Mental Health Units: Police Response

Baroness Walmsley Excerpts

Wednesday 23rd November 2016 Lords Chamber

[Baroness Williams of Trafford]

The noble Lord is right to raise this issue. The Government recognise the need to invest in places of safety and £15 million has been allocated to 88 projects in England to improve provision for those in mental health crises, including increasing places of safety.

[Baroness Walmsley (LD)]

Will the Minister define what she means by the last possible option? What are the Government doing to develop a humane alternative to the use of Tasers in psychiatric wards?

[Baroness Williams of Trafford]

I am happy to tell the noble Baroness what I mean by “last possible option”. Something like Taser would be used only when all other methods of restraint are deemed not appropriate or to have failed, and where distance is required between the police and the person who is being extremely violent. That is what I mean by the last option. As to never using it, we can never say that it will not be used because the alternatives—I talked about this with the noble Baroness the other day—are to use more extreme methods of restraint, and we would not want that.

Drugs Policy

Baroness Walmsley Excerpts

Monday 21st November 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I would like first to thank the noble Baroness, Lady Meacher, for the dedication she has shown to revealing and reversing the completely illogical, indeed cruel, position we have in the UK on drugs policy. I will focus my remarks on medicinal cannabis. I attended every meeting of the noble Baroness’s inquiry into this. To me, the evidence in favour of a change in the law is overwhelming in terms of compassion, economics, public order, scientific progress and indeed logic. As the UN says, drugs are a health matter.

On the same day as the presidential election, two additional US states voted to legalise the medicinal use of cannabis. When we wrote our inquiry report, 24 states, plus DC and Guam, allowed such legal use under certain circumstances. Now, it is the majority of states. I read the words of an attorney from Florida who had been campaigning for the change. He said:

“Compassion is coming. This November, Florida will pass this law and hundreds of thousands of sick and suffering people will see relief. What Tallahassee politicians refused to do, the people will do together in this election”.

And they did. I suspect that the same would happen here in the UK if the question were put to the vote.

While I was listening to the evidence during the inquiry, two things struck me particularly: the evidence from patients, and the scientific and medical evidence of benefits to sufferers of many different diseases. Nobody who heard the testimony of these patients and medical professionals could accept the positioning of cannabis in Schedule 1 among drugs that are very harmful and have no medicinal use.

One patient, having explained her symptoms and described how cannabis helped her, showed us two pages of A4 paper on which she had listed the conventional medicines she had been prescribed by doctors, along with the unacceptable side-effects she had suffered. It was a horrific list. Nobody reading it could have doubted that conventional medical services had done their best to help her, but nobody reading it would have tolerated the side-effects any more than she did.

Determined not to break the law, that patient had to get her GP’s referral, go to the Netherlands several times a year, see a doctor there and get a prescription, collect the medicine, and make prior arrangements with Her Majesty’s customs to ensure that she would not be arrested when bringing her medicine back—perfectly legally—into this country. This whole procedure cost her thousands of pounds and enormous effort—and all because successive Governments have resisted the overwhelming evidence that the benefits of laying down a legal framework for the provision of cannabis medicines vastly overtake any small perceived harms.

I hope that the Minister will not tell us that to raise this issue within government is above her pay grade. She is in a much more powerful position than I am. She is inside government and trusted by her colleagues. If she went back to her department and said, “Look here, we need to talk to the Department of Health about this and we need to do something”, she would make her name as someone with an open mind who acts on the evidence. She would also be thanked by up to a million people who might benefit. Otherwise, perfectly law-abiding sick people are having to risk their reputation and their liberty by breaking the law in order to alleviate their pain. That cannot be right.

What is it about the UK that is different from 28 US states, Canada, Israel, Austria, Belgium, the Netherlands, Romania, Portugal, Finland, Italy, Switzerland, Spain, Australia, Chile, Colombia, Uruguay and, most recently, Germany? Why are we afraid of this medicine, which was used legally until the 1940s? The scheduling of cannabis medicines in Schedule 1, while Sativex is in Schedule 4, is a complete nonsense and contradictory, and most people know it. The Royal Society for Public Health put its finger on it in a recent report:

“Given the poor correlation between drug harm and classification, the current system risks sending misleading signals to the public about relative harm, and this may be contributing to avoidable risk”.

Cannabis is a valuable medicine. Its legal use is a health matter for up to a million people and it should be treated as such. Will the Minister please go and talk to the Home Secretary and tell her the facts?

Policing and Crime Bill

Baroness Walmsley Excerpts

Committee: 3rd sitting (Hansard - part one): House of Lords
Wednesday 2nd November 2016 Lords Chamber

Moved by

[Baroness Walmsley]

189: Clause 79, page 101, line 19, leave out from “patients),” to end of line 21 and insert “for subsection (6) substitute—
“(6) Subject to section 136A, in this section “place of safety” means residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948, a hospital as defined by this Act, an independent hospital or care home for mentally disordered persons or any other suitable place.””

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[Baroness Walmsley (LD)]

My Lords, I shall speak also to Amendments 190 and 191, which are grouped with Amendment 189. We now come to the part of the Bill that deals with the Mental Health Act 1983. Amendment 189 would ensure that no one, regardless of their age, was taken to a police cell under an emergency section of the Mental Health Act. Amendment 190 defines a place of safety, and that does not include a police cell.

The Bill makes some very welcome changes to provisions under the Mental Health Act. It bans the use of police cells for children and young people in crisis; it seeks to reduce the use of police cells as places of safety for adults; and it reduces the length of time that a person can be detained from 72 to 24 hours. These are big, important and very welcome improvements. However, the Bill leaves the door open for police cells to continue to be used for adults in crisis. That should not be continued, and it does not need to happen. We have seen in places such as Hertfordshire and Merseyside, where no police cells have been used for people in crisis in the last year, that with careful planning and co-operation it is entirely possible for people to be supported in health-based places of safety instead of being taken to police cells. I commend the large reduction in the use of police cells that many other police forces have made over the last year across England and Wales.

