Mental Health Bill [HL]

Debate between Lord Scriven and Baroness Bennett of Manor Castle

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am acutely aware of the hour so I will be very brief. My Amendment 63A would provide for a duty for ICBs, local health boards and local authorities to implement preventive policies for mental disorders.

I join the noble Baroness, Lady Tyler, in regretting how the debate on this crucial Lords-starter Bill has been squeezed. However, I am in a lovely position because, in responding to the group beginning with Amendment 48, the Minister essentially supported my amendment. She said that if support can be provided much earlier, mental ill-health can be prevented. That is essentially what this amendment seeks to do.

I am obviously not going to divide the House at this stage of the evening, but I have spoken over the years to so many public health professionals, consultants and directors in local authorities, and they continually express the frustration that everyone knows that investment in preventive healthcare is the way to take pressure off the NHS. Understandably, when someone turns up with an acute mental health crisis or a broken leg, we have to treat that, and that is where the resources go.

This amendment is an attempt to write into the Bill—I hope it might be revisited in the other place—the duty of prevention. And it has to be a duty. This aligns very much with the Government’s rhetoric and their approach to public health. I will not press the amendment to a vote, but I hope this can be the start of a discussion.

[Lord Scriven (LD)]

My Lords, because of the lateness of the hour I will be very brief. These Benches support the aim of the amendment in the name of the noble Baroness, Lady Bennett of Manor Castle. It is important that, throughout all this, there is an element not just of treating the acute phase of mental ill-health but trying to ensure that prevention is there within the health service and across the whole of government, national and local. We believe on these Benches that a mental health commissioner would have been really helpful for that, as they could highlight elements that could help with prevention—but the House has made its decision on that.

I have only one question for the Minister. One of the three shifts of the Government is towards prevention. How do the Government see prevention of mental ill-health fitting into that shift, not just in NHS services but, as I said, across the whole of government, including local government, to determine how they can use their resources and levers to bring about what the noble Baroness, Lady Bennett of Manor Castle, is trying to achieve?

Mental Health Bill [HL]

Debate between Lord Scriven and Baroness Bennett of Manor Castle

Report stage
Monday 31st March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I start this group on community treatment orders by thanking the Minister and her team of officials for dealing not just with this issue but with most issues in the Bill on a collaborative basis, which should be a blueprint for how Ministers should deal with people with different opinions to those of the Government. It is genuine thanks from these Benches.

I also thank my noble friend Lady Parminter for giving her lived experience of community treatment orders. In Committee, there was a huge divide in this House about whether they should continue rather than pragmatism on how we deal with the problem. My noble friend Lady Parminter focused our minds on that.

My amendment tries to deal with what I see as the major flaw of community treatment orders, whether or not we have a review of them, and that is their potentially indefinite nature. As for the way that these community treatment orders are implemented, whether they are effective or not, there seems to be a revolving door which some people find impossible to get out of. This has led to a number of issues about whether they have therapeutic benefit and whether the treatment is actually effective. There have also been huge issues to do with racial disparities in their use and the length of time that people are on a community treatment order.

Even if we agree Amendment 23, in the name of the noble Baroness, Lady Bennett, and Amendment 62, in the name of the noble Lord, Lord Kamall, to have a review of their effectiveness, something needs to be done now to ensure that the initial community treatment order is time-limited—I suggest 12 months—then if it is to be reviewed, it has to be reviewed by not just the consultant who is treating the individual but also by another GMC psychiatrist who has to agree in writing that there is therapeutic benefit for the community treatment order to continue. That review should take place every six months. That would not stop community treatment orders, but it gives an absolute, firm process, which needs to be in the Bill—not in the code of practice—to ensure that individuals who are on a community treatment order have certainty about the length of time and review. It would also require a second doctor’s written agreement about the therapeutic benefit of reviewing and continuing the treatment order.

