Mental Health Bill [ Lords ] (Sixth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

This is consequential on amendment 40.

[Dr Danny Chambers (Winchester) (LD)]

I beg to move amendment 49, in schedule 2, page 87, line 13, at end insert—

“(18A) In section 130B (arrangements in relation to independent mental advocates: England), after subsection (3)(d), insert—

‘(e) support the patient’s carer and family members to prepare for the patient’s discharge from hospital treatment, and

(f) support the patient to access help with social and financial stressors that might otherwise increase their likelihood of future detention.’”

This amendment extends the support offered by Mental Health advocates to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.

It is an honour to serve under your chairmanship, Mrs Harris. I jumped the gun this morning, so I have already spoken in detail about the amazing initiative at Melbury Lodge with Winchester Citizens Advice. I will not bore the Committee with the details again, except to say that it is a brilliant example not only of delivering really good care for patients, but of a really good cost-effective intervention for the taxpayer. If it is not appropriate for it to be set out in secondary or primary legislation, will the Minister consider a meeting with me, Melbury Lodge and Winchester Citizens Advice to discuss how this type of initiative could be rolled out across the country?

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to make some brief comments on amendment 49.

I am sympathetic to aims of the hon. Member for Winchester in tabling the amendment. A patient who is being discharged from hospital may indeed require specific, targeted support. The overall success of their treatment and continued recovery can be greatly enhanced where the right structures are in place to support them in the community. The amendment rightly draws attention to social and financial stressors that may affect an individual at the point of discharge and in the weeks and months that follow. We all recognise that there is a pressing need for a more joined-up approach between in-patient services and community provision. Without that, we risk patients falling through the cracks and suffering unnecessary and distressing re-admissions. Better discharge planning must be at the heart of our efforts.

I have some concerns, however. Although I acknowledge the good intentions behind the amendment, it risks expanding the remit of independent mental health advocates beyond what might be appropriate. There is a delicate balance, but an important distinction, between advocacy and care co-ordination. Independent mental health advocates play a vital role, and it is essential that their independence and clarity of purpose be preserved. If we are not careful, we risk blurring that boundary. In doing so, we may undermine the very effectiveness of the independent mental health advocate in fulfilling their primary function.

The role of an IMHA is to support patients in understanding and exercising their rights under the Mental Health Act. They may already be involved in supporting an individual to prepare for discharge, including by contributing to plans for ongoing care and support. The amendment would significantly increase the breadth of that role and might shift the focus away from the core purpose of advocacy.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The intention of his amendment is to extend the support offered by independent mental health advocates

“to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.”

It would amend paragraph 18 of schedule 2, which deals with amendments relating to nominated persons. It should more properly be inserted into schedule 3, which deals with independent mental health advocates.

The Bill will already extend the support that advocates can provide to help patients to be involved in decisions about their care and treatment, to be able to make a complaint and to be provided with information about other available services. Those other services could include support following discharge from statutory or voluntary organisations, which may cover social and financial issues, and help to support carers. Those organisations would be better placed to support patients with these specific needs, rather than independent mental health advocates, whose skillset is specific to supporting patients to understand their rights under the Mental Health Act and participate in decisions about their care and treatment. We will consult on guidance in the code of practice to help independent mental health advocates to understand their extended role.

In addition to policy regarding independent mental health advocacy, advance choice documents give individuals the chance to give instructions about practical aspects of their life. Examples of such aspects include domestic, financial or caring responsibilities, such as children or pets. This provision allows the individual to be looked after when unwell and aims to ease additional anxieties. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.

[Dr Chambers]

I appreciate the valid points that hon. Members have made. The point about running a pilot was a sensible suggestion. We have had something that could be viewed as a pilot in Winchester for two years. We know that it works well, and every £1 spent on it saves £14.08. If I have suggested this amendment in the wrong part of the Bill through my naivety and inexperience, or if mental health advocates are not the right people to deliver a solution that we know works, may I ask the Minister whether there is a more appropriate part of the Bill in which to include it or another way to implement this proven system, such as by amending a different Bill, before I decide whether to press the amendment to a vote?

