Mental Health Bill [HL]

Baroness Browning Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Parminter (LD)]

My Lords, this is a very limited amendment. It aims to prompt ICBs to ensure that there are adequate placements for those with severe eating disorders—both those who are sectioned and those who are not sectioned. There is a need for this because general acute mental health hospitals are not appropriate if we are going to ensure the best outcomes for people with eating disorders, and there are far too few beds out there at the moment.

Let us address that last point first. In the UK, at the moment, there are 450 adult beds—that is a combination of NHS and private beds—and less than half that number for children. However, last year there were 30,000 hospitalisations for people with eating disorders, which is a fourfold increase on 2010, when there were 7,000. This means that people are being placed in inappropriate settings, be that in general acute hospitals, the general hospital down the road, or in out-of-area placements. All of those will deliver non-optimal recovery rates and result in more costs in the long term to the country, as well as greater suffering for individuals and their families and carers.

It is pretty obvious to most people that eating disorders require specialist staff—it is not rocket science. People with very severe eating disorders, sectioned or otherwise, will often need nasogastric tube feeding, which is a specialist skill, and there will be issues around avoiding refeeding syndrome, along with the cardiac risk. It is very clear why there is a need for specialist staff. The APPG on Eating Disorders did a recent report on this, The Right to Health, which looked at why specialist eating disorder nurses are required. Those provisions are not in general mental health hospitals, or indeed in the general physical health hospital down the road. It is pretty clear to most people that you need specialist staff.

What is probably not so clear, if you are not familiar with eating disorders, is that the physical constraints of a general mental health facility are not appropriate or optimal for people with eating disorders. If you have a severe eating disorder, you need feeding six times a day. People who are very anxious about eating will need to be supervised, one to one, in a calm environment. That is not what you get in a general mental health facility. Those people will then need to be supervised, one to one, for a period after meals, to help them to keep that food, again in a calm and spacious environment where they can be managed one to one. Those individuals will all have diets, weekly prepared especially for them, which will require a specialist canteen. Not only will you need staff to facilitate the provisions of those meals but you will need an area where people with eating disorders can be helped over a period of weeks to refamiliarise themselves with preparing food and to not be anxious about touching or preparing food—so you will need a second kitchen. The provisions in a general mental health facility are not optimal for people with specialist eating disorders. The legislation as it stands asks ICBs to focus only on general mental health facilities.

I am not making the case that eating disorder sufferers are somehow special—please do not think that. I am just making the case that they are different. For too long, they have not had a focus on their needs, which is why we have so few eating disorder beds in this country at the moment. This is probably a very poor attempt, but it is my attempt to ensure that ICBs are given a gentle nudge by the Government to do what I think the Government want to do—which is to treat the majority of people with eating disorders in the community but, for those who require beds, ICBs must at the appropriate time ensure that there are such beds. We must not rely on general mental health facilities, which will not produce the outcomes that we need. I beg to move.

[Baroness Browning (Con)]

My Lords, I support the noble Baroness, Lady Parminter, on the particular point that she raises about eating disorders in her amendment and on a more general point.

In an earlier debate, I tried to make the case that people being diagnosed with autism by clinicians should be seen by clinicians who specialise in autism. I was reminded of this very much when the Minister, responding to an earlier amendment this afternoon, talked about parity of esteem in the health service between the physical health support provided and that for mental health. In the world of physical health, if you were to see an orthopaedic consultant, you would not necessarily see the same consultant, depending on the condition that you had. The same applies today with cardiology, whereby cardiologists now have more specialisms within that and you would therefore see the appropriate person. As raised by the noble Baroness, Lady Parminter, the facilities that go along with such specialised treatment and assessment are very important.

I put it to the Minister, prompted by the noble Baroness, Lady Parminter, and by the Minister’s own words, that it really is about time that, with regard to mental health as a generic term, whatever the condition, we stop—as they did even within my lifetime—locking people up in some old Victorian institution where they all get the same treatment, facilities and so on. Today, with our increased knowledge of mental health and of medication for mental health, and with the increased number of specialisms that we are now aware of, particularly around eating disorders, it is really about time, if there is truly to be parity of esteem, that mental health is treated as physical health is treated, and that the specialisms that occur and the specialists there to work within those specialisms are given weight within legislation so that facilities and specialists can be provided—because we know that they are not.

