Mental Health Bill [HL]

Baroness Neuberger Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, I declare interests as chair of University College London Hospitals NHS Foundation Trust and Whittington Health NHS Trust, and as a member of the North Central London Integrated Care Board. I am delighted to be able to speak in support of the Bill today, which has been a long time coming. As noble Lords know, I was one of the three vice-chairs of Simon Wessely’s review. It seems a long time from when we published that in 2018.

I pay particular tribute to the noble Baroness, Lady Buscombe, and her team for their pre-legislative scrutiny, which did so much to clarify and to push the draft legislation nearer to what our original review had said, but your Lordships will not be surprised to hear that there are still some areas of concern. I say that as I pay tribute to the Minister for all her engagement, both formal and informal, with members of the review team.

The Government have published the impact assessment for the Bill, showing what they believe will be the costs of the improvements that we all wish to see happen, but have said absolutely nothing about how they will pay for all of this. If we are going to make these reforms work, we are going to need money in the system. Other noble Lords have said precisely that, notably the noble Lord, Lord Alderdice, and the noble Baroness, Lady Watkins, on the subject of staff. You have only to speak to people working in this field to realise that they are desperate for resources, beds and staff—particularly nurses—alongside alternatives to detention that provide real care and do not leave people on the streets. That goes back to the issue of community treatment orders, which we will no doubt come back to in Committee, because this is a really serious concern.

We all know that public finances are under huge pressure but I urge noble Lords, and particularly the Minister, to push as hard as possible for funding for these reforms and the mental health system as a whole. It really is needed and if we do not do that, whatever we legislate will make precious little difference to what happens. That is what we ought to worry about. It is also vital that this House notes the commentary from the Royal College of Psychiatrists whose president, Dr Lade Smith, warns us that these reforms must not make worse the racial disparities already associated with the use of the Act. We need to take heed of that, as many other noble Lords have said.

I want to thank some people in particular, notably Sir Simon Wessely, the chair of the review and, one might argue, the architect of these reforms, and my co vice-chairs Mark Hedley and Steven Gilbert, for their essential contributions. I want also to pay tribute to the Civil Service teams in the Department of Health and Social Care and the Ministry of Justice, particularly Matthew Lees, who put in huge amounts of hard work and showed astonishing devotion to the cause. Some of them have seen it all the way through.

We are delighted that the Bill includes the new guiding principles that we devised and recommended, as well as provisions to promote the use of advance choice documents; but as the noble Earl, Lord Howe, and the noble Baroness, Lady Berridge, have said, there is something very peculiar about the way this is framed. Advance choice is not given as a right to patients; it is a duty upon the ICBs. When we get to Committee, we need to push that one quite hard.

We also remain disappointed that the Government have not been able to include measures relating to our recommendation that the tribunal consider appeals from patients whose expressed preference for a particular kind of treatment has been overturned by doctors. We believe that that would be an uncommon occurrence; nevertheless, it is an important safeguard for patients’ rights—a right to be involved in decisions to do with your own care. I really hope that the Government will reconsider this proposal, ideally before we end consideration of the Bill.

We are living in a time of increasing tolerance and understanding of mental ill health and decreasing stigma surrounding it, but that is not what many people in the system experience. Many people are most distressed not by the detention itself but the way in which they are treated and made to feel helpless, ignored and stripped of their dignity and self-worth. That is why the review identified—and this is key—a clear gap when it comes to supporting and valuing patient autonomy. It is why we argued that we must move away from what we heard all too often: the default position of clinical staff rejecting what the patient wants. Many of the independent review’s recommendations therefore aim to shift the dial in favour of greater respect for the wishes, choices and preferences of patients. It was also clear that when people were—rightly, in their own view—being deprived of their liberty, they were also all too often being deprived of any say in how they should be treated. As one service user who was part of our core team told us when we started on this process:

“I am sure being detained saved my life, but did it have to be such a terrible experience?”


In one significant respect, the Bill goes beyond any recommendations that we made, proposing, in effect, to exclude learning disability and autism from the scope of the Act, except for short-term admission. Other noble Lords around the House have spoken on that; however, we were and remain concerned that exclusion from the scope of the Act might not solve the problem—although it should—but instead simply shift it elsewhere. The noble Lord, Lord Alderdice, I believe, was hinting at that too.

This Bill, unlike its predecessors—I am a veteran of 2008 as well—enters Parliament with a considerable level of agreement from all the political parties, professionals, media, the charitable sector, service user groups, and in particular stakeholders representing ethnic minority communities, although there are considerable worries.