I understand that the Minister will probably and quite rightly say that the Bill has moved forward and that there are certain elements which help with the review of treatment orders and the people being put on them. For example, the community doctor has to be consulted. However, there is a difference between being consulted and giving agreement. That is why my amendment talks about the agreement of a second doctor. Consultation in itself does not mean that community treatment orders cannot be indefinite, as they are in some cases. My amendment is practical and solves this problem. As my noble friend Lady Barker said, we tend to get legislation about the Mental Health Act once every 15 years, and we cannot wait another 15 years to deal with this anomaly.

I and others on these Benches would be supportive of a review of community treatment orders and of the evidence about whether they are effective in the grand sense. However, the practical pragmatism is that people will continue to be put on community treatment orders, that, even with the changes that the Government have put in the Bill, people would still be there indefinitely and that the second doctor’s opinion would not necessarily have to be taken into consideration if the order were to continue to ensure that there was therapeutic benefit.

I will not say much more, but I believe that my amendment is practical, needed and will get the correct balance both for service providers and for those who are on a community treatment order to deal with some of the unintended consequences we have found since they were introduced. It is a practical step to ensure that we get them right, if reviews take place. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Scriven, and to agree, in essence, with everything he said. Amendment 11 is truly important; it would immediately affect the well-being of some very vulnerable people in our community. Should the noble Lord decide to divide the House, the Green Party will support his amendment.

I will chiefly speak to my Amendment 23, which also relates to community treatment orders and calls for a statutory periodic review of them. I can see quite a few noble Lords in the House, so it is worth very briefly going back a little over what we discussed in Committee. The Joint Committee on the draft Bill concluded that CTOs should be abolished for people under Part II, the civil sections. For people under Part III, the Joint Committee recommended a statutory review of CTOs with a provision to abolish them unless the Government legislated to keep them.

My amendment does not go that far, but it starts from the point that the noble Lord, Lord Scriven, mentioned, citing the noble Baroness, Lady Barker: it is likely to be at least 15 years before legislative attention returns to the Mental Health Act. That is a very long time—especially for the health of people who are going through certain experiences. I stress that it is not my own initiative that brought this amendment forward; the organisation Mind encouraged me to do so. I will quote from a couple of people who Mind has spoken to about CTOs, because we have to consider what the actual lived experience is like. One person said:

“Being on a CTO is like being cornered … It is good that you are out of hospital but only a little better because it is so intrusive”.


Another person who had been on a CTO said that it can feel like:

“A tag that nobody can see but you know it’s around your mind”.


Throughout the debate on this Bill, we have considered getting rid of CTOs entirely. As the noble Lord, Lord Scriven, said, the noble Baroness, Lady Parminter, made the very powerful case that there may be circumstances and conditions where they are indeed appropriate. However, my amendment simply calls for a statutory review, so that we do not wait 15 years and then say, as we have been saying about so many aspects of what we are trying to fix now, “This has been terrible for so long. We really need to do something about this”.

I say to the noble Lord, Lord Kamall, that I am still planning to arrange the Trieste meeting; I am afraid I have not got there yet. Looking at community alternatives has to be the way forward. There are models around the world where that is achieved. If we were to have a review, as my amendment would require, then everything in proposed new subsection (3)—which looks at

“the impact … on people from different ethnic minority backgrounds”,

preventing readmissions and whether CTOs provide “therapeutic benefits”—would be considered within a reasonable period. We could affect and improve people’s treatments within a foreseeable period and not sentence them to another 15 years.

It is not my intention to divide the House. I very much hope that the Bill will continue to work on this, and that the arguments for including a statutory review will become evident as the Bill progresses. On that basis, I urge noble Lords, particularly the Minister, to consider that, and I echo the points that the noble Lord, Lord Scriven, made. My engagement between different stages of the Bill tends to be limited by the fact that I am juggling a great many Bills at the same time. However, I have heard reports of how the Minister has been engaging with noble Lords, and I hope that she and the department will bring an open mind to the idea that we should not sentence people to another 15 years of CTOs without a statutory review, because there have been so many questions and concerns about them. On that basis, I hope that we can move forward as the Bill progresses.

