Mental Health: Unregulated Treatment

Debate between Lord Bethell and Lord Marks of Henley-on-Thames

Monday 2nd March 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I join others in thanking the noble Baroness, Lady Jolly, for raising this important issue. Before I make my formal comments, I should like to recognise the clear and strong feelings expressed on this issue in the House today, which one cannot help but feel moved by. On a personal note, perhaps I may share that I have myself lost a friend to manipulative individuals. It was a friendship that I valued very much, so I can feel some of the hurt that Members have expressed about that sensation of losing loved ones in such difficult circumstances.

I shall move on to the more formal comments about the Government’s approach to mental health services. I want to reassure the House that this Government absolutely put the modernisation of mental health services at the heart of our commitment to the health of the British people. The message on mental health has come up again and again in the Chamber and I have stood at this Dispatch Box many times to hear it. I want to reassure noble Lords that that message is 100% understood.

I need hardly remind some of those here that spending on NHS mental health services has already risen under this Government from £10.9 billion in 2015-16 to £12.5 billion in 2018, and that under the mental health investment standard, for the first time clinical commissioning groups are increasing the amount spent on mental health services by at least the amount of their overall budgets. The noble Baroness, Lady Jolly, asked for clarification of the role of the NHS. Let me reassure her that the NHS Long Term Plan also explains that there will be a comprehensive expansion of mental health services, giving 380,000 more adults access to psychological therapies, which represents a huge expansion in the Government’s investment in mental health.

However, I recognise that as well as expanding the size of mental health services provision, the Government need to understand the importance of ensuring the quality of the services that are delivered. We agree absolutely that service users should be able to expect high-quality psychological therapies that bring about positive impacts on mental health and recovery. The noble Baroness, Lady Jolly, asked specifically what progress has been made on mental health goals in the NHS Long Term Plan. I reassure her that 12 pilot sites have already received £70 million of funding for new specialist services and that that is the first step in a £975 million investment as part of the long-term plan to transform community mental health services.

The Government are committed to improving access to psychological therapies through the Improving Access to Psychological Therapies programme. Each year, more than 1 million people access IAPT services and the Government are committed to expanding them massively so that by 2023, 1.9 million people will be able to access those services. I can reassure the noble Baroness, Lady Jolly, that waiting times, which she asked about, for access to IAPT services have also improved to the point that 98% of patients seeking a first referral get that referral within 16 weeks, against a target of 95%.

The IAPT service provides a gold standard, highly professional service, routinely monitored on outcomes achieved, and the professionals providing these services undergo regular outcomes-focused supervision. These principles ensure that therapies are delivered by fully trained and accredited practitioners with appropriate skills in providing individualised support to people with mental health problems. The intensity and duration of each IAPT therapy is designed to optimise patient outcomes and, as the noble Lord, Lord Alderdice, alluded to, all IAPT clinicians should have completed an IAPT-accredited training programme with nationally agreed curricula aligned to NICE guidelines. High-intensity therapists in IAPT services should be accredited by the relevant professional bodies and all IAPT clinicians should be supervised weekly by appropriately trained supervisors in the manner rightly described by the noble Baroness, Lady Bryan.

None the less, we are aware of concerns regarding the treatments that some people receive from some services outside the provision of government services. My noble friend Lord Astor spoke very movingly about healthy and unhealthy therapies, and in this matter he is entirely right. The anecdotes recounted by noble Lords, including the story from the noble Lord, Lord Macpherson, about the ACCPH, are clearly disturbing. We acknowledge that some private individuals are delivering therapies that may be putting patients’ safety at risk. I have read the Unsafe Spaces blog and the contributors’ concerns. I watched the BBC documentary that noble Lords referred to. Who can read these stories without feeling a sense of sadness? I think of my own lost friend.

Let us be clear. The Government are committed to a proportionate system of safeguards for the professionals who work in the health and care system. I join the noble Baroness, Lady Thornton, in paying tribute to the Professional Standards Authority and its important letter that was circulated among noble Lords, and describing its recommendations as interesting.

Where practitioners pose a direct risk of harm to the health and well-being of patients, legal avenues will and must be explored. The noble Baroness, Lady Jolly, described many of the legal remedies. I assure the noble Lord, Lord Astor of Hever, that coercive or controlling behaviour has been an offence since 2015. The Government remain committed to supporting the police to bring offenders to justice and to ensuring that victims have the support they need to rebuild their lives.

However, more rules are not always the answer to every problem. While statutory regulation is sometimes necessary where significant risks to users of services cannot be mitigated in other ways, it is not always the most proportionate or effective means of assuring the safe and effective care of service users.

We do not take this position without careful thought. We have previously considered the introduction of statutory regulation of counsellors and psychotherapists. We have considered various Private Members’ Bills, including from the noble Lord, Lord Alderdice. None the less—in reply to the noble Lord, Lord Macpherson, and others who have asked the question straight—I will give a straight answer: we currently have no plans to do this. This may come as disappointing news but, as I am sure the noble Baroness will appreciate, there is a wide range of mental and physical therapies on offer in modern Britain and an important focus on personalised approaches to mental health care and treatment. What might suit one person today might be snake oil to another.

