Mental Health Bill [ Lords ] (Sixth sitting)

Josh Dean Excerpts

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Stephen Kinnock]

This amendment seeks to overturn the previous amendment tabled—sorry, I should have said “the clause”. The clause seeks to overturn the previous amendment, tabled by Earl Howe and Lord Kamall. Although we support the intention of the amendment, our view continues to be that it would be duplicative.

There are already many ways in which service user feedback is used to inform policy and practice. For instance, every year the Care Quality Commission conducts thousands of interviews and visits with people detained under the Mental Health Act 1983. That may result in the CQC investigating a complaint or requiring an action statement from providers about service improvements. Although there may be room to enhance existing feedback mechanisms, we would prefer to improve what we have rather than create something new that would risk confusion.

If the objective is to provide time and space for the person to reflect on their past experiences post-discharge, I reassure the Committee that that should already form a part of co-producing a person’s care in the community plan. We also intend to create space for individuals to reflect on past experiences when making their advance choice document, with facilitation from a suitably qualified person.

[Josh Dean (Hertford and Stortford) (Lab)]

Young people who have been through detention often report challenging circumstances following that detention. Rather than supporting them, that sometimes increases their trauma. Can the Minister assure me that, as part of the changes he just set out, we will still ensure that young people have the opportunity to feed their experiences back? What specific work will the Government undertake to gather those views from young people?

[Stephen Kinnock]

My hon. Friend makes an important point. We are absolutely committed to ensuring that we create a space for young people to provide feedback. Some of that will be around past experiences when making their advance choice documents, but much broader opportunities for feedback will absolutely be built into the system. We want this to be a learning process. It is important that the code of practice is not just a document that sits on the shelf gathering dust; it should be a live document. That is why the feedback is so important.

It should be noted that although reflecting on past experiences may be therapeutic for some individuals, for others it can be traumatic, so the measure should be entirely service-user led. We also continue to be concerned about the burden that the amendment would place on independent mental health advocacy services, which are already under strain.

--- Later in debate ---

[Aphra Brandreth]

I rise to speak to clause 41, which brings into sharper focus two pillars of a fair and rights-based mental health system: the provision of clear information to patients and the strengthening of independent mental health advocacy. It rightly recognises that, when a person is detained under the Mental Health Act 1983, often during a period of acute crisis and difficulty in their life, they need to feel that their clinical needs are being met, but in a way that respects them as individuals, with the same entitlements to dignity and agency as any other member of our society.

The clause provides for informal patients to be eligible for an independent mental health advocate. I welcome the extension to enable more individuals to access this vital advocacy. It empowers patients to know that independent advocacy is available, but we must ensure that there are sufficient resources so that those who choose this help are given sufficient support when they are in a potentially vulnerable position. As someone representing a constituency that is in England but borders Wales, I also welcome that these changes bring care into line so that advocacy help is offered to informal patients, regardless of which side of the border they are accessing treatment.

The clause places a renewed duty on services to ensure that information is given to patients clearly, promptly and in a form that they can understand. It introduces an obligation for advocacy providers to determine, through an interview, whether a qualifying patient wishes to use the service. This support is important; no person should be expected to navigate the complexities of mental health legislation, or their rights under it, without proper guidance. However, where there is a duty

“on hospital managers and others to notify providers of advocacy services about qualifying patients”,

can the Minister clarify who is meant by “others”? Will there be a list of people and roles who are given this responsibility?

The role of an independent mental health advocate is vital. These individuals can be a lifeline. They can help people to understand their rights and any medical treatment, and crucially, can support an individual to have their say about any treatment. Clause 41 rightly reinforces the importance of independent mental health advocates, and it is important that we match that ambition with the legal and practical steps to support them.

It is entirely right that we welcome the recognition of the role of independent mental health advocates, who serve a vital function in ensuring that patients’ voices are heard and their views represented, especially when navigating what can be an incredibly complex legal and clinical environment. Their independence is fundamental to not only their effectiveness but the confidence that patients and families can place in the system, which brings me back to my point. It is therefore important that we support independent mental health advocates with the resources that they need to do their job effectively.

