Mental Health Bill [HL]

Baroness Parminter Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Parminter (LD)]

My Lords, it is a pleasure to follow the noble Lord, Lord Adebowale. I will not have quite as many questions for the Minister as he had, but I very much agree with what he says about community treatment orders, which I will return to at the end of my remarks. Like many other Peers, I welcome the Bill, which I hope will improve the treatment of people who are detained when they need to be, for their safety and other people’s, because they are in mental crisis. As others have said, it is a long time coming, and I very much congratulate the Government on bringing it forward so early in their term.

I am not an expert in the field, unlike just about everybody else in this debate, and nor do I have scars on my back from considerations of the legislation in the past. I come to it as someone with lived experience of the impacts of the deadliest of all the mental health conditions, eating disorders, and, in the context of the Bill, as the mother of a daughter who was sectioned aged 17. I know that sectioning is hard. It is hard for the individual: they are separated from their loved ones and the people who care, they cannot do what they want, and they are not where they want to be. It is hard for families and loved ones who are trying to navigate the system. But I know that sectioning works. It saves lives. It saved my daughter’s life when she was in the grips of an extremely vicious eating disorder. She was so malnourished that she could not even allow anyone to feed her by a nasogastric tube, and the state had to step in and save her life. She went to a hospital more than 100 miles away. She was initially restrained and then kept there for five months. We visited her and they kept her safe. At the end of those five months, we were able to bring her home. She was treated in the community by the NHS team, and we are grateful for that care.

I know that detention works, but as the noble Baroness, Lady Watkins, rightly said, we would need less of that detention if there were more provision of community services all around the country so that people could be treated quickly and appropriately. We know that will require more funding, and that was a point that the noble Lord, Lord Adebowale, raised very well. It will require a bigger workforce, and it will require those community services to support people when they need it.

It will also need more specialist beds, and these are particularly needed in the field of eating disorders. At the moment, there are only 251 NHS beds in our country and 198 in the independent sector of specialist adult eating disorder services. The Bill covers England and Wales, but there are no beds at all in Wales. Yet we know that they are absolutely needed. Beat, the leading charity for eating disorders, estimates that about 1.25 million people in this country have an eating disorder. Mental health eating disorder services are absolutely up to the gunnels and beyond, and since 2010 the number of hospital admissions for eating disorders has quadrupled from 7,000 to 28,000—so there is a real pressure point.

When my daughter Rose needed an eating disorder bed, one was not available. She was kept for a month on an adult general ward in the local hospital, where her condition deteriorated to the extent that she had to be sectioned. We need more of these beds. It is no good if we just spend all our time in this Chamber focusing on the particulars of this very small but important part of the Mental Health Bill, on detentions, if the Government do not also grasp the nettle about the need for more beds for people when they really need them.

The other worrying aspect about not having beds is that it stops the mental health law being applied in the first place. The 1983 Act insists that local areas make arrangements for beds in urgent circumstances. I was talking to Dr Ashish Kumar, the chair of the eating disorder faculty at the Royal College of Psychiatrists, who told me that

“even after two medical recommendations, clinicians are not allowed to apply the section because the tier 4 (inpatient unit) services do not offer them a bed. Hence this is a silent crisis—where these seriously unwell patients are not admitted to psychiatry wards or given the opportunity to have a legal provision of the MHAct applied … The whole legal provision is disregarded in a very high number of cases”.

Therefore, I ask the Minister to reassure us—in summing up today and, I am sure, in Committee—that the Government will put equal focus on ensuring that there is community provision for people with eating disorders to minimise the need for people to go into beds, and that there will always be sufficient beds for people with severe eating disorders who really need it.

I agree very much with the comments of the noble Lord, Lord Adebowale, about community treatment orders. It pains me to disagree with the noble Baroness, Lady Browning, for whom I have the highest regard, and with Mind. When we faced Rose being sectioned, the place we turned to for advice to understand the Mental Health Act, as parents literally pushed into it, was Mind and its fantastic website, and I pay tribute to it for that. But I believe that for eating disorders, community treatment orders can be very beneficial.

If you are sectioned for an eating disorder, it is because your condition is such that you are at risk. When you come to be released, you are at high risk, even if you have community support, of losing weight quickly and facing an urgent readmission. That is because the complexity and the tyranny of the eating disorder mean that the person cannot, of their own volition, maintain their weight. A community treatment order puts a boundary around the eating disorder in a way that a voluntary agreement could not, in that it makes it clear what will be the result and what will result in an in-patient setting.

Eating disorders are a really complex battle of control. The person with an eating disorder feels that they are completely out of control, but they are desperate for control. A community treatment order gives them control by not keeping them in a hospital, but it also gives them some sense of control through the terms of the order: they know what is going to happen. Let us not forget that it also gives some control to the community treatment team, who do not have to wait for a medical emergency in order to readmit if that is needed.

I contend that if it is done in the right way—in an open and consultative manner, with the intention of supporting that person to live in the community and access their community care—a community treatment order can be uniquely beneficial for people with eating disorders. It has the benefit of keeping that person out of hospital, and the restriction is on the eating disorder and not on the person. In Committee, I hope to carry on making the case for people with eating disorders and their carers, alongside the many other experts in this field, so that we can ensure that this welcome Bill is as good as it needs to be.