So there are some concerns, and we know about that. I very much hope that the Minister will be able to meet once again with the team from the Royal College of Psychiatrists and with some user groups, particularly people with autism and other disorders who are expressing major concerns—all of us will have had some of those emails. I hope that that can happen as the legislation goes through, so that we can see if any further fine tuning can be done. But this is without doubt the right time—one might even say it is overdue—to modernise the Act, and I very much hope that the House will support it.

Mental Health Bill [HL]

Baroness Neuberger Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I remind the Committee of my entry in the register of interests that I am on the advisory board of the Money and Mental Health Policy Institute. I mention this particularly because the three amendments in my name, dealing with the financial implications for people who struggle with their mental health, have been based on the work of the institute.

As I have reminded the House on many occasions, these amendments speak to the undeniable but all too often overlooked fact that our mental health and money are closely linked. When someone is hospitalised for a mental health crisis, bills still need to be paid and debts can mount up, resulting in financial difficulties that greatly damage people’s prospects of recovery.

It is worth focusing on the numbers. In 2022-23, almost 90,000 adults were admitted to hospital for a mental health problem. The Adult Psychiatric Morbidity Survey indicated that around one-quarter of people experiencing a mental health problem are also in problem debt. The rate of problem debt is undoubtedly higher among people experiencing a mental health problem, which leads to hospitalisation. An earlier study from 2008 found that one-third of all people with probable psychosis are in problem debt.

The three amendments dealing with the link between finance and mental health deal with different aspects of the problem, and they are, quite rightly, being considered in turn in relation to the relevant parts of the Bill. Today, we start with my Amendment 59, and I thank the noble Baronesses, Lady Tyler of Enfield and Lady Neuberger, for their support for it. Like the other amendments in this group, it deals with care and treatment plans. Later, we will come to the implications of advance choice documents, which is currently in group nine, and then provision for mental health crisis breathing space, which is currently in group 17.

The Mental Health Bill provides an important opportunity to tackle the vicious cycle of poor mental health often leading to financial problems, and financial problems often leading to poor mental health. We must break that cycle and ensure that people’s financial needs are addressed as part of a supported recovery from a mental health crisis. That focus is missing from the Bill in its current form, and my amendments seek to address that gap.

As I have already indicated, these amendments are informed and supported by the independent charity, the Money and Mental Health Policy Institute, which has done considerable and excellent work in this area. They are small changes designed to improve the Bill and the outcomes for those it aims to help, by ensuring that a person’s financial situation is routinely considered and acted on as part of their treatment and recovery from a mental health crisis. Addressing a person’s finances is one of the many factors that mental health practitioners must consider in their assessment and care planning.

However, services cannot rely on patients to tell them when they are facing financial difficulties. The experience is that people rarely take the initiative to tell mental health professionals about money problems, often because they are too unwell or because the stigma around both mental health and financial problems acts as a barrier to disclosure. Adding an explicit prompt about people’s financial situation in care and treatment plans will ensure that this is routinely and consistently considered by healthcare professionals and will open up more opportunities to safeguard patients from financial harm.

There is a precedent for this. In Wales, “finance and money” is already included as a section in the care and treatment plan template. That does not mean that busy healthcare professionals are required to support people with their money in a way that they are not trained or intended to do. Rather, this is a case of empowering them to identify those in need and refer them to the relevant welfare adviser in their service, so that healthcare professionals can focus on medical care. Ultimately, that could free up time for health professionals, as well as improving outcomes for patients.

I will illustrate the need for this proactive inquiry with testimony from someone with lived experience of money and mental health problems, as they do it so much more powerfully than I can. A participant in Money and Mental Health Policy Institute research shared:

“I didn’t realise how much my mental health affected my finances and vice versa. I lived for years in shame and horrific anxiety about money which caused my mental health to spiral. I thought there was no help out there for me and I didn’t want to be alive, as I couldn’t see a way out of my money troubles”.


Legislating to include a consideration of people’s finances, when they are in a mental health crisis and throughout their recovery, will help prevent further illness, support recovery and reduce waiting lists, and will help people return to daily life, including work, more smoothly.

I can imagine what my noble friend the Minister’s response will be, because she has already written to the institute. She said in her letter: “We intend to set out in secondary legislation the required contents of the statutory CTP. However, we plan to further consult stakeholders to make sure that the CTP covers all the information that is critical to an individual’s recovery and timely and effective discharge from the Act”. I hope that she does not mind me taking the opportunity to stress the importance of this issue. Does she agree with that, including the importance of its place in treatment plans?

