Mental Health Bill [ Lords ] (Sixth sitting)

Debate between Anna Dixon and Gregory Stafford

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Gregory Stafford]

I rise to support clauses 36 to 40. Clause 36 addresses a legal gap identified in case law, which held that the Mental Health Act 1983 did not permit the imposition of conditions amounting to a deprivation of liberty for conditionally discharged patients. The clause provides a clear statutory basis for such conditions, but only under strict safeguards. It aims to balance public protection with patient rights, ensuring that DoL conditions are used only when absolutely necessary and proportionate. This is a positive step, because it clarifies the legal authority, resolving any uncertainty, following court rulings, about the legality of DoL conditions in conditional discharges. It protects public safety by ensuring that high-risk patients can be managed safely in the community, under appropriate restrictions. It includes safeguards that require DoL conditions to be justified and proportionate, with a focus on patient welfare, and it aligns with notable human rights law, especially the definitions and principles from the Mental Capacity Act and the relevant case law.

However, I have a couple of questions for the Minister. My view is that there is potential for overuse. Without robust oversight, there is a risk that DoL conditions could be used too readily. What safeguards is the Minister putting in place to ensure that that does not happen? There is clearly an impact on patient liberty, and we need to get the balance right. Even with the safeguards, these conditions significantly restrict individual freedom and therefore must be carefully monitored. How is the Minister ensuring that that will happen? In relation to the legal thresholds, determining whether conditions meet the legal test may require detailed clinical and legal assessment. We have talked about the practical implications of this Act on numerous occasions. I again ask the Minister whether he is certain that we have the relevant clinical and legal assessors out there to ensure that we can push that forward.

Clause 37, entitled “Transfers of prisoners and others to hospital: conditions”, will update the legal framework for transferring individuals from prison or immigration detention to hospital under the Mental Health Act. The previous wording of the Act required that treatment be “available”, but did not specify that it must be appropriate for the individual’s condition. This clause will align the criteria with more modern clinical standards and broader reforms in the Bill, which emphasise person-centred care and treatment suitability. It will also ensure that immigration detainees are clearly included in the scope of these provisions. Again, it is positive, because it updates and consolidates the list of immigration-related detention powers covered by the Act. It supports human rights compliance, because it aligns with principles of lawful and proportionate deprivation of liberty under article 5 of the European convention on human rights; it brings the Act in line with the current clinical and legal terminology; and, most importantly, it ensures that transfers are made only when appropriate treatment—not just any treatment—is available.

I have just a couple of questions for the Minister on this clause. I see potential for disputes. Determining what constitutes appropriate treatment may lead to disagreements between clinicians and authorities. What are the Minister’s thoughts on those potential disagreements? There are also some resource implications. It may increase demand for secure hospital beds if more transfers are approved under the revised criteria. I would welcome any thoughts from the Minister on how to ensure that we have the right number of secure hospital beds, not just as a totality, but in the specific regions and areas where people may be being detained.

Clause 38 is also about the transfer of prisoners and others to hospital, but specifically about time limits. It responds to a long-standing concern about delays in transferring prisoners and immigration detainees to hospital for mental health treatment. Under the current system, there is no statutory time limit, and individuals can wait weeks or months in prison, despite being assessed as needing urgent psychiatric care. That has been criticised by mental health professionals, legal advocates and human rights bodies. The clause will introduce a legal framework for setting and enforcing time limits, aligning with the Bill’s broader goals, which I think we all agree with, of improving patient rights and dignity and timely access to care. Again, I support the clause, because it will reduce delays. It will help to ensure that mentally unwell detainees are transferred to appropriate care settings without unnecessary delay, and will introduce clear expectations and accountability for decision making. It enables some flexibility, I think, because it allows for tailored regulations, to accommodate different case types and operational realities.

Again, however, I have some questions. I think there will be some implementation challenges. Services may struggle to meet the deadlines without sufficient resources —an issue that I mentioned in relation to the previous clause. Also, time limits may be difficult to apply in complex or borderline cases without clear guidance. Does the Minister see a need for explicit guidance in the code of conduct, or in some other form, to ensure that the risk of a rigid application does not make things more complicated or, more especially, mean that a potential patient is sent to the wrong care simply because we are focusing on the time rather than the appropriateness of the care? Of course, I would welcome his thoughts on how any new tracking systems and co-ordination between prisons, hospitals and the Ministry of Justice might work in this case.