If we are to rely further on advocates, we need to ensure that they are in a position to deal with that, so that we do not create statutory entitlements that are difficult to act upon. Actions, as well as words, are needed. At present, many areas already struggle with advocacy coverage. If we now place additional expectations on the service, and I believe that we will through this provision, we must ensure that there are sufficient numbers of trained, experienced independent mental health advocates across the country to meet rising demand. Can the Minister reassure the Committee that the necessary people with the skills and training are available to fulfil this expanded role?

We must also consider the patients’ experience, as has been the focus of so many of the remarks made in the Committee today. Again, I emphasise the vulnerability of patients at times of crisis. If we are to tell patients that support in the form of an advocate is there for them, we need to ensure that it is accessible and easy to reach and understand. Clause 41 moves us in the right direction, but implementation is everything. It must be backed by local accountability, adequate funding and clear operational guidance. This includes ensuring that all patients, regardless of background, language or capacity, are given support that is appropriate and effective.

It is vital to consider the wider implications of this clause. The reinforcement of the independent mental health advocate’s involvement should be mirrored by greater investment in advocacy services, stronger integration with care planning and more regular engagement with patients themselves on how these services work in practice. In our earlier discussions, my hon. Friend the Member for Farnham and Bordon suggested that we use trials, which could also be considered here to ensure that, as changes are brought in, they are matched by appropriate service levels.

I am largely supportive of clause 41, which I think moves us in the right direction towards a transparent mental health system that is there for patients, ensuring that they have a voice and are not an afterthought. As long as it is deliverable in practice, and does not give false hope to patients, the clause strengthens the Bill.

[Josh Dean]

It is a pleasure to see you in the Chair, Mrs Harris—when I wrote my speech, it said “this afternoon”, but it now says “this evening”. I rise to speak to clause 41 and schedule 3. I welcome the role that they will play in extending the right to access the services of an independent mental health advocate to voluntary patients in England not detained under the Mental Health Act, and ensuring that all detained patients are offered these services through an automatic referral, creating an opt-out system.

Independent mental health advocates play an important role in supporting patients detained under the Act to understand their rights and participate in decisions around their care and treatment. Clause 41 and schedule 3 seek to ensure that the individual needs of each patient are taken into account, even where they may not be able to engage in decision making about themselves. In doing so, they recognise the patient as an individual. This provides for important safeguards for patients and reinforces the Bill’s principles of autonomy and least restriction, which is a crucial part of bringing mental health legislation into the 21st century. I similarly welcome Government amendments 42 and 43, which seek to further strengthen the important safeguards in the Bill.

I hear the points that the Minister has made on children and young people admitted informally, but I would be grateful if he could address the matter further. As we know, informal patients are those who consent to an admission to a mental health hospital or whose parents consent to an admission on their behalf. Often, they are treated under the same or similar conditions as those detained under the Act. While detained patients will receive an automatic referral to advocacy services under the new opt-out scheme, my understanding is that that will not be the case for those admitted informally, meaning that informal patients would still be required to ask for the support of an independent mental health advocate.

Children admitted informally are likely to experience the same conditions as another child detained under the Act, but without the parity of access to advocacy services through the opt-out system. Because a parent is able to consent to informal treatment on their child’s behalf, they are one of few groups, if not the only one, able to be admitted informally without their own consent. Therefore, there is a concern that children and young people admitted informally may continue to experience problems accessing the support of an advocate. I seek the Minister’s assurance that the Government have considered fully the provision of advocacy services for informally admitted children and young people, and how this gap might be addressed.

I welcome how these parts of the Bill will embed those important principles of individuality, autonomy and least restriction, expanding the important safeguards offered by independent mental health advocates. I would be grateful if the Minister could touch on those points about children and young people in his response.