Mental Health Bill [ Lords ] (Fourth sitting)

Aphra Brandreth Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Gregory Stafford]

I will keep my remarks relatively brief. As my hon. Friend the Member for Hinckley and Bosworth has pointed out, Members on this side of the House entirely support clause 8, mainly because of the change towards a therapeutic focus, which ensures that all compulsory treatment must have a clear clinical benefit. The clause is much more patient-centred; it gives legal clarity and stronger safeguards than currently exist in the law.

I will also touch briefly on amendments 44 and 45, which my hon. Friend the shadow Minister tabled. The key point about amendment 44 is the promotion of the therapeutic environment, which is absolutely key to this. It aligns with the best practice in mental health care and supports recovery-orientated approaches.

The key point about amendment 45 is the reinforcement of the compassionate, person-centred care that we are all trying to achieve. It ensures that responses to symptoms or behaviours are not punitive but supportive, and complements amendment 44 by applying the same principle to clinical interpretation of patient behaviours, which ultimately will encourage understanding of trauma-related behaviours, reduce risks of re-traumatisation and promote the psychological safety in treatment settings.

I entirely support the view expressed by the hon. Member for Thurrock, my colleague on the Health Committee, that a requirement to consider other trauma factors could be added to the Bill, either now or at a future point. I would be interested to hear the Minister’s thoughts on that subject.

I will also touch briefly on amendment 12, which was tabled by the Liberal Democrats, on treatment centres. Like my hon. Friend the shadow Minister, I support the overall context of what the amendment tries to achieve, but I have some concerns about how clinical decisions might be complicated if disagreements arise over the suitability of a treatment environment; and again, additional resources might be required to ensure that appropriate settings are available and accessible. When the hon. Member for Winchester winds up for the Liberal Democrats on that amendment, I will be interested to see whether he can assuage my concerns in that regard.

Finally, we support clause 9. It brings the consistency that we want. The alignment, between the treatment standard for prisoners that would be used for non-prisoner patients, adds clarity. Again, it is rights-based, and I think it will reduce the possibility of misuse, thereby helping to prevent inappropriate or unnecessary hospital transfers.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers.

I rise to speak in support of amendments 44 and 45, which have been tabled by my hon. Friend the shadow Minister. These amendments seek to put patients at the centre of the Bill by promoting a safe therapeutic environment and recovery from any childhood trauma.

Clause 8 provides for a new definition of “appropriate medical treatment”, which requires that treatment to have

“a reasonable prospect of alleviating, or preventing the worsening of…a patient’s mental disorder.”

Amendment 44 would introduce an additional criterion to the definition of “appropriate medical treatment” by establishing that an appropriate medical treatment should not only address the individual’s immediate health needs, but be designed with the intent to reduce psychological distress and actively support an individual’s recovery from the effects of childhood trauma. This recognises the long-term impact that early, adverse experience can have on mental and emotional wellbeing and ensures that treatment approaches are trauma-informed, compassionate and conducive to long-term improvement.

People who present with serious mental health concerns need to know that they are receiving support and care in the right environment. They are at their most vulnerable, and having the confidence in their environment can make a world of difference. That is particularly pertinent for those who have suffered childhood trauma. It is important that we deal with the consequences of mental ill health, and adequately address the root causes. Among these, childhood trauma is one of the most serious and persistent factors contributing to long-term psychological conditions. By supporting this amendment, we would create a more resilient system that is equipped to respond to the reality and prevalence of childhood trauma in our society.

I recently met with Alison, who heads up a fantastic organisation called WeMindTheGap. It is based in Wrexham, but it is now moving and expanding to cover parts of my constituency, Chester South and Eddisbury. It does a fantastic job supporting young people who have struggled in the conventional education system, are absent from school or have dropped out of the system. We discussed childhood trauma and the rise in the number of young people not currently in any kind of education. One of the points that Alison made that resonated with me is that absence from school is linked not just to deprivation, but many contributing factors, including difficult domestic situations, isolation and rural isolation.

Many of these challenges are the most severe ones linked to childhood trauma, and although there are many wonderful organisations stepping in to support young people at an early stage, for some the impacts of childhood trauma continue to affect psychological wellbeing into adulthood. Sadly, childhood trauma is a societal issue that we face, and it is more common that we might imagine. Therefore, a step to embed trauma-informed care into the legal framework, specifically for childhood trauma, is a step in the right direction.