The limited change to the use of police cells in the Bill is based on an assumption that 4% of people detained under Section 136 need to be taken to a police cell due to “exceptional circumstances”. However, these circumstances have not been defined. Clearly, we need further information on the exact situations in which the Government envisage a police cell being an appropriate place for someone in crisis. I do not believe that anyone in crisis should be taken to a cell. That is not a place of safety for someone in crisis. When someone has a mental illness, everything that a public authority does to and for them should help them recover. Putting them in a cell does not achieve this. Indeed, it often achieves the exact opposite. One patient told the charity Mind that, “Being put in a police cell where hardly anyone is trained in mental health issues is not good. To be locked up and isolated made me think I was worthless. All I wanted was to talk”.

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We can all agree that the best interests of detainees and the safety of the public must be paramount. I believe that the provisions in the Bill best achieve this outcome. Accordingly, I ask the noble Baroness to withdraw her amendment.

[Baroness Walmsley]

My Lords, I thank the Minister for her reply. I have a few points to make in response but want first to apologise to the noble Lord, Lord Bradley, for not mentioning his excellent report. I congratulate him and the Government on the recommendations in the report that have been achieved on the ground. The street diversion teams are particularly good and would certainly come into play were a person found to be violent and in danger of hurting themselves or somebody else. The teams have had a fantastic effect and I look forward to their being rolled out universally.

It has been suggested that the amendment is a little premature and that we do not yet have the infrastructure in place to enable us to have a complete ban on the use of police cells. As with every other Bill, it would be perfectly possible for the Government to accept such a measure and then delay its implementation until such time as the review suggested by the noble Lord, Lord Bradley, had taken place and the extra beds had been put in place. That would not be an impediment to the Government accepting my amendment.

The noble Lord, Lord Rosser, asked what would happen if no health-based place of safety was available, the implication being that only use of a police cell was possible. Every local authority has hundreds of care homes and the lucky ones have nursing homes, too. Not all beds are occupied all the time; indeed, a recent report in the media cited instances where the contract with the family concerned stated that after the person in question had died, the family would have to carry on paying for two, three or four weeks while the home found another occupant for that room. That means that vacant rooms will be available. Some of them would be perfectly suitable for some patients, because they are acceptable and legal places of safety. If Hertfordshire and Merseyside can do it in those circumstances, then why not everywhere else?

[Baroness Chisholm of Owlpen]

Is the noble Baroness suggesting that mental health patients are able to go to care homes as places of safety?

[Baroness Walmsley]

I beg the Minister’s pardon. I should have said that there are care homes in every local authority where staff are specially trained to deal with people with mental health problems.

If Merseyside and Hertfordshire can do it, why not everywhere? Do they not have any patients who are in exceptional circumstances? I am sure they do.

On funding, the Minister suggested that the LGA was incorrect in briefing us that none of the money was going to local authorities. That is where my statement came from, and it should know.

On Amendment 191, about use of the home, it is important that somebody in a mental health crisis be able to see someone who is trained to assess and treat them as soon as possible, and as soon as would happen if they had a physical problem. They will not get that in their home. I do not believe that those choosing to take them home would be in a position to assess whether that home was really safe. Even members of the family would not know whether the home was safe, so getting their agreement is no guarantee that the home is a real place of safety. Many mental health patients have said that they would find it a serious intrusion on their privacy if the police brought them home and stood guard over them while they were there. I accept that it would be for only a short period, but to have a policeman outside the door would have a great effect on how they felt they were seen. As the noble Lord, Lord Thurlow, said, they already feel stigmatised by a link being made between mental health and criminality, which there really is not. We should therefore pursue these issues on Report. Of course, this is Committee stage, so for the moment I beg leave to withdraw the amendment.

Amendment 189 withdrawn.

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Moved by

[Baroness Walmsley]

192: Clause 80, page 103, line 5, leave out “person arrives at” and insert “constable takes that person into custody (within the meaning of section 137 of the Mental Health Act 1983) in order to remove them to”

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[Baroness Walmsley]

My Lords, the amendment would ensure that people are really only detained under the Mental Health Act for up to 24 hours. To achieve that, the clock needs to start when the decision is made to detain someone and not when they arrive at the place of safety. If the Government want people to be detained only for up to 24 hours, Amendment 192 is needed. This is the only way to ensure that we are not detaining people for longer than 24 hours during what is often a distressing and alienating experience for people in crisis. They may be detained on the street in one of the special vehicles that have been mentioned or in another public place. They may be kept in a police car until a suitable destination is found. Wherever it is, distress will ensue for the person concerned.

We need to look at the position in parallel with that of a person with a physical illness who calls an ambulance. When ambulance services are assessed, the clock starts ticking from the moment the ambulance is called and not from the moment the patient is picked up. This is a matter of parity between physical and mental health.

When discussing these parts of the Bill, it is crucial that we remember that people detained under the Mental Health Act have not committed any crime. They are unwell and require health support. That is why I beg to move.

[Baroness Hamwee]

My Lords, I support the amendment. From the point of view of the person detained the detention starts at the point described by my noble friend Lady Walmsley. It is not a question of that being some sort of limbo; that must be how it feels. If a person is on the way to a place of safety, they are being detained, held and controlled as much as they would be when they reached their destination.