[Stephen Kinnock]

I thank the hon. Gentleman for that question. Fundamentally, our view is that the role that he is proposing is not the right one for an independent mental health advocate. The role of an independent mental health advocate is to work with the patient around their legal rights, rather than to deal with some of the more practical issues that he is talking about here. Our sense is that there are both statutory and voluntary organisations who are better placed to carry out that work. I do not think that a pilot would work with IMHAs, because by definition that is not the right role for IMHAs.

[Dr Chambers]

In that case, can we have a discussion outside the Committee about how to do this?

[The Chair]

Order. Does the hon. Gentleman wish to press the amendment?

[Dr Chambers]

indicated assent.

Amendment 49 negatived.

Schedule 2, as amended, agreed to.

Clauses 25 to 28 ordered to stand part of the Bill.

Clause 29

Detention periods

Question proposed, That the clause stand part of the Bill.

[Stephen Kinnock]

Currently, under the Mental Health Act, a person detained for treatment can be kept in hospital initially for six months before the responsible clinician must make an assessment to decide whether to continue their detention or to discharge them. The independent review raised concerns that six months is too long. It heard evidence that patients were sometimes detained longer than necessary and were only considered for discharge when a tribunal hearing was due. It found that in up to 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing. That suggests that some patients are being detained longer than is necessary.

The review recommended reducing from six months to three months the initial detention period for people admitted for treatment, so that a patient’s detention is reviewed sooner to ensure that patients are not detained when they are no longer benefiting from treatment and can be safely discharged.

Clause 29 will mean that patients detained for treatment have their detention reviewed three times—up from twice—in the first year: at three, six and twelve months from the date of detention. The new renewal periods will not apply to part III patients, except in very specific circumstances when an unrestricted patient changes status. I commend the clause to the Committee.

--- Later in debate ---

[Dr Chambers]

I do not know whether we could combine yoga with our proceedings, Mrs Harris.

The hon. Member for Hertford and Stortford spoke really well in a similar vein to what I am about to say. Our amendment 19 to clause 41 would extend the provision of opt-out advocacy services in England to informal patients under 18 years old. Young people and their families and carers often face a nightmare navigating the mental health system. We find this on every level. A psychiatrist who came into my office in Winchester said that he and his wife, who is also a medical professional, were struggling to navigate the system to get care for their own child. His words were quite profound: “If we can’t navigate the system, what hope has anyone else got?”

Even when young people have secured desperately needed in-patient care, often after many months of delay, they can face real challenges in understanding the care being implemented and its impact. Often, such young people are cared for far from home. Enabling them to benefit from mental health advocacy that ensures the pressures on the system do not lead to unfair or damaging decisions for mentally ill young people is crucial. It can help to ensure that the patient’s whole situation and entire history is always taken into account, and that treatment is always appropriate, rather than symptoms just being addressed in isolation. We should be looking to empower patients and their families and carers across the whole system, not just in relation to those who are sectioned.

[Gregory Stafford]

You will be delighted to know that there will be no yoga from me, Mrs Harris.

I rise to support clause 41 and schedule 3, which will expand access to independent mental health advocates to not only those detained under the Mental Health Act but informal voluntary patients. Like many Committee members, I am sure, a number of IMHAs in my constituency have approached me about this, and they welcome the expansion. I pay tribute to the amazing work that they do across Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Previously, only patients detained under specific sections of the Mental Health Act or subject to certain treatments were entitled to IMHA support.

The clause reflects the recommendations of the 2018 independent review of the Mental Health Act and the 2021 White Paper, and aims to enhance patient rights and reduce disparities in access to advocacy. That clearly empowers more patients by giving informal patients access to advocacy support. It improves transparency and accountability in mental health care settings. It ensures proactive outreach so that patients are not left unaware of their rights or support options, and supports informed decision making and potentially reduces coercive practices.

