Mental Health Bill [ Lords ] (Fourth sitting)

Danny Chambers Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

I beg to move amendment 12, in clause 8, page 15, line 11, after “treatment” insert

“including the setting in which treatment takes place,”.

This amendment ensures that the definition of appropriate medical treatment includes the setting in which treatment takes place.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 44, in clause 8, page 15, line 17, at end insert—

“(iii) seeks to minimise the patient’s distress and promote psychological wellbeing and recovery from any childhood trauma;”.

Amendment 45, in clause 8, page 15, line 22, after “manifestations” insert

“and seeks to minimise the patient’s distress and promote their psychological wellbeing and recovery from any childhood trauma.”

This amendment, along with Amendment 44, seeks to promote a therapeutic environment and culture which recognises a patient’s trauma.

Clause stand part.

Clause 9 stand part.

[Dr Chambers]

It is a pleasure to serve under your chairmanship, Mr Vickers. Amendment 12 attempts to ensure that the needs of patients in terms of setting and the design of their wards are considered in their treatment. We are particularly concerned that many people are being treated, as Lord Darzi’s report highlighted, in Victorian-era former asylums, which cannot be conducive to effective treatment. Multiple sites have been designated as not functionally suitable.

The independent review of the Mental Health Act and the Care Quality Commission also found that many mental health wards are unsafe for staff and patients, and provide poor-quality care in unsuitable buildings. One CQC inspection report found that the seclusion rooms had low ceilings that contained electrical wires overhead, creating a safety hazard, and staff could not see people clearly through the window panels because they were cloudy. Is the Minister confident that the mental health estate is adequate to fulfil the objectives of the Act? In particular, is he satisfied that the mental health estate is sufficiently safe in structural terms and designed appropriately for those using it, such as being free of ligature points and with sufficient in-patient capacity for children and young people?

[Dr Evans]

I will speak to clause 8 first, then work my way through the other provisions in the group. The clause will introduce a statutory requirement that medical treatment under the Act must have a reasonable prospect of therapeutic benefit for the individual. This is a significant and, I believe, welcome development, bringing the law into closer alignment with modern principles of person-centred care and clinical justification. Again, the intention is clear: to ensure that no one is detained or treated under compulsion unless there is a realistic chance that they will benefit from the treatment. That is another laudable aim, and as a doctor myself, I fully support it.

Significant concerns have been raised that individuals, especially those with complex or treatment-resistant conditions, have been subject to interventions where the purpose was therapeutic but the likelihood of benefit was minimal or uncertain. By introducing a consistent legal definition of appropriate medical treatment early in the Mental Health Act, and ensuring its application across both civil and forensic pathways, the clause marks a step forward in rights protection and clinical accountability. I welcome the shift away from vague references to appropriateness towards a test that is both objective and patient specific; however, several important questions remain, and I hope the Minister will address them.

The first is on defining a reasonable prospect in practice. While the term “reasonable prospect” is a flexible one, that flexibility cuts both ways. The explanatory notes clarify that clinicians do not need to conclude that the benefit is more likely than not, only that it is reasonably possible, but what guidance will clinicians receive to ensure that this threshold is applied consistently and fairly across the country? Will the updated codes of practice provide clear examples or scenarios, and will the guidance be subject to consultation with patients, carers and professionals?

When it comes to forensic patients, and equity and safeguards, I welcome the fact that the clause applies equally to part III patients, who are involved in the criminal justice system. Historically, this group has sometimes been subject to more coercive and less scrutinised care pathways. Will the Minister confirm that the same therapeutic benefit test will apply at every decision point—initial detention, transfer, conditional discharge and recall—so that forensic patients are not denied the safeguards enjoyed by civil patients?

When it comes to legal remedies and review, what mechanisms will be available to patients who believe that the reasonable prospect test has not been met? Will this be a justifiable cause in tribunals or courts? Will mental health tribunals be empowered to scrutinise the clinical judgments behind this test, and if so, what training will be provided to tribunal members?

While I welcome the statutory clarity that clause 8 brings, we must be mindful that legislative change is only the first step: implementation will be critical. I would hope the Government will publish a clear timetable for updating the codes of practice, as well as plans for training, auditing and evaluation. Without that, there is a risk that the reasonable prospect test becomes, again, a box-ticking exercise rather than a meaningful safeguard.