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[Baroness Walmsley]

My Lords, I thank the Minister for her reply. Obviously, I will consider what she has said very carefully in case there are any unintended consequences, but I confess that up to this point I am not quite convinced. Once a person has been taken into custody they are under the control of the police, their liberty has been taken from them, and I cannot imagine anywhere in this country that you could not get to within 24 hours. Because we are in Committee I will certainly withdraw my amendment and I will think carefully about whether we need to ask for further consideration of this on Report. For the moment, I beg leave to withdraw the amendment.

Amendment 192 withdrawn.

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Moved by

[Baroness Walmsley]

193: After Clause 81, insert the following new Clause—
“Detention under the Mental Health Act 1983: access to an appropriate adult
(1) A person detained in a place of safety under section 135 or 136 of the Mental Health Act 1983 shall have the right to have access to an appropriate adult.(2) For the purposes of subsection (1), “appropriate adult” means—(a) a relative, guardian or other person responsible for the detained person’s care;(b) someone experienced in dealing with mentally disordered or mentally vulnerable people but who is not a police officer or employed by the police; or(c) some other responsible adult aged 18 or over who is not a police officer or employed by the police.”

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[Baroness Walmsley]

Amendment 193 would ensure that people detained under Section 135 or Section 136 of the Mental Health Act 1983 have access to an appropriate adult. Such access is key to providing people in crisis access to advice while under emergency detention. It is a uniquely distressing and confusing time, as we have heard, and one where independent advice from someone with knowledge and skill who can handle the situation calmly is crucial.

At the moment detained people only have the police, who were involved in detaining them, and the person doing their mental health assessment as their key contacts. Clearly, neither of these can be seen as impartial to their situation. The person doing their assessment, although qualified, is going to be deciding what happens to them next, and so cannot really be described as impartial. There is a huge gap here, since people under most other sections of the Mental Health Act have the right to access an independent mental health advocate. People who are under arrest also have the right to access an appropriate adult. The National Appropriate Adult Network says about people detained or questioned by police:

“While both children and mentally vulnerable adults are required to have an Appropriate Adult under the PACE Codes of Practice, there is only statutory provision for children. As a result many people aged over 17 who are mentally vulnerable do not get the support that they are entitled to. This includes people with mental ill health, learning disabilities and autistic spectrum disorders”.



I recognise the concern of local authorities that they are strapped for cash, but I feel that making this provision statutory will put pressure on the Government to provide the necessary resources. The JCHR shares my concerns about this gap, as we read in its third report of the 2016-17 Session. It wrote to Mike Penning MP, then Minister for Policing and Criminal Justice. He replied on 1 July 2016 to the effect that persons detained under Sections 135 and 136 were only there in order to allow for a mental health assessment and he was keen,

“that we do not inadvertently build unintended and unnecessary delay and bureaucracy into this process or as a consequence of having to await the arrival of a formal advocate or independent representative”.

He also pointed out that the person could request the presence of a legal adviser or a relative or friend. This did not satisfy the JCHR and it does not satisfy me.

The JCHR said:

“We believe that additional safeguards are required to ensure that a person detained in a place of safety under s 135 or 136 of the Mental Health Act 1983 should have access to an ‘appropriate adult’, particularly in circumstances where they are detained in their own home”.

It drafted an amendment very similar to my Amendment 193, which I think it proposes to bring forward on Report, unless the noble Baroness can satisfy us all this evening. Given the state a person is likely to be in when they are detained, I believe it would be a breach of their human rights not to allow them the right to access an appropriate adult. I beg to move.

[Baroness Chisholm of Owlpen]

My Lords, it is absolutely right that people detained under Sections 135 or 136 should have the help and support they need to understand what is happening to them, and the current arrangements already allow for that. Detention under Sections 135 and 136 is for a short period of time and for the specific purpose of assessing the need for care and treatment, and making the necessary arrangements for its provision.

This amendment calls for each person detained to have access to an appropriate adult; an issue which was also raised by the Joint Committee on Human Rights in its report on the Bill. It is true that appropriate adults provide an incredibly valuable service, providing support and advocacy for children and vulnerable adults detained in police stations, usually when they are under arrest in connection with a criminal offence. Appropriate adults are not currently required to be provided by the police to support people detained under the Mental Health Act, nor are they trained to meet their particular needs. We must be cautious of the potentially stigmatising effects of conflating the support services provided to people suspected of an offence with those needed by people detained in connection with their mental ill health.

In the majority of cases under Sections 135 or 136, the person will be taken to health-based places of safety, where appropriate adults do not operate, rather than to police stations. In 2015-16 police stations were used in only 7% of Section 136 cases in England and Wales. The provisions in the Bill mean that police stations will be used even less than they are now; in fact, quite rarely, I expect— we hope, not at all. These rare cases require particular attention and I expect that the regulations on the use of police stations as places of safety for adults will give very clear direction about the level of support that will need to be in place.

I recognise that this amendment is about all people who are detained under Sections 135 or 136, regardless of which place of safety they are taken to. It is about supporting them, informing them and speaking for them if necessary. The Government are clear that the mental health professionals involved in the detention and assessment process are best placed to do this. Also, mandating the attendance of an appropriate adult, or some other person with a similar role, could very easily cause avoidable delays in getting on with the mental health assessment that is the proper purpose of a detention under Sections 135 or 136. Given that the Bill reduces the maximum period of detention from 72 hours to 24, it seems unhelpful to then introduce additional requirements that would, in all likelihood, impinge on that reduced period of time.

Guidance is now being developed on the changes the Bill makes to the 1983 Act. It will make clear the expectations on healthcare staff—those whom people detained under Sections 135 and 136 will encounter—to ensure that detainees have the support and advice they need while awaiting and undergoing an assessment. The Government are engaging with a wide range of experts to draw up this guidance. Current practices and the needs of people experiencing a mental health crisis will be carefully considered.

