustices in the use of the Act, and we need to have that front and centre in our minds as we work our way through the Bill. Addressing racial inequalities is one of the key issues identified in the 2018 review, and there remain concerns that the Bill still does not go far enough to address that deeply entrenched inequity. As I set out on the first day of Committee when introducing my amendment on including equity as an additional principle in the Bill, black people are more than three and a half times more likely to be detained under the Mental Health Act than white people and over seven times more likely to be placed on a community treatment order. I make no apology for repeating those figures because I think they are scandalous.

Evidence shows that, on average, people from racialised communities experience greater difficulty accessing mental health services and have poorer experiences and outcomes, and we have heard examples of that. For example, black or black British people are more likely to be detained for longer and to experience repeated admission. They are also more likely to be subject to police powers under the Act and experience higher levels of restraint. It is worth noting that the noble Lord, Lord Darzi, in his recent report on the NHS, said the use of restrictive interventions in in-patient mental health settings had continued to rise, and the most recent data shows that people from a black or black British background are still significantly more likely to be subject to restrictive intervention.

I readily acknowledge that there are some measures in the Bill that should have a positive impact for people from racialised communities—for example, the introduction of the advance choice documents that we were talking about earlier, which I very much welcome—but, in my view, the Bill in its current form still only scratches the surface, really. It does not take on many of the recommendations in this area from both the independent review of the Act and the pre-legislative scrutiny committee. Can the Minister explain why those recommendations were not taken on board?

I turn to my amendments. Amendment 65—and I thank the noble Baroness, Lady Bennett, for adding her name—is a probing amendment designed to understand better the Government’s thinking on how they intend to address racial disparities in the use of community treatment orders, which we debated at length on Monday. I do not want to repeat that, save to say that community treatment orders have been used more widely than anticipated and disproportionately on individuals from particular ethnic backgrounds. It is vital that this is closely monitored to ensure that the disproportionality in use is tackled head on. We must not focus just on reductions in the overall numbers of CTOs. Does the Minister agree that that should include collecting evidence on the effectiveness of NHS England’s patient and carer race equality framework and its approach to reducing the overrepresentation of people from black and minority ethnic communities?

Just to show that, rather like my noble friend Lord Scriven, I do not get out enough, I noticed that page 88 of the lengthy impact assessment talks about 13 pilots—trusts that have already started to make changes as a result of this anti-racism framework. Can the Minister update the House on their progress? If she cannot do so now, perhaps she could write to me.

We know that people from these racial backgrounds may also be reluctant to seek help from formal services, based either on previous negative experiences or in some cases because of social stigma attached to mental health issues within their own community. Amendment 133 would require mental health units to appoint a responsible person to address and report on racial disparities and other inequalities relating to the use of the Act. This is really important and it is vital that a new responsible person role is introduced at hospital level to oversee race equality and address inequalities in the operation of the Act.

The responsible person would be responsible for publishing a policy on how that unit plans to reduce racial and other disparities which are based on protected characteristics in that unit or community mental health service. They would have responsibility for monitoring data on equalities as well as overseeing workforce training and policies and drawing up policies to address bias and discrimination. In my view, the creation of a responsible person role at local level would materially help us to move forward to a more transparent and accountable mental health system, and this accountability would be reinforced and amplified by the responsibility this amendment also places on the Secretary of State to report on progress made on reducing inequalities at national level. That is set out in proposed new Section 120H.

I really believe that such a dual-pronged approach to clear and transparent accountability could make a tangible difference in this critical area of public policy, and I look forward to the Minister’s response.

[Baroness Bennett of Manor Castle (GP)]

My Lords, as has already been acknowledged, I have put my name to Amendment 63, tabled by the noble Baroness, Lady Whitaker, and Amendment 65, tabled by the noble Baroness, Lady Tyler. Both of them have done a comprehensive job of introducing the amendments so I will be extremely brief.

The noble Baroness, Lady Whitaker, is well known in your Lordships’ House for championing the many issues affecting Gypsy, Roma and Traveller people. I particularly wanted to sign Amendment 63 because it is a very broad-ranging amendment—it is crucial that everybody gets culturally appropriate forms of explanation. It struck me as we were debating that we are focused now on mental health, but I think this probably would also apply right across the NHS to physical health because there are, of course, cultural differences in understanding our bodies, et cetera.

If we imagine the case, perhaps, of a refugee who suffers mental health difficulties, having fled their home country, where they were subject to abuse by the authorities. It is important to make sure, if they are to be sectioned, that that is carefully explained to and understood by both the patient and potentially the patient’s family. There needs to be an extra level and a sensitivity to that person’s circumstances. We will all have different circumstances, but it is important to look at it in that broad frame.

On Amendment 65, we have already canvassed quite extensively the way in which minoritised communities are currently seeing significant disparities in the way they are treated under the law in the area of mental health, particularly in community treatment orders. The noble Baroness, Lady Tyler, described this as a probing amendment. Whether this is the exact means or not, it is clear that we have to have much better data and to make sure that as soon as trends and patterns emerge in that data, they are acted on. It is encouraging to hear that this is being piloted and work is being done but it is crucial that this becomes standard and that is why it is tempting to feel that it really has to be in the Bill.