Finally, I will briefly touch on clause 39. This is a technical update regarding the term “remand centre”, because that is no longer used in law or in practice; instead, young people are remanded to youth detention accommodation. Given that the clause is purely technical, I support it.

[Anna Dixon]

It is a pleasure to serve under your chairship, Mrs Harris. I will briefly speak in support of clauses 36 to 40. These clauses reflect the principle of least restriction, albeit for people who are subject to part III, and who are therefore subject to the deprivation of liberty conditions. It is really important that there are frameworks around conditional discharge, and these clauses will do a lot to bring it in line with best practice, and to put the limit set out in the best practice guidelines on a statutory footing to ensure that there is a 28-day transfer. To be successful, that will require multidisciplinary working between the health and justice systems. With that in mind, will the Minister give an assurance that he is confident that the 28-day limit can be met? If there is already data on how many transfers are made within that time limit, in line with best practice guidelines, that would give some assurance that the new statutory time limit is likely to be met.

I am pleased to see that the time limit should be breached only in exceptional circumstances, and that the Bill specifies that a shortage of hospital beds or staff does not constitute exceptional circumstances. It is really important that that is not used as a reason not to transfer or discharge people later than the 28-day limit. Some of the discharge test rests not only on whether there is a risk of harm to another person, but on a public test. Can the Minister clarify how those two tests will work in tandem? Is that already being done in practice?

Finally, I note that the evidence that we have received from the Care Quality Commission says that it welcomes closing the legal gap following the High Court ruling, as set out in the explanatory notes. However, the CQC believes that supervised discharge should be used only “when strictly necessary”, and I know that there are ongoing discussions between the Department’s officials and the Care Quality Commission. Can the Minister give an update on those discussions and clarify what role, if any, the CQC will play in the oversight of these measures?

As the hon. Member for Farnham and Bordon said, clauses 67 to 70 bring the Bill in line with youth justice practices and terminology, and with immigration policy. It is important that we take the opportunity to make sure that the Bill is fully up to date and in line with other pieces of legislation, so I support the clauses.

Mental Health Bill [ Lords ] (Second sitting)

Debate between Anna Dixon and Gregory Stafford

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Gregory Stafford]

I entirely agree with my hon. Friend. To touch on his point about social media, it is a very useful tool, but is deeply pervasive and can cause the bullying, harassment and mental health issues that he describes. As far as I can tell, the risk factors in amendment 47 would not cover something like that unless it was part of something else—for example, part of domestic abuse, armed conflict and so on.

[Anna Dixon]

This discussion of the list of risk factors throws up a concern for me: one of the risk factors that has been facing families and other constituents of mine in Shipley for some years is the inability to get appropriate support for their children from children’s social care, for example, because there are very long waiting times for child and adolescent mental health services. Even when people have EHCPs, they are often not fulfilled. Does the hon. Gentleman recognise that we need to address special educational needs and disabilities and children’s social care and put those things in place, as the Government are doing? Children with autism and learning disabilities will remain at high risk of much more complex mental health needs if they do not get the support they need at an early stage.

[Gregory Stafford]

Once again, the hon. Lady tempts me to make a party political point, but I shall resist. On her general point, there are factors, such as the ones she described, that would not necessarily fall within the list in amendment 47. [Interruption.]

--- Later in debate ---

[Gregory Stafford]

I accept that we should aim for the pinnacle and the best. What I was trying to say was that because the amendments restrict us, rather than giving us the space to, hopefully, reach the pinnacle, or to explore other options if we cannot, they could have unintended consequences if we cannot reach that pinnacle.

[Anna Dixon]

rose—

--- Later in debate ---

[Gregory Stafford]

I am doing my best—I will get it right by week three, I promise.