I hope I have been able to persuade the noble Baroness that mandating access to an appropriate adult is inappropriate in the context of a short Section 135 or Section 136 detention, and that, having had this opportunity to debate the issue, she will be content to withdraw her amendment.

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[Baroness Hamwee]

My Lords, I am a member of the Joint Committee on Human Rights and my name is on the amendment. I will make two points. First, the Government’s argument is that using the term “appropriate adult” causes some sort of stigma. I cannot speak for the committee or my noble friend whose amendment it is, but you can call that person what you like—it is the job that needs to be done, and that is what the amendment is driving at. Secondly, I wish to draw attention to the provision of subsection (1) of the proposed new clause, which is,

“the right to have access”.

Rights should be in legislation.

[Baroness Walmsley]

I agree with my noble friend on that point and on all the points she made. I thank the Minister for her comments, which I will of course consider between now and Report. I do not agree with her that the person formally doing the mental health assessment can be regarded as the appropriate adult, for the reason that I gave in my opening remarks; that is, that person is in control of what happens next to the person being assessed. It is important that the person has a right—they may not choose to use it—to consult somebody else about whether that is the right thing for them and how they feel about it.

Of course, the Minister is right that the number of people detained in police stations in these circumstances is going down very rapidly. If my Amendment 189 was accepted, it would become zero very quickly. In those few cases—many fewer now—where a person is in that situation, I still think that they should have a right to choose if they feel the need to have somebody else there to advise them. However, this is Committee so I will withdraw the amendment.

Amendment 193 withdrawn.

Moved by

[Baroness Walmsley]

194: After Clause 81, insert the following new Clause—
“Disallowing use of Tasers by police officers on psychiatric wards
A police officer may not use a Taser or electroshock weapon during a deployment on a psychiatric ward.”

[Baroness Walmsley]

My Lords, Amendment 194 would ban the use of Tasers in psychiatric wards. It must be remembered that a Taser is a firearm and when they were first introduced they were restricted for use by trained firearms officers only. How could it possibly be justified to use a firearm on a person going through a mental health crisis and whose liberty has been removed, especially when you do so in a health-based setting where staff are supposed to be trained in the behaviour management of people suffering a mental health crisis? Could it be that the increased use of Tasers in these settings is an indicator of the shortage of properly trained staff in them?

A Guardian freedom of information request on the police response to calls for help from staff at psychiatric units spotlighted the pressures on an overburdened system. The staggering 617 emergency 999 calls by one London trust in the past 12 months indicate a service in crisis. What we are seeing is the health service relying on a forensic solution to meet clinical need, because we have lost more than 4,000 mental health nurses in recent years. This is a health issue as well as a Home Office issue.

It is also a human rights issue. The United Nations Committee Against Torture has stated that Taser X26 weapons provoke extreme pain, constitute a form of torture and in certain cases can also cause death, as shown by several reliable studies and certain cases that have happened after their use. While termed non-lethal, there have been at least 10 known deaths associated with the use of Tasers in the past 10 years, yet Tasers have been used against patients detained in secure psychiatric settings over that same period. But this scandal has come to public attention only recently, due probably to the imbalance of power between those who use them and those upon whom they are used. I would like to know why the CQC and/or the IPCC have not reported on this before.

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[Baroness Williams of Trafford]

I start by thanking all noble Lords who have taken part in this debate. Although there have been opposing views on the amendment, it has provided a very balanced set of points. This group of amendments includes two proposed new clauses about police use of Tasers. As the noble Baroness, Lady Walmsley, explained, her amendment seeks to bar the use by police officers of a Taser or other electroshock device in psychiatric wards.

Any use of force by police officers in psychiatric wards, or in any other setting, must be appropriate and proportionate—the noble Lords, Lord Harris and Lord Dear, the noble Viscount, Lord Hailsham, and my noble friend Lord Attlee made that point and gave some very good examples this evening. The use of force must be necessary and conducted as safely as possible. Therefore, it is right that if police officers need to attend and use force, they should be expected to account for their actions, as the noble Lord, Lord Harris, said.

It remains the Government’s position that the deployment of police officers to mental health settings, and the tactics used, should remain an operational matter for the police force in question. Tasers are an important tactical option for police officers. Unfortunately, some of the most extreme behaviour can occur in mental health settings and can escalate to the point where it can be met only with force—as dictated by the high degree of urgency and grave threat to staff and other patients. I am talking about cases where other de-escalation tactics have probably been tried and have failed. Again, the noble Lords, Lord Harris and Lord Dear, and the noble Viscount, Lord Hailsham, made those points.

A blanket ban on the use of Tasers on psychiatric wards, as proposed by this amendment, would remove this valuable police tactic and therefore potentially reduce the safety of officers, hospital staff and indeed patients. In some extreme cases, it could leave officers with no choice but to use another, potentially more dangerous option as the only means to resolve a violent situation and keep others safe. The same noble Lords made these points. Police officers themselves have made it clear that they would not want their options constrained by a blanket ban on Tasers. Officers have a range of tactics and equipment available, and a Taser is but one of them. In deciding which tactic to use, an officer will assess which is likely to be most effective and proportionate.

The Government accept that more can and should be done to ensure that all uses of force, including of Tasers, are necessary and proportionate. For this reason, the former Home Secretary asked former chief constable David Shaw to lead an in-depth review of the publication of use-of-force data, including data on where force is being used, such as in a hospital setting, to ensure that the use of these sensitive powers is transparent. With the agreement of fellow chief officers, Chief Constable Shaw recommended that every time the police use a significant level of force on an individual, such as the use of Tasers, a range of core data must be recorded. This includes ethnicity, age and location, so that we will be able to identify every time force is used in a hospital or mental health setting. The data will enable thorough scrutiny of proportionality and effectiveness.