Mental Health Bill [HL]

Debate between Lord Scriven and Baroness Bennett of Manor Castle

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will be brief, but in following the noble Baroness, Lady Fox of Buckley, I have to note that I do not believe that a complaints culture is a problem in the contexts covered by this Bill. There is, perhaps, a lack of listening to patients and those affected, and a lack of action rather than a problem with listening to complaints. In that context, I commend the noble Earl, Lord Howe, who cited extensive testimony from Blooming Change. One thing that struck me when looking back over the previous days of Committee was that it would have been good to hear, perhaps even more than we did, direct testimony and the voices of those who are experts by experience. The phrase “nothing about us without us” really stuck in my mind and it is important that we keep that in mind throughout Committee. Again in response to the noble Baroness, Lady Fox, I think it is important not to seek to downplay the mental health crisis that we are seeing across our society. There is a huge shortage of services meeting people’s very clear and acute needs, and acute needs are what we are largely covering in this Bill.

I attached my name to Amendments 50 and 51 tabled by the noble Baroness, Lady Tyler of Enfield, which address non-drug-based interventions. In essence, I agree with everything the noble Baroness said; I just want to stress her points. When we talk about non-drug-based therapies, we are tempted to think we mean talking therapies and psychological therapies. Those are tremendously important, but this is where we also need to take the broader public health context. I mentioned on an earlier group digital treatments such as Avatar for those who hear voices. They are the kind of new, different ways of looking at things that people may not have been trained in, and it is important that they are considered. I also talked a fair bit about the gut-brain axis and dietary interventions such as green prescribing, in which we have seen great advances across the medical fields in recent years—exposure to green spaces and the chance to get exercise in green spaces. That makes me think that we need to think about facilities and how we make sure there is provision within them, which, in some ways, this amendment would help to cover.

As a noble Lord said earlier, we are talking about making sure we are treating the whole person and not a condition with a drug. I thought the contribution from the noble Lord, Lord Crisp, was very important, as is his amendment. I am not sure whether it needs to be in the Bill, but it would be interesting to have the Minister’s comments on making sure that consideration of withdrawal symptoms is part of prescribing practice. That is absolutely key and central. I note a report from the universities of Berlin and Cologne out last year which showed that the second-most prescribed antidepressant in the UK, venlafaxine, also has the second-highest rate of problem withdrawal symptoms. We need to make sure that is carefully considered pre-stage—before we get to the withdrawal stage, are we going to create that problem? I do not know whether it could be incorporated in the amendment, but it is something to think about anyway.

The other amendment—slightly oddly—in this group in my name is Amendment 154, which again, as on a previous group, I put down at the request of the Law Society. It is about mental health tribunal pilots for challenges against treatment decisions. To some degree, we have already discussed this in the earlier group, but I would be interested in whether the Minister has any comment on the amendment. I think that it is fairly self-explanatory, so I will not go through it further.

[Lord Scriven (LD)]

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

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

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

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


New Section 62ZB(3) then says:

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


That is quite a wide Henry VIII power.

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

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

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

The regulations would have to be written so that

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


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

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

Mental Health Bill [HL]

Debate between Lord Scriven and Baroness Bennett of Manor Castle

Committee stage
Monday 20th January 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I will speak to my Amendment 44 in this group. Having listened at Second Reading, I was minded to table this amendment based on my noble friend Lady Parminter’s speech giving her real-life experience of the need for community treatment orders. Both the amendments and the Second Reading debate show the wide range of views on community treatment orders, ranging from some who feel they are not needed to those who feel that they are needed and those who feel a review is needed. However, something in the present system is not quite right, so, again, this is a probing amendment to try to understand where the Government’s thinking is.