New clause 24 would allow people who have attended or been brought to hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act. As other Members have mentioned, section 5(1) of the Mental Health Act allows for the detention of individuals who are already in-patients. However, there has been ambiguity about whether that applies to individuals who are on hospital grounds but not yet formally admitted; for example, those who arrive voluntarily or are being brought in during a crisis. New clause 24 seeks to close that gap by explicitly allowing applications for detention to be made in such circumstances, ensuring that a timely intervention can occur when necessary for safety or treatment, according to my hon. Friends the Members for Solihull West and Shirley and for Runnymede and Weybridge.

I listened carefully to my hon. Friends on the benefits of the new clause, and I accept some of them. However, I have some concerns about deterring people from turning up to a hospital setting, either for some other treatment or to visit friends or relations. I am worried that people would be concerned that they would be forcibly sectioned or detained without their consent by just turning up. There is a real risk of overreach in new clause 24. If we go back to the point about autonomy, people need to have assurance about when and where they will potentially be detained when they seek voluntary help.

The line between voluntary attendance and involuntary detention is the nub of the new clause. While I accept the arguments that have been made by my two hon. Friends, I am not thus far convinced that the balance in the clause is correct, but I am hopeful that the Minister can give some clarity.

[Anna Dixon]

I have a great deal of respect for the hon. Member for Runnymede and Weybridge. I have worked with him on some aspects of the Terminally Ill Adults (End of Life) Bill; he brings great expertise as a psychiatrist, and an understanding of the Mental Capacity Act that is perhaps greater than mine and that of some Members of the Opposition. However, even though I respect the hon. Member for Runnymede and Weybridge, does the hon. Member for Farnham and Bordon recognise that we need to ensure compatibility between the Mental Capacity Act and the Bill before us? I hope the Minister will be able to assure us that the legal checks have been done and that the proposals before us are compatible. Given that pre-legislative scrutiny was carried out under the previous Government, I am sure that process fully got to the bottom of these issues, and I therefore hope that we can move on.

Mental Health Bill [ Lords ] (First sitting)

Debate between Anna Dixon and Gregory Stafford

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Gregory Stafford]

I thank the hon. Member for her helpful intervention. If that is correct, I will draw my comments on that point to a close.

Amendment 6 concerns CETR frequency. It seeks to change the timetabling of these reviews. The same issues, both positive and negative, run through it as in amendment 3.

Amendment 7 would strengthen the legal obligation on integrated care boards and local authorities by requiring them to implement recommendations from the care, education and treatment reviews rather than merely considering them. That would ensure that review outcomes lead to concrete action and improved care. I do not think that anyone in the Committee could possibly disagree with that point. It would lead to greater accountability and would ensure that CETR recommendations are not ignored or delayed. That would clearly improve outcomes, because it would increase the likelihood that patients receive timely and appropriate care.

The amendment would also introduce stronger legal clarity. By removing “must have regard to” and replacing it with

“have a duty to carry out”,

it would remove ambiguity around the responsibilities of the ICBs and local authorities, supporting the rights-based care and the principles of transparency and enforceability in service provision that we all support.

I hope that the hon. Members for Winchester and for Guildford will be able to clarify the problem of resource pressures, which applies to all these amendments. Local authorities and ICBs may struggle to implement all the recommendations due to funding or capacity constraints. What would be the legal sanction for ICBs and local authorities if, through no “fault” of their own—although one might argue that they should have the necessary resources in place—they genuinely do not have the resources to implement all the recommendations? I would hope that such a sanction did not put them into further financial difficulty.

The reduction in flexibility concerns me. It may limit professional discretion in cases in which recommendations are impractical or outdated. It may require new systems for monitoring and enforcement, and if recommendations are not implemented it could increase the likelihood of legal challenges.

[Anna Dixon]

The hon. Member is going into some detail on these amendments. There is a duty where EHCPs are in place. Local authorities have had their funding cut over many years, so they have found it difficult to meet their EHCP obligations for the many children with SEND needs. Is there not a similar risk that the amendments will put duties on local authorities that they will not be able to meet unless they have sufficient resources? There must be some flexibility as well as duty on local authorities and the NHS to balance their duties and responsibilities with resources.