That brings in the point that I think the noble Lord, Lord Rosser, made about force seeming to be used more in some places than in others. All forces have worked to implement this new recording system, and I anticipate that the collected data will form part of the 2017-18 Home Office annual data return. I can tell noble Lords that in 2015 there were 10,329 uses of Tasers by police. Actual firings of the device—this is an important point—accounted for 17%. Non-discharges —where the Taser is drawn, aimed, arced or red-dotted—accounted for 81% of Taser use. Red-dotting accounted for 51%—the most common use.

All forces have worked to implement this new recording system and, as I said, it should be in force in 2017-18. The Government have also taken further steps to ensure greater scrutiny of the use of Tasers in mental health settings at local level, where operational decisions are made. Charles Walker MP raised some valuable points on this matter during consideration of the Bill in the House of Commons.

Both Home Office and Department of Health Ministers have in the past few days written to police and crime commissioners, chief constables and the chairs of local mental health crisis care concordat partnerships to ask them to work together to ensure that sufficient local joint scrutiny arrangements are in place. As local leaders with overall responsibility for policing and mental health crisis care, they have been tasked with ensuring that mechanisms are in place in their areas for the joint identification and scrutiny of any use of Tasers in a mental health setting.

I expect this additional scrutiny to lead to all relevant policing and health partners working closely to look at the full circumstances surrounding police officers being called to attend, the specific circumstances of any use of Tasers, and the lessons they can learn for the future.

As I have said, the Government and police believe that a blanket ban on the use of Tasers in psychiatric settings risks the safety of the police, hospital staff and patients. That said, I agree that more should be done to ensure that any use of Tasers in such circumstances is open to effective scrutiny. That is an important point.

The amendment tabled by the noble Lord, Lord Rosser, goes rather wider in seeking a review of all police use of Tasers—not just in mental health settings. As I just explained, the Government are committed to ensuring that the police use their powers and tools proportionately and are keen that all use of force by the police—including Tasers—be recorded and published.

The benefits of the planned new data collection system will be to enable the police and others to review practice in certain locations, against certain groups, and so on. This will enable deeper examination of the reasons for the use of force and inform adjustments needed to guidance, policy and authorised professional practice, if any. We have asked the police and others to ensure that this happens and, on that basis, I hope the noble Baroness feels able to withdraw her amendment.

[Baroness Walmsley]

My Lords, I thank the Minister for her reply and the noble Lords, Lord Ouseley and Lord Rosser, and my noble friend Lord Paddick for their support. I am sorry that I have been unable to take the noble Viscount, Lord Hailsham, or the noble Lords, Lord Dear and Lord Harris, along with me. I must say that I felt that in his enthusiasm in making his case, the noble Lord used somewhat unparliamentary language. In 16 years in your Lordships’ House, I have never been called silly before. The amendment was certainly not regarded as silly by the mental health patients who have approached us about the issue.

The noble Baroness mentioned that use should be appropriate, but we have had to move the amendment to highlight the issue today because it seems that “appropriate” has become a lot more frequent. We have heard some figures about the number of times that the police have been called in. At least the noble Lord, Lord Harris, was able at the end of his remarks to agree with me that part of the problem is undoubtedly the lack of sufficient properly trained staff in mental health wards, which needs to be addressed.

We will think carefully about what has been said on all sides of the argument between now and Report, but, for the moment, I beg leave to withdraw the amendment.

Amendment 194 withdrawn.

Moved by

[Baroness Walmsley]

195: After Clause 81, insert the following new Clause—
“Child sexual exploitation: duty to refer
(1) Where the police have a reasonable belief that a child has been sexually exploited or subject to other forms of child abuse, the police must refer the child to a named mental health service. (2) The Secretary of State must by regulations define “named mental health service” for the purpose of this section.”

[Baroness Walmsley]

The amendment is intended to ensure that children who have been abused or sexually exploited are made known to mental health services in their area. It is beyond the scope of the Bill to mandate what happens next, but it is inconceivable that services to which the child is referred should not provide the necessary assessment and therapeutic services.

However, we know that many thousands of children who have been abused sexually and otherwise have not received any help, despite the fact that up to 90% of children who have been sexually abused develop mental health problems before they are 18. Recent NSPCC and Children’s Society research has highlighted that abused children are not routinely getting access to the mental health and therapeutic support they need. They found that traumatic experience of abuse on its own rarely triggers therapeutic support, with abused children reaching high clinical thresholds for services only when they have severe mental health issues and are at crisis point.

Evidence from the Children’s Society report, Access Denied, said that despite abuse being a major risk factor for mental health issues, less than half of mental health trusts identify children who have experienced sexual exploitation in referral and initial assessment forms, and only 11% of trusts fast-track access to CAMHS for this group. Only 14% of local transformation plans for children’s mental health contained an adequate needs assessment for children who have been abused or neglected, and one-third of plans do not mention services to meet the needs of such children at all. Identifying young people who experience sexual exploitation and their needs in the first place can be a particular challenge.

Since I entered your Lordships’ House 16 years ago, I have attended many presentations and seminars, but one sticks in my mind from my very first months here. It was with the NSPCC, highlighting the lack of therapeutic help for abused children. Here we are, 16 years later, talking about the same thing, despite all the efforts of my right honourable friend Norman Lamb MP to get more funding for CAMHS.

This morning, I attended the 30th birthday party of ChildLine, and I was discussing the amendment with Esther Rantzen. She, of course, supports it, but she made another relevant point, which was that although ChildLine often refers children to the police—with their permission—it is rarely the other way round. The point is that if the police are having difficulty getting a child to disclose to them about suspected sexual abuse, they should put them in touch with ChildLine, which will not only help them to disclose safely, in the way they should, but will support them through the proceedings that may follow.