At the heart of the Bill before us is the fact that we are taking autism and learning disabilities out of the Mental Health Act 1983, in which they were all treated the same—lumped in together and treated by the same clinicians, whether they had a specialism in that area or not. This is a real opportunity for the Minister and the Government to make sure that there is true parity of esteem and that conditions such as eating disorders are respected and treated in the way in which they should be.

[Baroness Butler-Sloss (CB)]

My Lords, I remember a specific case of a friend’s 17 year-old daughter who was suffering from an eating disorder. She had to go into hospital, where she was not treated at all well; she was criticised for not eating—the very thing she had gone into hospital to get help for. She did not for quite some time get any specialised help on how to deal with her eating disorder. This amendment would deal with that issue.

--- Later in debate ---

[Baroness Browning (Con)]

My Lords, I too was pleased to add my name to Amendments 155 and 156 in the name of the noble Baroness, Lady Hollins. She has already spoken on this subject, and it would be remiss of me not to say that the title of the report she mentioned, My Heart Breaks—which is of course in her name and authorship—was chosen for a purpose. This is a heartbreaking situation, and on the piece of paper I am holding in my hand, headed GOV.UK, it says: My Heart Breaks—Solitary Confinement in Hospital Has No Therapeutic Benefit for People With a Learning Disability and Autistic People.

As we have heard, it is not just that it is not therapeutic; it is actually harmful. On the terminology, other speakers have already spelled out why they have dumbed down the real raw facts of the language that they use to describe this type of incarceration—for that is what it is. It reminds one of prisons. Look at the legal structures needed to put somebody into a prison, yet people who are ill are treated in the same way as prisoners.

I remember visiting a school for autistic children many years ago. It had a single room where they took children who were having a meltdown. It was a padded room, and they felt that was the appropriate treatment for children. We know, from the many debates in this House about people who have been held for extended periods in mental health hospitals, the damage it does and the difficulties when these practices are in place.

Ironically, this does not happen everywhere. You have to ask why it happens in some institutions and not in others. There is an answer to that. It is not because of a different profile of patients in these two different types of settings but because in some places they understand the problem and have sufficient training and resources. Training of personnel, particularly senior personnel, is key. If the person in charge says, “This is what we are going to do”, very few people in the structure below them are going to challenge it, so that is what they do and it becomes the norm.

Fifteen months ago the noble Baroness, Lady Hollins, produced this report, which now bears government approval and GOV.UK and the Department of Health and Social Care on it. It is now really time for the Government to adopt the amendments from the noble Baroness, Lady Hollins, and her recommendations. It is a wealth of experience that we can only admire, and I urge the Minister to please accept these recommendations. They come from the very highest level. We are very lucky in this House to have the expertise of my dear friend, the noble Baroness, Lady Hollins.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak very briefly and on a slightly related topic. I want to talk about a different group of people who are in long-term segregation who are not sectioned and often do not get mentioned—prisoners. Long-term segregation is used when very mentally ill people in prison are not transferred to hospital and nobody knows what to do with them. They are put into isolation and left there, psychotic, delusional and forgotten—dumped, in effect.

The noble Baroness, Lady Browning, alluded to prisons, but even prisoners should not be treated like prisoners sometimes. The confusion and conflation of punishment and treatment outside prison is no less shocking when it is inside prison. You are not meant to punish somebody doubly because they are in prison and happen to get ill.

The Chief Inspector of Prisons, Charlie Taylor, has made the point that the segregation units are completely unsuitable for people who are severely unwell. They are also a significant drain on the hard-pressed staff, because very often the restraints are of people literally going out of their mind. They are not getting any medical intervention at all. According to the chief inspector, it requires multiple officers to unlock the cells even just to deliver meals.

Is it possible for the Minister to give any thoughts on that? Also, in a way, this is an appeal to the noble Baroness, Lady Hollins—if she takes this amendment forward—to bring that into the situation, even though I know I am slightly squeezing it in because I have Amendment 160A on reviewing prisons.

On Amendment 146 and the use of force, I absolutely agree with the mover of the amendment in relation to the need to keep records. That is obvious. I suppose the nightmare for us all is the misuse of force. It is horrifying—the stuff of nightmares—when people are ill.

I do not want to be naive. I know that when people are very ill and very psychotic, sometimes appropriate force is necessary; I just think it needs to be recorded. When I say force, I obviously do not mean violence or anything not within the realms of professional intervention. Sometimes I think we forget how ill people can be and how violent and how difficult it is for the people who work with them. We should record every instance of the use of force but be wary of demonising or damning every use of it, because it is not quite as simple as that.