Given that, even if a review were to take place, CTOs would still exist, my amendment would in principle provide an initial 12-month period for a community treatment order with some very clear provisions. If we are going to have these provisions, they need to be on the face of the Bill rather than in the code of practice—even if they are not the provisions in my amendment. I suggest that the initial order is for 12 months and that, before the order is made, the patient has to be consulted, as well as

“the patient’s nominated persons, and any relevant mental health care professional involved in the patient’s treatment or care planning”.

Importantly, the CTO has to be in line with the necessity for therapeutic benefit, and it has to involve consulting a second medical professional. I understand that the wording of the amendment may not be correct, because a particular type of medical professional, a psychiatrist, would need to be consulted with regards to the community treatment order and whether it will have therapeutic benefit.

I suggest that, at the end of the 12 months, if the clinician feels that an extension is needed, a review takes place, which goes through the process that I have just outlined—to ensure that there is therapeutic benefit, and a second medical practitioner is consulted—and that it is then reviewed after a maximum of six months. That is absolutely right in terms of trying to ensure that the therapeutic benefit is central and a second medical opinion is provided, particularly at the review stage, to ensure that there is a need for the CTO. The reason for this is the wide range of views on CTOs but also the statistics regarding the racial discrimination that there appears to be around their use, which is well documented and well evidenced.

I look forward to the Minister trying to explain the Government’s thinking on community treatment orders and how they need to change. Clearly, something is not quite right in the implementation, the length of time that people are on CTOs and whether CTOs have therapeutic benefit for many of those who are on them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak to my Amendments 67 and 86. I think that this is the right place—I apologise for my earlier confusion; I had a problem with the list.

I will start with Amendment 86 because it follows on from the very important contribution from the noble Lord, Lord Scriven. I should preface this by saying that I cannot claim that what I will say originates from me; it is based on the Law Society briefing, which many noble Lords will have received. I saw that nobody else had picked up this amendment, but I thought that it was so important that it should be picked up. As the explanatory statement says:

“The amendment would keep the safeguard of an automatic referral to the tribunal when a patient’s Community Treatment Order is revoked which results in them being detained in a mental health hospital”.


As the noble Lord, Lord Scriven, said, a range of views on CTOs has been expressed in these debates, but the general direction of travel is certainly not to remove safeguards and we should be keeping the safeguards that already apply. I will not claim great expertise on this, but it seemed to me that this is an important issue that we need to discuss in Committee.

Amendment 67 is somewhat different but really important. Later on, we will discuss very important issues, which I have signed amendments about, concerning minoritised communities being potentially overtargeted or subjected more to mental health provisions. This amendment picks up something that no one else has picked up, which is economic and social disparities relating to community treatment orders. I went looking for some statistics on CTOs in disadvantaged communities, but I was not able to split them out; perhaps the Minister has them. However, the charity Rethink Mental Illness talks about the burning injustice of how Mental Health Act detention rates are three and a half times higher in the most deprived areas of England compared with the least deprived. Looking at those figures, I can only see that CTOs must be something very similar to that.

We need to ask a question here, and we need the stats and that is why we should have the reporting. It is probably unclear whether we have a psychiatrisation of poverty, so that when people are living in conditions of poverty, that is seen as some form of mental illness in itself, or a discriminatory application of the law against people living in conditions of poverty. The third possibility is that poverty is making people ill. Either way, we should know about these facts. They should be regularly reported, and we should be able to examine them and check on them.

I was just looking at an issue that will be raised later about debt and mental health, on which I will point noble Lords who have not seen it to a really interesting POSTnote that the Parliamentary Office of Science and Technology produced on that subject last year. It suggests a two-way relationship between financial and mental well-being. People with mental health issues are three or more times more likely to have problem debt.

Some interesting recent research in a study published in Public Health indicates how social conditions are related to mental health. “Sandwich carers” in the UK —the 1.3 million people who have responsibility for caring for children and older parents—have experienced a significant decline in mental health.

These issues around social and economic disparities and the use of community treatment orders are embedded in the community, and it is crucial to see what is happening. Amendment 67 aims to ensure that we get regular reports relating to community treatment orders.