The phone number of ChildLine should be on the wall of every police station: 0800 1111. Perhaps this would also remind police to refer children to their local mental health services for an assessment. They know they should, but they do not always do it. That was admitted this morning on Radio 4’s “Today” programme, when Sarah Champion MP, a great champion for abused children, and a senior police officer, discussed this very thing. Although it was accepted that the police’s attitude to abused children has improved enormously, it was admitted that there is still some way to go.

There is an opportunity through the Bill to pursue the recommendations set out in Future in Mind: that sexually abused or exploited children receive a comprehensive specialist initial assessment and a referral to appropriate services, which can provide evidence-based interventions according to their need. Where victims of child sexual exploitation come into contact with the police or a local authority, the Bill provides an ideal opportunity to state in law that the police must refer them for a psychological assessment, and then we must rely on providers to give them the support they need to recover.

These children are going to cost the NHS a great deal of money unless we act promptly. A report from Public Health Wales this week found that people who have been abused in childhood are three times as likely to contract a serious illness later in life. The Government must see the amendment as prevention of a great deal of expenditure later, and accept it tonight. I call on them to do so and beg to move.

[Lord Paddick]

My Lords, I rise very briefly to support my noble friend Lady Walmsley’s amendment, to which I have added my name. It seems absolute common sense that, if the police are investigating an allegation that a child has been sexually exploited, the needs of the child should be paramount and that referral to appropriate support for the child should be compulsory in those circumstances. I feel that I really need say no more than that.

--- Later in debate ---

[Baroness Williams of Trafford]

My Lords, I am grateful to the noble Baroness, Lady Walmsley, the noble Lord, Lord Kennedy, and the noble Baroness, Lady Benjamin, for their explanation of the amendments. We appreciate that their intention is to ensure that the proper provision is made for vulnerable or traumatised children. We absolutely agree that we must ensure that such children never fall through the gaps between services, but I put it to the noble Baroness, Lady Walmsley, that the overriding determinant of referral for health services must be clinical need. Not all children and young people who have been abused or exploited will develop a mental health problem, and intervening unnecessarily or inappropriately can in itself be harmful.

All that said, it is essential that healthcare practitioners who work with abused children and young people should have the capacity and capability to provide evidence-based treatment where needed. This will be addressed through the emerging workforce strategy, which is being put in place to deliver the key proposals in the Department of Health report on children’s mental health. The Department of Health is also introducing routine procedures so that sensitive inquiries are made to establish whether a child undergoing a mental health assessment has experienced neglect, violence or abuse. This will be an important step towards establishing a child’s or young person’s need for support. The important thing is that children and young people get the right care at the right time, based on their needs, not on a non-clinician’s view of their potential needs based on their experiences.

On amendment 221, it is worth adding that individuals, including children where appropriate, need to consent to receive treatment. Where a person indicates that they would like to avail themselves of any referral, consent can be sought for relevant personal details to be passed to the health provider, which is the proper course of action. It would be likely to be inappropriate, and in breach of data protection, automatically to pass on personal details and potentially sensitive information, even to a health provider. It may be helpful for noble Lords to know that NHS England published a Commissioning Framework for Adult and Paediatric Sexual Assault Referral Centres (SARC) Services in August 2015, which outlines the core services in SARCs and referral pathways to other services. They are now being rolled out throughout England.

On the basis of my remarks, I hope that the noble Baroness feels content to withdraw her amendment.

[Baroness Walmsley]

My Lords, I thank the Minister, though I hardly know where to start. I know that I want to keep my remarks short, as those here for the dinner-hour debate are waiting.

The Minister suggested that not all young people who have been abused require therapeutic help. Bearing in mind the figures that I gave at the beginning of my speech, we will not really know which 10% will not develop mental health problems unless we get them properly assessed. I may have used the wrong word—“refer”—in my amendment, but the point I am trying to make is that the police must ensure that the appropriate mental health commissioners in the area are made aware that a child may need therapeutic help and that an assessment should be done by a qualified person to find out whether they do. That is absolutely essential.

The fact is, we know that it is not always happening and that is why, as the noble Lord, Lord Harris, accepted, I felt it necessary to raise this, and I am not the only one. As I say, ChildLine also very much feels that this would be helpful.

Given the effect on the rest of the lives of these children, as my noble friend Lady Benjamin mentioned, a little bit of over-referral would not necessarily be a bad thing, because it will soon come out in the wash. If they do not need any help, it will soon be found out and the help will stop if it is not needed. The National Health Service is not going to give a whole lot of help to people who do not need it—it does not have the money. But the fact is that most of them do need it and it is not happening. After 16 years, I cannot believe that we are still here.

I will of course consider what the Minister has said and make further inquiries between now and Report stage in case it is not necessary, although I think it is. For the moment, I beg leave to withdraw the amendment.

Amendment 195 withdrawn.

Syrian Refugees: Settlement in the UK

Baroness Walmsley Excerpts

Monday 7th December 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords—

[Lord Swinfen (Con)]

My Lords—

--- Later in debate ---

[Lord Bates]

That, of course, was one of the big pressures. There is now in place the Kent dispersal scheme, for which Richard Harrington is responsible: rather than people being concentrated in a given local authority area, they are redistributed nationally. So far, 55 local authorities have signed up to that scheme, through which they can receive unaccompanied asylum-seeking children.

[Baroness Walmsley]

My Lords, will the Minister note the activities of Siemens in Germany, which is offering—

[Baroness Stowell of Beeston]

My Lords, I am so sorry. Although I understand why the noble Baroness is trying to get in, there are occasions when we should give priority to Back Benchers rather than Front Benchers. I suggest that if we are to have one more speaker, it should be a Back Bencher.

