Mental Health Bill [HL]

Baroness Fox of Buckley Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, it is somewhat humbling and not a little intimidating to follow so many insightful speeches from those at the heart of the issue. For me, as a bit of an amateur outsider, I broadly welcome the Bill, with some reservations that I will pursue in Committee.

For Second Reading, I suggest that we should always remember the cultural and political context of our deliberations and indeed definitions—I will come back to that. We also need to remember the lessons of history: locking people up for mental illness has been mired in ethical and political scandal over many years. We all can cite the former Soviet Union, where political dissidents were labelled mentally ill, but even in democracies it was not until 1973 that the American Psychiatric Association voted to declassify homosexuality as a mental disorder—and let us not forget those unmarried mothers who were sectioned in the 20th century.

However, even with this misuse of psychiatric power, it is still possible to be a defender of liberty—such as myself, I hope—and yet acknowledge the need for some people to have their liberty restricted because of their mental health. Many years ago, when I worked for Mind, this was a very polarising debate; but I argued then, and continue to believe, that when someone is severely psychotic, manic or out of their mind, psychiatric coercion is not a violation of individual autonomy. That is because the subject at that point in time—“at that point in time” is key—is not autonomous in any moral sense.

However, is release not different? And that brings me to the issue of community treatment orders. Along with others, I too would like them to be abolished. The general problem of CTOs was well explained by Dr Ken McLaughlin is his pamphlet Escaping the Straitjacket of Mental Health. In it, he makes the point that, while the case for compulsion can be justified at the point of hospital admission, when the patient is likely to be in an acutely psychotic state, can compulsion be justified at the time of hospital discharge when the patient should have mental capacity restored? Prior to 2007 and CTOs, on leaving hospital, an ex-patient regained their full rights of citizenship, including the right to refuse medical treatment. The problem of being released with a CTO is that you return to the community as neither a patient nor a citizen. This hybrid state is troubling in terms of compromising civil liberties.

I tend to agree with the noble Earl, Lord Howe, and others: at the very least I question why the Bill will allow indefinite CTOs to occur. I agree with the Centre for Mental Health’s call for the safeguard of time limits, and then CTOs could be extended only if there was proof of proportionality for the individuals concerned.

The question of indefinite “coercive orders” inevitably reminds us of the plight of the almost 3,000 prisoners held indefinitely behind prison bars under the abolished and discredited IPP sentence. Many of these people are incarcerated in prisons precisely because their mental health has deteriorated as they have been refused release, even on licence; a sort of unacknowledged section is happening here. What is more, shockingly, a wide range of experts now blame this very sentencing regime as the cause of IPP prisoners’ mental distress. The hopelessness—“psychological terror”, as it has been described—of never-ending sentences has literally driven prisoners to lose their minds, and even their lives through suicide.

So, while I am delighted the Bill will remove prisons from the list of places of safety, how does it help IPP prisoners? They are deemed too mentally unwell to be released safely. Their illness is derived at least partly from a shameful state mistake, yet IPP prisoners are coercively detained indefinitely in institutions that the Bill would have the state now deem as unsafe for those with serious mental illness.

One case that has recently attracted headlines illustrates an IPP prisoner’s plight as it relates to the Bill. Forty year-old Thomas White has served 12 years as part of his indefinite IPP for a non-violent theft of a mobile phone in 2012. According to his psychiatrist, Thomas developed his religious hallucinations and psychosis as a direct result of being on an IPP sentence. His sister Clara has been campaigning for over a year to have Thomas transferred to a hospital, but his recent assessment appointment was cancelled due to staff shortages. Clara notes despairingly:

“We waited a long time to have Thomas assessed again by the psychiatrist. We more than likely won’t get the assessment again. The system is nothing but criminal—people like my brother are being seriously failed”.


James Frith, the Labour MP for Bury North, agrees. He said:

“Thomas’s indefinite imprisonment has had a hugely detrimental impact on his mental and physical wellbeing. Thomas should be a patient, not a prisoner”.


Hear, hear.

Things are little better for the general prison population. The annual report from the Chief Inspector of Prisons complains of high healthcare staff vacancy rates and chronic recruitment and retention issues. In that context, Richard Garside, the director of the Centre for Crime and Justice Studies, concludes that the provision in Clause 35 to introduce a statutory target of 28 days for transfer from prison to hospital, while welcome, feels aspirational rather than practically implementable in the current system.

The broader crisis of staffing and resources and whether it will hinder the Bill, as we have seen in jails, is also mirrored outside the prison gates. Many briefings that we have all received for this Second Reading query whether the Bill will deliver its promises as a consequence of such problems.

I will now raise a related concern. I think that overstretched mental health services are not just a question of resources but rather a consequence of a recent cultural trend: the problematic medicalisation of more and more aspects of the human condition. Ever greater numbers of people are being encouraged—often by Government-backed policies—to view normal, if adverse or perhaps painful, life events through the prism of mental illness. As a consequence, a greater number of people now demand expert pharmacological or therapeutic intervention.

Over recent decades, this huge increase in classification in the psychological realm has moved the job of diagnosis far beyond the field of psychiatry. A veritable industry of counsellors, therapists and psychotherapeutic practitioners now label an ever-expanding set of behaviours as mental ill-health. As the number of labelled conditions has grown, those reporting that they suffer from such problems has risen exponentially. The stats bandied around are eye-watering. According to the psychologist Oliver James, a third of the adult population shows sign of “psychiatric morbidity”. The problems of worklessness and sick leave, which the Government are rightly tackling, seem dominated by those who have removed themselves from productive work because of mental health-related problems.

Student Minds reports that one in three students experiences clinical levels of psychological distress, but as it is now claimed that students might suffer PTSD if exposed to certain literary texts, it is difficult to assess the clinical authenticity of the so-called mental ill-health epidemic among the young.

The main thing is that the pathologising of ever more aspects of life has unintended consequences, some pertinent to the Bill. For example, we risk reducing the time and resources available to those who desperately need professional help if the system is clogged up with inappropriate referrals and arguably overdiagnosed conditions.

Finally, there is a danger of confusing public opinion if the true horrors and tragedy of serious psychotic illness are relativised and given the same mental health moniker as unpleasant but mundane psychological challenges.