Mental Health Bill [HL]

Baroness Browning Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

The noble Baroness, Lady Berridge, raised some concerns about inappropriate discharge by the nominated person, a point that I understand. As the noble Baroness is aware, the nominated person has the power to discharge from detention under the Act. I can say in initial response that the responsible clinician can overrule the request to discharge from detention under the Mental Health Act. The parent or other person who the patient lives with would be involved in the decision to discharge from hospital, and this is a separate decision. The responsible person should consult those people concerned for the patient’s welfare, including the family, where relevant, on the patient’s care and treatment plan. That includes the discharge plan, which is set out clearly in the Bill.

[Baroness Browning (Con)]

Reflecting on what the Minister has just said, would that close the Bournewood gap, which we tried to close in earlier legislation, where a professional carer cared for an autistic man who was not able to articulate for himself, but was overruled by the clinician? I am just trying to get my head round what she has just said because that was the Bournewood gap and, as the Minister will know, it ended up in the European Court before it was resolved.

[Baroness Merron (Lab)]

We need to be considering that as one of the scenarios and I would certainly be very glad to give the noble Baroness and noble Lords a more considered response to the very important point that has just been raised.

Under this policy, an approved mental health professional would terminate their appointment if the nominated person is not acting in line with the patient’s interests. I really wish to emphasise this.

For all these reasons and the responses I have given, I hope that the noble Baroness will feel able to withdraw her amendment.

--- Later in debate ---

[Lord Davies of Brixton (Lab)]

My Amendment 121 seeks to add financial circumstances to the advance choice documents. I spoke in the last session of the Committee about the importance of the link between financial problems and mental health problems. I draw attention again to work that has been undertaken by the Money and Mental Health Policy Institute, which suggested this amendment, and declare that I am a member of its advisory committee.

It is very welcome to see, in Clause 40, that health commissioners will have a duty to ensure that services inform people about advance choice documents. I listened to the speeches of the noble Baroness, Lady Barker, and the noble Earl, Lord Howe, about extending the reach of these documents. I very much look forward to the reply from my noble friend the Minister, because they sounded pretty convincing to me.

Ensuring that everyone has access to an advance choice document is something that the Money and Mental Health Policy Institute has called for previously. We believe that this clause must go further to advance a specific prompt about people’s financial situation. It may seem a small matter, but for people who have been detained under the Mental Health Act, who are possibly too unwell to keep themselves safe, finances are understandably often the last thing on their mind. As I mentioned in a previous session, this does not stop bills needing to be paid, debts mounting and collections activities being escalated. Including a section on money in the document would help people have greater choice and control over their finances when they are in crisis.

A person recalling their experience of receiving treatment for their mental health shared this comment with the Money and Mental Health Policy Institute:

“I was never asked if there was anyone who was opening mail and keeping on top of my day-to-day living stuff … It’s always the same. I go in for treatment and come out to find my financial world is in a bigger mess than when I went in. The resultant terror, shame and guilt undoes all the work of the treatment and I am back in crisis again”.


This section should include explicit prompts which encourage people to reflect on and stipulate their preferences around finances. That can include consideration of how priority bills will be paid; preferences around access to credit; and advance planning to identify and empower a third party to manage their finances on their behalf, such as a lasting power of attorney or third-party mandate.

By including a systematic consideration of finances in ACDs and offering explicit prompts, people can be supported to have greater control and choice. It would better enable healthcare professionals, as well as the individual concerned, to put in place preventive measures to safeguard individuals from the financial harm that can be caused by, and exacerbate, mental health crises.

As mentioned previously, this is not about requiring healthcare professionals to support people with financial advice, or to deal with issues they have neither the expertise nor the capacity to deal with. It is about empowering them to identify people in need and refer them to the appropriate existing support.

[Baroness Browning (Con)]

My Lords, Amendment 122 is in my name and that of the noble Lord, Lord Patel. When I read through the Bill initially, it concerned me that there was no mention of lasting power of attorney, which, of course, is a legal document under the Mental Capacity Act. A registered lasting power of attorney for health and welfare will appoint attorneys chosen by the patient—the donor—at a time when they had capacity, to speak and act on their behalf if they lose capacity. This is particularly important for people who may periodically lose capacity due to mental disorder. The attorneys, of course, could also provide information about the patient, which is essential in distinguishing behaviours that may be associated with autism or learning disability but are not mental disorders. This does not, of course, apply to children, who cannot make lasting powers of attorney, but it would be remiss of me not to raise it with the Committee, because I have become rather concerned.