[Baroness Neuberger (CB)]

My Lords, I will speak to Amendment 59, in the name of the noble Lord, Lord Davies of Brixton, to which I have added my name. I must declare rather a lot of interests. I am chair of the University College London Hospitals NHS Foundation Trust and of the Whittington Health NHS Trust, which provides child and adolescent mental health services. I was also one of the vice-chairs of the independent review of the Mental Health Act in 2018, which feels like a long time ago.

I am keeping my comments in Committee fairly short and sparse, because I feel that I have had quite a lot of say already, having been involved in that review. However, I want to speak about the issue of financial difficulties and mental health problems, because we should have looked at it in greater detail when we were conducting the review. It was an omission on our part, as we did not focus on it in any detail. The noble Baroness, Lady Barker, cited one of the people who spoke incredibly movingly to our review and who talked about how awful it is to be an in-patient. She said that she recovered and was given the care she needed, but she asked why it had to be such an awful experience.

One of the things that is becoming clearer—the noble Lord, Lord Davies, alluded to it—is that when you have had a mental health crisis and your finances are in an absolute mess, because you did not get it together to do anything about them, why does your recovery have to be so awful because nobody helped you and gave you the advice you needed at the time? That is why this is so serious. If you are in hospital, you may not even get access to your computer, you may not be using your mobile phone all the time, you may be in something of a mess and your cognition may be severely affected. If that is the case, you will not be paying your bills, claiming your benefits or paying your rent. When you recover, it will take you ages to get into a situation where you can live a normal life again and not be hugely in debt.

I was going to cite some of the experts by experience—the quotations have been given to me by the amazing Money and Mental Health Policy Institute, to which I am extremely grateful. However, since I do not want to take much more of your Lordships’ time, I shall just say that, although NICE stipulates that assessments in care and crisis plans at present should consider patients’ holistic social and living circumstances, which would include things such as housing and finance, mostly, in normal circumstances, the issues are too great. Often, the mental health needs are at crisis point and it just does not happen, and the same will happen with care and treatment plans unless we put this in the Bill.

I ask the Minister—I have already heard what the noble Lord, Lord Davies, has said—whether she will think quite hard as to whether this could be in the Bill, along with parental involvement. I agree with all the amendments in this group. There are some things that need to be in the Bill that would make sure that, when we see treatment in place—and I see a lot of it in what I do in the other part of my life—those things are taken into account. If it is in secondary legislation, it is much harder and much less likely.

House resumed. Committee to begin again not before 8.10 pm.

Mental Health Bill [HL]

Baroness Neuberger Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I apologise for my absence from earlier debates in Committee. I will speak very briefly in support of these amendments. My noble friend said that we need to save ourselves from ourselves. Actually, we need to raise aspirations to change the culture of believing that it cannot be done and thinking that it will cost too much to take a more preventive approach, to care properly for people in the community and to achieve parity for mental health outcomes. These amendments are really important to try to achieve that, so I support them.

[Baroness Neuberger (CB)]

My Lords, I will speak very briefly in support of Amendments 163 and 164, to which I have added my name, and particularly about the length of time, the five years.

We first started talking about the reforms to the mental health legislation eight years ago, when we set up the review of the legislation under Sir Simon Wessely, and I was the vice-chair. It reported in 2018—seven years ago—and it was not even a very radical rethink of our mental health legislation. Yes, it will make a lot of difference to a lot of people—service users are very keen for this to come about, and they certainly do not want to wait longer than five years to see all the measures come into force—but this is relatively gentle stuff. At some stage we will need a much more radical rethink of our mental health legislation. Five years is quite a long time, so I rather hope the Minister can give us some comfort by saying that most of it will be done in two years, or perhaps three years at the outside.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, first, I support Amendment 130 in the name of the noble Lord, Lord Scriven. I have been concerned, as we have discussed this Bill, that costs are likely to spiral. I am not objecting to that, but it seems to be the elephant in the room. Unless we know, the Bill will become a white elephant because people will just say that we cannot afford to do it. It is far better to have transparency, as has been argued.

Secondly, I oppose Amendment 153. For a number of reasons, I do not think we should prohibit for-profit entities being involved in this endeavour. The suggestion is that if we remove the profit motive, all will be well. A word of caution: not-for-profit organisations are not necessarily the most efficient, virtuous organisations, as we might imagine. In the charitable sector there are some worrying trends of money being spent, rather self-indulgently, on staffing and on all manner of extraneous and sometimes politicised endeavours.