Childhood trauma can lead to self-destructive behaviour in adults. There is, as my hon. Friend pointed out, evidence to show that it is a causal factor. We must recognise the long-term impact of adverse childhood experiences on mental health. This amendment, by adding a new criterion to the definition of “appropriate medical treatment” to require that treatment to aim to minimise distress and to support recovery from childhood trauma, would embed trauma-informed care into the legal framework.

Amendment 45, by inserting the words

“seeks to minimise the patient’s distress and promote their psychological wellbeing and recovery from any childhood trauma”,

would reduce the risk of re-traumatisation. Responses to symptoms or behaviours must be supported; it is about helping people to move towards genuine recovery.

Childhood trauma is unique, and it presents symptoms that are different from other mental health illnesses. Therefore, having a dedicated, compassionate and person-centred approach to care is incredibly important. Setting the right culture to support patients, recognising the trauma that they carry and ensuring that there is adequate support and provisions in the legislation and the legal framework, is the right approach. I am therefore pleased to support these amendments, which would strengthen clause 8.

[Stephen Kinnock]

I will start by commenting on amendment 12, which was tabled by the hon. Member for Winchester. We do not consider the amendment necessary, as section 13(2) of the Mental Health Act 1983 already requires an “approved mental health professional” to consider all the “circumstances of the case” before making an application for admission, which could include the appropriateness of the setting.

Clause 8 embeds the principle of therapeutic benefit into the Bill by providing a new definition of “appropriate medical treatment”. That requires that there must be “a reasonable prospect” of therapeutic benefit to justify detention for treatment, and that medical must be “appropriate in a person’s case”. We would expect a setting in which someone is going to be detained to be considered as a part of those considerations. The code of practice already states that patients should be offered treatment and care in safe, supportive and therapeutic environments, so that also addresses that point.

I turn to amendments 44 and 45. We recognise the significant impact that childhood trauma can have on a person’s psychological wellbeing throughout their life. Mental disorder is defined in the 1983 Act as

“any disorder or disability of the mind”,

and that is already broad enough to include the impact of childhood trauma.

Clause 8 requires decision makers to take into account

“the nature and degree of the disorder”,

what is “appropriate” in the person’s case and “all other circumstances” when considering whether medical treatment has a reasonable prospect of therapeutic benefit. That could include consideration of childhood trauma. Although we recognise that childhood trauma may be a factor for many patients, it will not be a factor for all patients. It is critical that consideration of appropriate treatment is tailored to, and reflects, individual experiences and needs. All treatment interventions should include the aim of minimising distress and promoting psychological wellbeing. As well as legislative requirements, it is vital that all aspects of care in in-patient settings should be trauma-informed and that patients are always put at the heart of effective, compassionate care. That expectation is set out in NHS England’s “Culture of care standards for mental health inpatient services” and will be further emphasised in the revised Mental Health Act code of practice.

I turn to clause 8 stand part. The clause strengthens the concept of therapeutic benefit in the Mental Health Act to ensure that patients are detained for treatment or placed on a community treatment order only when there is a reasonable prospect they will benefit from their treatment. The current criteria for detentions under section 3 of the 1983 Act is that

“appropriate medical treatment is available”,

and the definition of medical treatment focuses only on the purpose of the treatment. In practice, that means that clinicians may not consider whether the treatment under section 3 will be effective. If we are going to deprive people of their liberty, it is vital that detention is of therapeutic benefit to them, regardless of whether the patient is detained for treatment under part II or part III of the Act, so the new therapeutic benefit criteria apply to both.

Under the Bill, for treatment to be considered appropriate, there will need to be a reasonable prospect that the patient will benefit from it. The therapeutic benefit criteria will apply at the point of detention and renewal to patients detained under section 3 in part II of the Act, patients on a community treatment order when they are first subject to the order and at the point of renewal, and all part III patients.

The clause also retains the definition of the purpose of “medical treatment” in the 1983 Act:

“to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.”

A focus on therapeutic benefit will ensure that patients receive the care and treatment they need to support their recovery and enable discharge when it is safe for them to leave hospital.