Clearly, there may be some resource implications for advocacy services, which the Minister may wish to touch on. Likewise, there may be some implementation challenges, which other hon. Members have raised, especially around ensuring timely and consistent notification and engagement. There could be potential delays in care co-ordination if advocacy processes are not well integrated. I would welcome the Minister’s thoughts on that.

This shift is long overdue. Too many vulnerable people, admitted voluntarily but feeling powerless, have lacked a clear, independent voice. The clause corrects that injustice by embedding advocacy deeper into the system, moving from passive availability to proactive engagement.

Schedule 3 underpins clause 41 by putting clear duties on hospital managers and advocacy providers alike to ensure that patients are automatically offered support. It is opt out, not opt in. That clarity of responsibility will reduce coercion, increase transparency and ultimately lead to fairer treatment decisions.

Schedule 3 operationalises the principles set out in clause 41 by embedding them in the structure of the Mental Health Act 1983. Like clause 41, it reflects recommendations from the 2018 independent review and the 2021 White Paper, aiming to reduce disparities in access to advocacy and ensure that all patients, regardless of detention status, are supported in understanding and exercising their rights. Like clause 41, it strengthens patient voice, reduces inequalities, improves compliance and encourages the early intervention and resolution of concerns.

Let me turn to Liberal Democrat amendment 19, which was tabled in the name of the hon. Member for Winchester. Clearly, its purpose is to extend the opt-out advocacy services in England to include informal patients under the age of 18. This ensures that children and young people who are not formally detained under the Mental Health Act, but who are receiving in-patient care, still have automatic access to an IMHA.

Currently, opt-out advocacy provisions primarily apply to patients who are formally detained. However, informal patients aged under 18, who may be in hospital with parental consent, can still experience significant restrictions and may not fully understand or exercise their rights. This amendment seeks to close the gap by ensuring that young informal patients are automatically offered advocacy support, recognising their vulnerability and limited legal autonomy.

My view is that this does strengthen patient rights. It safeguards vulnerable patients and promotes equality by aligning the rights of informal patients aged under 18 with those of detained patients. It supports informed decision making and helps young people to understand their rights and treatment options. If the hon. Member is minded to press the amendment, I hope that the Government will at least give it tacit support, even if they do not vote for it. That being said, I would welcome the Minister’s comments on why he does not feel that the amendment, or an alternative draft of the wording, if he does not like the specifics of it, should be included in the Bill. I do believe that this is important.

Government amendments 42 and 43 to schedule 3 are relatively technical but important elements of the Bill that align provision in England and Wales. I have just a few questions for the Minister. Robust rights must come with realistic resources. How will the Government ensure that advocacy services are funded and resourced properly to meet the new wider demand? Although they are technical, the Government amendments will still have an impact. What steps will be taken to monitor consistency so that a patient in Farnham, Bordon, Haslemere, Liphook or one of the villages surrounding my constituency has the same access to an advocate as a patient in Coventry, Aberafan or Swansea. We want to make sure that there is consistency.

Finally, will there be clear standards for timely engagement, especially given the risk of treatment delays if advocacy is not well integrated? If the Minister can answer those questions, I think that this will be a good step forward for patient voice and fairness in mental health, and I would support the clause and schedule 3.

--- Later in debate ---

[The Chair]

Does the hon. Member for Winchester wish to press amendment 19?

[Dr Chambers]

I think the hon. Member for Farnham and Bordon has spent more time discussing our amendments than I have, so I would like to give him the opportunity to vote in favour of one of them.

Amendment proposed: 19, in schedule 3, page 91, line 13, after “patient” insert—

“or English qualifying informal patient under 18”— (Dr Chambers.)

This amendment extends the provision of opt-out advocacy services in England to informal inpatients under 18.

Question put, That the amendment be made.