Asylum Support (Amendment No. 3) Regulations 2015

Baroness Walmsley Excerpts

Tuesday 27th October 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this whole thing is shameful, but what the Minister has just said is quite unrealistic. In 12 months’ time, when the review is done, one could have undermined the health of hundreds of children, and that, in the future, will cost the NHS a great deal more money. Have the Government taken account of that?

[Lord Bates]

Our position is that we have gone into this in exhaustive detail, as my letter to the noble Baroness, Lady Hamwee, set out, probably in too much detail. It set out right down to the last penny where we felt that these amounts had come from. We clearly believe that we are complying with our international obligations. If this is shown to have a real detrimental effect, and evidence can be provided to us, then of course we will consider that very carefully next year, when this comes to be reviewed.

Serious Crime Bill [HL]

Baroness Walmsley Excerpts

Monday 2nd March 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I shall speak to Amendments 5 and 6 in particular. Before I start, let me say that I absolutely agree with the Minister that female genital mutilation—FGM—is a horrible procedure, and it is right to criminalise it, with the severest of penalties for anybody involved. I have seen many adolescent girls and young women whose subsequent health has been affected by female genital mutilation—occasionally resulting in death during childbirth, but much more often in the horrible condition known as obstetric fistula, which I have seen in Africa. I am therefore totally committed to making sure that this horrible procedure is made illegal and removed.

During the passage of the Bill through the Commons, the Government introduced an amendment to make it a duty for regulated healthcare professionals to notify police of female genital mutilation, and the amendment was accepted there. Like the professional organisations—particularly the regulators of the medical profession, the General Medical Council and the British Medical Association, and some of the colleges, particularly the Royal College of Paediatrics and Child Health—I am concerned about that amendment.

Our concern is about the proposed duty to report FGM in all known cases in girls and young women under 18. That duty will be a significant step change in the law. I am not aware of any other circumstances in which healthcare professionals are required to refer patients to the police without any regard to the potential impact on the patient. That is what concerns me—the potential impact on the patients, particularly young girls under 18, including 16 to 18 year-olds.

Doctors are required to make the care of patients their first concern, but of course they have to balance that duty against wider public interest considerations. There are clear circumstances in which they should disclose information to an appropriate agency. For example, it might be necessary to protect a specific person or people, or the public more broadly, from a risk of death or serious harm, or to assist in the investigation or prosecution of a crime. The General Medical Council guidelines in Protecting Children and Young People: The Responsibilities of All Doctors make that absolutely clear.

The proposed duty, however, allows no scope to consider the best interests of the child or young person. In effect, the duty mandates that the wider public interest in investigating whether or not a crime has been committed would always outweigh the girls’ rights and interests, including those of the individual child or young person. It is difficult to see how that satisfies the proportionality argument or requirement of Article 8 of the European Convention on Human Rights. It also means that doctors will sometimes be obliged—I agree, in rare circumstances—to act against what are considered to be the best interests of the patient. That is in conflict with the primary duty of doctors.

The Royal College of Paediatrics and Child Health also found that,

“there is no credible or conclusive evidence that ... mandatory reporting … better protects children at risk of harm, and its introduction would undermine that cultural approach of risk and responsibility sharing that has been developed in the current system. Mandatory reporting still raises more questions than it provides answers”.

In response to the Government’s consultation, the professions argued that any duty to report FGM should include a “reasonable excuse” for not reporting if it would be contrary to the best interests of the child or young person to do so. Further consideration needs to be given to the position of young women between the ages of 16 and 18. There is no clear line between childhood and adulthood. While under-18s have a different status in law, at 16 it is presumed that young people have the ability to make a whole range of decisions, including about their own care. Discussions about the treatment and care of a 17 year-old may be indistinguishable from those relating to an adult. Particular risk may arise in the context of maternity care, and here I have a particular concern. A young woman may not present to healthcare services if she fears it will result in a referral to the police. Young women who have undergone female genital mutilation as children will be at increased risk during maternity care and childbirth. They require particular and extra care during labour. That duty would undermine the provision of care that might be given to them.

There are many positive aspects to the Bill which I absolutely support. It makes a real difference to the lives of children and young women. This particular duty goes counter to that and I wish there was a phrase saying that in some circumstances there might be a need to protect children and young women. If we cannot change this today, I hope that at least there will be a commitment on the Minister’s part to make sure that the guidance will reflect our concern.

[Baroness Walmsley (LD)]

I wish to speak to Amendments 5 and 6 and hope that, in the further consultation on the guidance, the Government will be able to address the concerns raised by the noble Lord, Lord Patel. I have a question for my noble friend the Minister. There is nothing in the amendment about sanctions for not fulfilling this very serious duty to report a very serious crime, but the letter from the noble Lord, Lord Bates, referred to the fact that the sanctions would be professional and employment sanctions. I wonder whether my noble friend can clarify what that means and say why the Government feel that such sanctions to this new duty would be any more effective than the professional sanctions that already exist within professional associations for the sort of misconduct that we are talking about. To ignore knowledge of such a serious crime is not the sort of thing we would expect of a professional. Some of us feel that overlooking such a serious crime must require a more serious sanction than just leaving it to the professional associations to deal with.

Independent Panel Inquiry into Child Sexual Abuse

Baroness Walmsley Excerpts

Wednesday 4th February 2015 Lords Chamber

[Lord Bates]

We are grateful for the right reverend Prelate the Bishop of Carlisle’s statement on that. I do not think that any of us can claim to have got it absolutely right. The important thing is that we get it right going forward for the survivors.