We have seen the emergence of EDI—equality, diversity and inclusion—policies, which the Health Minister, Wes Streeting, has worried about happening in the state sector, and we have seen them become absolutely rampant in the charitable and not-for-profit sector. I want us to concentrate on the people the Bill is designed to help and therefore not to have our own political idea that only the state can deliver well—I just do not believe that is true.

For example, I have done work in prisons over a period of time—that also relates to the Bill—and have worked in both private and state-run prisons. Some private prisons are awful and some state-run prisons are worse—and, by the way, I have worked in some brilliant state-run prisons and some brilliant privately run prisons. We should judge on the basis of the quality of the care or the service that they provide, not some prior presumption that because they make profit they might be useless, somehow evil or not attending to their core mission.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Davies of Brixton, and to offer the strongest possible support. These are issues that the noble Lord and I—the noble Lord very much in the lead and me following along in support—have engaged with on financial services and markets Bills previously. They are crucial issues for people’s well-being and the well-being of our whole society.

The noble Baroness, Lady Hollins, was talking on the last group about the patient journey. For someone who has become ill, who is seeking treatment and who has the weight of debt sitting on their shoulder, it is worth thinking about how damaging that weight of debt can be to the whole experience of the patient journey. It is worth thinking about how this interacts with issues around discrimination and unequal outcomes that we have looked at regarding other parts of the Bill in terms of the intersectional pressures that people can experience.

In preparing for this, I was looking at the middle of last year and mental health awareness week. The Women’s Institute was focusing particularly on the impact of energy debt, and 14% of the people in the study were at that stage in debt to their energy suppliers. Nearly a third said that they were worrying seriously about this. A fifth said that they had suffered sleepless nights. For the people who are suffering under debt pressures—single parents, very often women, or people from disadvantaged communities that are already economically disadvantaged—all these things feed in together. This is simply a measure for that. “Breathing space” is so evocative of the sense of taking off that pressure and allowing people the chance to focus on their own recovery and their own treatment, rather than just worrying away about that debt. I cannot see why the Government, or why anyone, would oppose this very modest measure.

[Baroness Neuberger (CB)]

My Lords, I should have declared interests before, as chair of University College London Hospitals NHS Foundation Trust and of Whittington Health NHS Trust. I also was a vice-chair of the review of the Mental Health Act, which reported in 2018 and is relevant, because I very strongly support this amendment to which I have added my name. It is something that the review did not address. We should have done. We did not have it raised sufficiently strongly with us by service users to whom we talked a great deal. That was an omission. It is very important that we do this. I hope that the Minister can say that this will be included in the legislation in its final form, and that she will accept this amendment or something redrafted along its lines.

I am very grateful to the wonderful Money and Mental Health Policy Institute—I pay full tribute to the noble Lord, Lord Bradley—for its briefings. When, in 2022, it conducted a piece of research looking at the finances of 200 people who had received care from secondary mental health services, it found that, quite unsurprisingly, a majority of the people who responded had experienced an income drop while receiving support from mental health services and struggled to pay their mortgages or for food, or missed a payment on energy, rent, council tax, or whatever it might be. This was a problem that kept coming back and they kept talking about. But the majority also expressed real support for the idea of making plans, ahead of time, for how to deal with their finances and how this would all be managed when they were unwell, as many people have episodic periods of being unwell. It seems to me that that piece of work is a cast-iron argument in favour of using breathing space to tackle these financial issues. I very much hope that the Minister will be able to support this.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise very briefly to add my support to this amendment. I have been very pleased to add my support to all three of the amendments that the noble Lord, Lord Davies, has tabled in this area of financial inclusion. I remind your Lordships’ Committee of my interests as a member of the Financial Inclusion Commission and president of the Money Advice Trust.

I have always been a strong supporter of breathing space. It is a really important debt respite scheme, which has made a huge difference to the lives of many people struggling with debt. The idea of automatically offering this to people who are detained under the Act is absolutely the right thing to do. There is just so much evidence about the links between people spiralling into mental health crises and then into financial crises, which makes their recovery so much harder. I was pleased to hear the noble Lord, Lord Davies, talk about the sort of debt advice which might also then be available.

Everything that needs to be said about this amendment has already been said, so I underline my support for it and, like other noble Lords, very much hope we might hear some encouraging words from the Minister.