Mental Health Bill [HL]

Baroness Tyler of Enfield Excerpts

Tuesday 14th January 2025 Lords Chamber

Moved by

[Baroness Tyler of Enfield]

21: Clause 4, page 8, line 21, at end insert—
“(ba) the person is under 18 years old and satisfies the conditions in (b)(i) and (b)(ii),”Member’s explanatory statement
The amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.

[Baroness Tyler of Enfield (LD)]

My Lords, I will also speak to Amendments 27 and 32 in my name. My amendments all relate to children and young people, but this group also includes important amendments in the name of my noble friend Lord Scriven, which I support, on the duties on commissioners, integrated care boards and local authorities regarding care provisions for people with a learning disability or autism. Also important are the amendments from the noble Baronesses, Lady Browning and Lady Hollins. I add my condolences to the noble Baroness, Lady Hollins. I am sure we are all thinking of her today.

By way of context, the Bill introduces a new duty on integrated care boards and local authorities to commission community services for those with a learning disability and autism. The Bill also places dynamic support registers on a statutory footing. These are welcome and much-needed duties, and the Bill presents a crucial opportunity to strengthen the support provided to those with learning disabilities and autism. However, I want to go further. I recognise that there is some piggybacking on my part, but I am passionate about the mental health support that is available to children and young people, so I believe that the duties to provide community services should be extended to include everyone aged under 18, to ensure that children and young people can have their needs met without them having to be admitted as in-patients. That is where is my Amendments 21, 27 and 32 come in—they are all interrelated.

Amendment 21 seeks to extend the duties placed on integrated care boards to maintain a register of those at risk of detention to all under-18s. Amendments 27 and 32 would extend the new commissioning duties on integrated care boards and local authorities to include under-18s. In essence, the duties are both to identify and to commission services in the community that meet the needs of all under-18s.

As I think we all know, the Bill has been introduced at a point when waiting times and thresholds for mental health support for children and young people across early intervention services, targeted support services, CAMHS, et cetera are worryingly high. Consequently, too many children and young people are left to reach crisis point. Evidence shows that the number of children referred to emergency mental health care in England has increased by more than 50% in three years. These amendments will not only help to achieve improved outcomes for children and young people but have wider benefits for the mental health systems through intervening at an earlier stage, providing improved care for children and young people in the most appropriate settings, and reducing costs. This is all in line with the Government’s key drive to move to a more community-based, preventive model of healthcare—and, frankly, that should apply to mental health as well as to physical health, and to children and young people as well as to adults.

We all know, as we have discussed so many times in this Chamber, that children’s mental health support has historically been woefully underfunded. There is a lack of clear accountability to ensure that effective community provision is in place. I therefore consider that adding all children and young people to the new commissioning duty placed on local authorities and ICBs in the Bill is crucial to ensuring that their needs can be met at an early stage, preventing crisis and later admission to mental health in-patient care. We should worry about the whole system and try to prevent people getting to in-patient care, as well as worrying about those who do. In short, my argument is that their needs should be met without the need to detain children and young people, wherever that is possible.

Research has demonstrated that children’s and young people’s experience of in-patient care is consistently poor, too often further harming their mental health. A survey conducted by Mind on children’s and young people’s experience of care in mental health hospitals found that 69% of the young people surveyed said that their experience as in-patients had not been positive. In my view, a shift to such community-based provision would not only reduce the number of children and young people requiring in-patient beds but would in turn reduce demand for in-patient care and the risks of children and young people being cared for in what can often be highly unsuitable environments. It would also ensure that those with the most complex needs who do need in-patient care receive high-quality care in a setting that is right for them.

In case people are sceptical as to whether this sort of care can be provided in the community, I am aware of case studies of types of support in the community, such as hubs and the like, that can be used to manage high levels of risk. Where that care is provided in the community, in a relaxed, warm and calm environment, it can often be an alternative to young people having to visit A&E, where they may not get specialist mental health support and waiting times can be so long. I beg to move.

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With those remarks, I ask that the noble Baroness will be good enough to withdraw her amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her response. I also thank other noble Lords who have participated in this debate.

For me, the nub of this grouping has been the whole issue of prevention—I think “getting upstream” was the phrase my noble friend Lord Scriven used—and having in place within the community better and more responsive services, with the aim of reducing admissions to in-patient care but, at the same time, improving the in-patient care that is available, because the only people there are those for whom nothing else will work. It is very welcome that the Bill puts the dynamic support register on a statutory footing. On the two amendments from the noble Baroness, Lady Hollins, beefing that up still further, I think I heard a slightly encouraging response from the Minister. I will look carefully at Hansard tomorrow, as I am sure will the noble Lord, Lord Crisp, to see what was said.

I can see that while some people may think that prevention is very important, they would ask what it has to do with this Bill. I do not see it like that. You have to take a system-wide approach. To get the whole mental health service working, even when you are looking at what I call the hard end—the crisis end—you have to look at what is happening at the preventive end and try to reduce the number of people who might need to be admitted. That would send an important message that there are clear legislative requirements for what services should be available within the community. This Bill, frankly, is the obvious place to do it—hence the amendments around children and young people that I raised.

I was pleased to hear the Minister say that the transformation and the 10-year plan will apply at least as much to mental health as to physical health. That is very encouraging and I am glad that we have got it on record. I was not altogether surprised that the Minister thought that my amendments were unnecessary. I do not agree. I was not just talking about children and young people with learning disabilities and autism. They are obviously a very important group, but my rationale for trying to broaden it out to all children and young people was, in essence, to make sure that only those with the most complex needs would receive that higher-quality care in an in-patient setting—everyone would benefit from that approach. The Minister talked about a new approach to children’s and young people’s services, and I look forward to hearing more details. I do not know whether the Minister can tell us when we might expect to see that.

Finally, my view is that the 1983 Act was never really designed with children and young people in mind; I think everyone agrees with that. This Bill is an opportunity for us to put children and young people centre stage—hence my amendment. This is such an important topic that I think we shall be returning to it on Report. On that basis, I beg leave to withdraw my amendment.

Amendment 21 withdrawn.