The noble Lord, Lord Giddens, asked about health apps. The NHS app library contains a number of mental health apps, which undergo a number of quality checks before they are allowed on the website. Some apps, such as Chill Panda and Cove, are currently being tested in the NHS.

The regulation of these services is complex. Issues that must be considered carefully include the impact of any regulation on delivery, quality, ensuring that we do not stifle innovation, ensuring that we do not discourage individuals from working in mental health and the principle of consumer choice. However, I assure the noble Baroness and other noble Lords who have spoken in this debate that the Government remain committed to addressing the important recommendations of the—

[Lord Marks of Henley-on-Thames]

My Lords, I am sorry to interrupt, but I know the Minister has a few minutes left. There was mention of the Serious Crime Act. Does the Minister recognise that Act’s limitation—which the noble Lord, Lord Astor, and I mentioned—to the domestic context? Will he do something about it? Will he also confirm agreement to a meeting to discuss the future of regulation?

[Lord Bethell]

My Lords, I was just reaching the key segment of my speech. With kind permission, I will finish the speech, since time is of the essence.

I assure the noble Baroness and other noble Lords who have spoken in this debate that the Government remain committed to addressing the recommendation in the Five Year Forward View for Mental Health to consider the regulation of psychological therapy services, including their inspection. The department is currently considering issues around regulation of this area. I assure the Chamber that we will carefully consider the potential impact on services and the people who use them. I will endeavour to update the House on progress as it happens.

I assure in particular the noble Baronesses, Lady Barker and Lady Jolly, that the Government are committed to ending the practice of conversion therapy. The 2018 LGBT Action Plan clearly outlined that commitment. The Government Equalities Office is currently working on this.

In the meantime, I extend my thanks to the noble Baroness for securing this debate and to all noble Peers here today. It is an important debate. The noble Lord, Lord Alderdice, said there had been no progress in the last 20 years. We now have more than 50,000 talking service professionals on the registers, accredited by the Professional Standards Authority. The department is currently considering the regulation of psychological therapy services, as per the recommendations in the Five Year Forward View for Mental Health. This is progress. The department will set out further details of its considerations on these matters later in the year and Ministers will be happy to update the House as this work develops.

Terrorist Offenders (Restriction of Early Release) Bill

Debate between Lord Bethell and Lord Marks of Henley-on-Thames

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Monday 24th February 2020 Lords Chamber

[Lord Marks of Henley-on-Thames]

My Lords, my regret amendment does not ask the House to reject the Bill. If the noble Baroness, Lady Buscombe, or anyone else understood it as so doing, that was not intended. I fully agree with the many noble Lords who said that the Parole Board should carry out a safety assessment before terrorist prisoners are released. I agree with the Minister that that is sensible and proportionate.

Let me briefly take up the point made by the noble Baroness, Lady Meacher, to which I do not accept that the Minister had a satisfactory answer. If the Bill were to achieve Parole Board assessment prior to release but did not increase the minimum time in custody from half to two-thirds of the original sentence, the breathing space for which the Minister asked would be achieved. As soon as the Parole Board had decided that release was safe, release would follow.

I also agree that automatic release is not appropriate in the case of terrorist prisoners. My amendment is confined to expressing some regrets that the Bill will do nothing to improve deradicalisation and rehabilitation, that Ian Acheson’s recommendations are hardly being implemented, that without further measures we risk radicalisation of non-terrorists in custody and that the Bill may cut down the time for supervision of some lower-grade terrorist offenders, who will spend more time in custody and less under supervision, thereby losing the benefits of significant periods of supervision.

On the Bill’s retrospective effect, I agreed with the noble Lord, Lord Harris of Haringey, except when he described his reasoning as “simplistic”. I also agreed with the noble and learned Lords, Lord Falconer and Lord Garnier, the noble Lord, Lord Carlile, and other noble Lords that, whatever the position under Article 7, where a six-year sentence meant three years in custody under the 2003 Act when passed but after this Bill will mean four years in custody, it is mere sophistry to assert that this is not a retrospective change. Similarly, it is mere sophistry to draw legalistic distinctions between a presumption against retrospectivity and a principle against retrospectivity and mere sophistry to draw a legalistic distinction between the sentence passed and the time to be spent in custody. I agree with the noble and learned Lord, Lord Garnier, that such a retrospective change will rightly seem unjust and unfair to serving prisoners, their families and those around them and may fuel further radicalisation.

For the reasons explained by the noble Lords, Lord Anderson and Lord Carlile, the noble and learned Lord, Lord Garnier, my noble friend Lord Beith and others, I will support the amendments to be moved in Committee to introduce pre-release assessment by the Parole Board at the halfway point for terrorist prisoners already serving sentences with the prospect of release, if the Parole Board considers their release is safe. That said, I do not intend to press my amendment to the vote and I therefore beg leave to withdraw it.

Amendment withdrawn.

Bill read a second time and committed to a Committee of the Whole House.

[Lord Bethell]

My Lords, the Legislation Office is open for a further 30 minutes for amendments to be tabled for Committee. If no further amendments have been tabled, Committee will start immediately after the Question for Short Debate in the name of the noble Lord, Lord Lucas. If further amendments are tabled, we may need to adjourn during pleasure, with timings updated via the annunciator.