Finally, I want to focus particularly on how the measure will apply to people who have long-term, complex or non-degenerative mental conditions where there may be limited, if any, prospect of clinical improvement through medical intervention. These include, but are not limited to, some forms of autism, learning disabilities and personality disorders, particularly those for which trauma-informed approaches may be more appropriate than medical ones. What about acquired brain injuries, or individuals with treatment-resistant psychosis or chronic conditions for which medication has been ineffective? Under the Mental Health Act, such individuals can be and are detained for prolonged periods, sometimes years, even when no clear therapeutic progress is being made.

Families, advocates and patients themselves frequently describe a sense of clinical limbo—being held under compulsion with little hope of change, because the system has no better option. Of course, that is one of the big reasons for the Bill in the first place, and it brings with it an entirely new set of problematic scenarios that need careful consideration. In short, the prize of clause 8 is that that limbo should no longer happen: detention and compulsory treatment should occur only when there is a reasonable prospect of actual benefit.

How will clinicians be expected to assess the prospect of benefit in cases in which a condition is not considered medically treatable in the conventional sense? For example, if a person with autism is detained during a crisis, but their underlying condition is not one that responds to medication, will the presence of social support or behavioural interventions be considered sufficient to meet the threshold of therapeutic benefit?

Will the Government clarify that detention is not justified when the primary issue is risk management, rather than therapeutic progress? There is a long-standing concern that individuals are being detained primarily because of perceived risk, even when there is no viable treatment plan likely to improve their condition. Clause 8 provides an opportunity to set a clear boundary: that risk alone is not enough; there needs to be a reasonable prospect of improving the person’s mental health through treatment.

How will the new test interact with decisions around discharge and the renewal of detention? If a person has been detained and the anticipated benefit of treatment has not materialised, will the failure to have achieved a benefit trigger a presumption of discharge, or at least a fresh review of the justification for ongoing detention? Will there be specific guidance in the revised code that addresses how the new tests apply to conditions such as brain injuries? After a recent question, I know that the Government are continuing with the brain injury strategy, but has there been any work on how that can be incorporated?

Those are not mere technical questions; they speak to the ethical foundations of the Mental Health Act, which confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty.

--- Later in debate ---

[Stephen Kinnock]

In many ways, that is a question for clinicians, because they always have to make judgments in individual cases. In tragic cases such as eating disorders, at times it gets to the point where a person cannot be saved. If a patient is refusing to eat, it is notoriously challenging for clinicians to try to get that position reversed through talking therapies or other forms of treatment. Is about how we put in place legislation and a code of practice that give the system the best possible steer while recognising that clinicians make decisions on a daily basis in reacting to the circumstances that they face. I will take the hon. Gentleman’s point away and think about it, but I wonder whether there is a definitive answer to his question because of that interplay between the macro system and the micro challenges within that system.

My hon. Friend the Member for Thurrock raised several important points. She wisely said that the clause is about not just the principle of therapeutic benefit, but seeing the person as an individual and the principle of doing least harm. I thank her for those points, which are important for the Committee to take on board.

My hon. Friend asked about the impact of the therapeutic benefit provisions on the 1.5% of people with particularly complex needs. That is an important question, and to some extent touches on the intervention by the hon. Member for Hinckley and Bosworth about what we do in those really challenging situations. Where hospital admission is needed, the fundamental principle is that we believe it must be therapeutic, the least restrictive option and for the shortest time possible. Section 131A of the Mental Health Act 1983 places a duty on hospital managers to ensure that the hospital environment suits the patient’s age and needs. Current efforts, including NHS England’s quality transformation programme, aim to address the root causes of poor in-patient care by working with patients, families and professionals.

That is a roundabout way of answering the question, but fundamentally, the hospital manager has a duty to ensure that the environment suits the patient’s needs. Those needs will range from the most complex and challenging 1.5% of cases that my hon. Friend the Member for Thurrock mentioned through to the cases of others who may have milder disorders or challenges. Needs must be met across that landscape, and the duty is on the hospital manager to ensure that they are. My hon. Friend may also be interested to look at the quality transformation programme, which seeks to address some of the challenges that she mentioned.

In the light of those comments, I hope that hon. Members will not press their amendments. I commend clauses 8 and 9 to the Committee.

[Dr Chambers]

I appreciate the Minister’s considered reply to the amendments. I just spoke in a debate in the main Chamber about NHS infrastructure and buildings. Although I understand that that is not specifically in scope of the Bill, it is another good example of how the Bill is only as good as the system that it works within.

I will happily withdraw my amendment, but it is good to hear that the Minister understands the importance of hospital infrastructure. When substandard Victorian-era asylums are still being used for mental health care, not only is it inadequate for patients, but it affects the public perception of mental health and mental health treatment, which is an important aspect of the issue. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[The Chair]

Does the shadow Minister wish to move amendment 44?