Mental Health Bill [HL]

Baroness Whitaker Excerpts

Tuesday 14th January 2025 Lords Chamber

There is a strong case for giving these principles statutory force to ensure that the Bill, when it becomes law, can provide a compass to decision-making under mental health law and give people more power to challenge treatments that fall short of these principles. I beg to move.

[Baroness Whitaker (Lab)]

My Lords, I first apologise for not having been able to speak at Second Reading; I would have welcomed the Bill. In speaking to Amendments 2, 49, 52, 60, 112, 114, 118, 119 and 126 in my name, I declare my interests as honorary vice president of the Royal College of Speech and Language Therapists, as a former member of the Tavistock and Portman NHS Foundation Trust board, as a patron of the British Stammering Association, and as a stammerer myself. I thank the Royal College for its briefing and my noble friend Lord Bradley and the noble Lord, Lord Patel, for their support. I also warmly support Amendment 1 in the name of the noble Baroness, Lady Tyler. I shall add amendments consistent with it in a later group.

My amendments, which are supported by 49 professional, charitable and training organisations, are all based on the premise that speech and communication difficulties are an insufficiently recognised component of a very great number of mental ill-health symptoms and that professional speech and language therapy could—and should—enable more successful treatment. One study found that 80% of people accessing mental health services had a difficulty with language and 60% with communication or discourse. Especially in the case of children and young people, those with a mental health disorder report having five times more speech or language problems than those without. One study found that 81% of children with social, emotional and mental health needs had significant unidentified language deficits.

One of the problems with the lack of specialised staff to help such children is the demoralisation or challenging behaviour that comes from frustration with unmet communication needs, quite apart from the impediments to treatment. I could quote many examples of this, as well as some success stories—for instance, where speech and language therapy effected a sizeable reduction in the use of restraint in a secure children’s home, or enabled psychological treatment to work and give the inestimable benefit of the ability to cope. I must emphasise that most of us take the ability to communicate for granted, perhaps without realising how essential it is to our lives. It is when it is lacking that you notice what it means. I am therefore sure that it must underpin the principles of this excellent Bill.

Amendment 2 does that. Without a rider of that kind to the principles, we will not have effective treatment in very many cases of acute distress and challenging behaviour. Amendment 49 puts the speech and language therapist squarely in the frame of responsible clinician, so that where communication difficulties are the key problem, that can be tackled. Amendment 52 does the same for treatment decisions and Amendment 60 for care and treatment plans.

Amendment 112 provides the same safeguard for detained patients who need to complain and Amendment 114 is to make sure that patients can understand their information on discharge, which is surely essential. Amendments 118, 119 and 126 have a similar function: to make sure that advance choice documents are properly understood and properly made.

[Lord Bradley (Lab)]

My Lords, I rise to speak in support of Amendment 2, to which I have added my name, but first I declare my interests as listed in the register, especially as honorary vice-president of the Royal College of Speech and Language Therapists and as an honorary fellow of the same organisation. I am able to speak briefly as a result of the excellent explanation of these amendments by my noble friend Lady Whitaker, which I am pleased to support.

As we have heard, the lead amendment would place a requirement in the statement of principles to specify in the table the communication needs of the individual and recognise the disability, difficulty or difference to ensure they will be identified and supported. This requirement then flows throughout the Bill—as evidenced by the number of amendments to which I have also added my name—ensuring a thread of consistency for this vital area of support. These include, as we have heard, Amendments 49, 60, 112, 118 and 126, but I will not speak specifically to each of those and test the patience of the Committee.

The importance of Amendment 2 is clearly laid out in the excellent briefing, as we have heard, prepared by the Royal College of Speech and Language Therapists and endorsed by at least 46 related organisations representing this crucial area of work and service.

As we know, communication is fundamental and foundational to human life. It is central to how we express ourselves, how we understand others and how we interact. It is also fundamental and foundational to the aims of this Bill. It underpins the principles to inform decisions and is key to the matters to be addressed. Crucially, it ensures the individual is properly involved in the decisions taken as a consequence of this legislation. As we know, many people accessing mental health services have some form of communication disability, difficulty or difference. This can affect whether they are able to make themselves understood, understand what is being said to them, and how they interact with people. Left unidentified and unsupported, it can subject people to a range of negative outcomes, including inaccessible referrals, assessments, treatment and care and, potentially, unnecessary detentions and detentions longer than necessary.

I first recognised this issue when I undertook my independent report for the then Government, published way back in 2009, about people with mental health problems or learning disabilities in the criminal justice system. At that time, I identified appropriate adults as a key group to support people with communication issues and recommended that they should receive specific training to ensure the most effective support. They still play an invaluable part in such communication. I also recommended the establishment of liaison and diversion services, and I am pleased that in the subsequent years they have been rolled out across the country and we now have 100% coverage for that service.

These liaison diversion teams, placed in police stations and the courts, identify, assess and support people with complex needs, including mental health problems, to try to divert them away from the criminal justice system and support them along the criminal justice pathway. I recognised during this rollout that certain key additional services should be connected to the teams, including speech and language therapists, to enhance the support required for these people with communication difficulties in a variety of settings and circumstances. As the speech and language therapists who I have met over the years themselves identified, these many situations and settings include significant unmet communication needs among individuals on mental health wards, challenging behaviour relating to communication needs, lack of staff knowledge and skills in relation to communication needs in people with mental health conditions, and many more.

Although it is welcome that the Bill’s Explanatory Notes highlight that a care and treatment plan

“may also contain other information, for example, how the patient’s communication needs will be met”,

clearly this is not sufficient. The Bill must therefore be strengthened to make it explicit both that communication is central to the Bill’s aims and that

“communication disability, difficulty, or difference”

must be identified and supported. This would help to ensure that people receive the best possible treatment and care to support their recovery, including through the necessary reasonable adjustments that should be made. It would also help to reduce the risk to them, including of their being unnecessarily detained, and to assure the wider public. These issues must also be fully covered in the code of practice. I hope therefore that the Government will recognise the importance of such communication being in the Bill and look forward to the Minister’s response on these points.

--- Later in debate ---

I agree that people with communication needs are particularly at risk of poor experiences with mental health services, and they must benefit fully and equally from these reforms. So the statement of principles must comply with the Equality Act 2010, including the duty to advance the equality of opportunity between people who share a protected characteristic and those who do not. All those carrying out functions under the Mental Health Act must adhere to the Equality Act. Therefore, I suggest that the aims of the amendment are covered by existing legislative requirements, although I absolutely take on board the intent of the amendment.

[Baroness Whitaker (Lab)]

I apologise for interrupting my noble friend’s eloquence, but it is not the case that speech, language and communication difficulties are a protected characteristic. Can she absolutely assure us that they do come under the Equality Act?