[Baroness Walmsley (LD)]

My Lords, may we commend the Home Secretary for her persistence, because I think that she has got it right this time? We, too, have been calling for a statutory inquiry and we very much welcome that. I welcome the greater transparency—for example, the confirmation hearings that we are getting now—and I particularly welcome the direct line to the police and the CPS which we have with this structure. However, I have one concern, and that is the terms of reference and the structure of the inquiry. The scope of the inquiry is absolutely enormous. Although the inquiry is not likely to take 50 years, it will go back 50 years and it will take many years. Now, justice delayed is justice denied, and what I am concerned about is whether the Government will liaise with Justice Goddard and try to come up with a structure that will allow periodic reports—of considerable substance—upon which the services across the country can act. If we have to wait until right at the very end, many opportunities for improving what we do will have been missed.

[Lord Bates]

My noble friend is absolutely right that we do need to get it right and the terms of reference are key. When we set up the initial independent panel, she will recall that we planned to have six-monthly statements. I thought that was a good arrangement, but one of the whole points of setting it up under the independent Inquiries Act is that the terms of reference have to be agreed with the new chairman. That will be very important, but the fact that we have a former High Court judge—a member of the judiciary with great experience of getting through complex and difficult situations and getting to the heart of the truth—should help us in that task.

Child Abuse Inquiry

Baroness Walmsley Excerpts

Thursday 22nd January 2015 Lords Chamber

[Lord Bates]

First, I pay tribute to the work that the noble Baroness has done in this important area, not least on the all-party group and its report, which was extremely helpful and informed a lot of our thinking in this area. She made a specific point about funding and pressure that groups are experiencing at present. There is no doubt that with the increased publicity more and more people are coming forward. On one level, that is to be welcomed as an opportunity for justice and to learn lessons, but on another level it puts increasing pressure on those organisations which do tremendous work in caring for and working with victims and survivors. That was one reason why my right honourable friend the Home Secretary announced an additional £7 million of funding. Some £2.85 million of this funding will be available to the organisations representing child and adult victims of sexual abuse, and there will also be a child abuse inquiry support fund of £2 million. That fund will open very shortly, and bids will be invited.

[Baroness Walmsley (LD)]

My Lords, I wholeheartedly endorse the noble Baroness’s call for more prevention work. In my view, we need a statutory inquiry. I hope that the Secretary of State will choose the correct one of the three models, and will come up with that and the right chair as soon as possible. I have two questions. My noble friend mentioned additional funding. Could he please reassure us that this funding will both be swiftly available and not be ringed round with a lot of bureaucracy? More people will undoubtedly come forward as these issues are highlighted, and the money needs to get to the groups which support them quickly and without a lot of bureaucracy. Secondly, as more allegations are made, can the Minister assure us that these will be referred swiftly to the police, and preferably to a different police force from the one within which the allegations were made?

[Lord Bates]

On the last point, of course there is nothing in the delays which we are experiencing with the inquiry which should for one moment stop the prosecution or investigation of these heinous crimes. That should not occur. We now recognise that all three options must have a statutory element, and without doubt the inquiry will have that. Regarding the funding which is available, I have mentioned some special funding. We are also working with the Department of Health and the Department for Communities and Local Government to see what additional support can be provided, particularly for those who will be invited to come forward to give evidence to the inquiry.

Child Sex Abuse Inquiry

Baroness Walmsley Excerpts

Monday 15th December 2014 Lords Chamber

[Lord Bates]

The noble Lord’s latter point is of course central to the discussion with the survivors. They want to have confidence that individuals can be compelled to give evidence and that that evidence will actually be available to them. Perhaps I may say that it is a bit unfortunate for the noble Lord to take that tone in relation to the appointments. Both the people who were appointed to the role of chair are eminently qualified to do the work, but the question mark was over whether they would command the confidence of the survivors’ groups. It became apparent that that was not the case, and that is the reason the Home Secretary is going to the lengths that she is to listen to them now.

[Baroness Walmsley (LD)]

My Lords, when consulting with potential candidates for the chair, will the Home Secretary consider the length of time that that person will be available for the inquiry? We must bear in mind the fact that the very nature of the inquiry means that various new issues probably will arise during the course of the panel’s investigations, and they will need to be given proper consideration. She is going to need someone who can be available for really quite a long time.

[Lord Bates]

That was one of the reasons why the panel was set up in its current form for the initial period. It wanted to draw on the excellent work that had been done by Ann Coffey, Alexis Jay and the NSPCC, among others, who had produced literature and evidence. We did not want the panel to reinvent the wheel but rather to get on and make sure that our institutions are sound, that victims’ voices are heard, and that we take action to ensure that these things could not happen again. The emphasis is now on speed. We want to get this done, but obviously the work must be carried out with the confidence of the survivors’ groups.

Children and the Police

Baroness Walmsley Excerpts

Monday 24th November 2014 Lords Chamber

[Lord Bates]

It is certainly the case that those under the age of 16 should not be in police accommodation overnight but put into the care of the local authority, with an appropriate adult to look after their interests. We also welcome the change made in the Crime and Courts Bill, which applies to 17 year-olds. On specific numbers, I will get those to the noble Baroness.

[Baroness Walmsley (LD)]

My Lords, will the Government revise the national crime recording standards —as recommended by the inquiry, in which I declare I took part—so that looked-after children are dealt with in exactly the same way as others when there are trivial events that would not involve the police if they took place in a school or anywhere other than a children’s home?

[Lord Bates]

My noble friend is absolutely right, and I read that section of the report with great interest because it made a sound recommendation, which is that we should avoid looked-after children in care coming into contact with, and getting engaged in, the criminal justice system at too early an age. The police need to look at the range of options that are open to them in dealing with young offenders from such backgrounds—as they are available when dealing with other offenders in the wider community.