Mental Health Bill [ Lords ] (Eighth sitting)

Josh Dean Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the Minister for his comments on new clause 17, but I will speak to it briefly along with new clause 20, and then consider not pressing it later.

New clause 17 aims to end the harmful and inappropriate practice of detaining children on adult mental health wards. We know that children in mental health crises are among the most vulnerable in our care system. Placing them in an adult ward is not only developmentally inappropriate; it risks causing further trauma and harm. The practice continues not because it is clinically justified but because of a lack of specialist child and adolescent mental health provision.

Despite the existing statutory guidance under section 131A of the Mental Health Act, hundreds of children are still admitted to adult settings each year. That is a systematic failure. The new clause sets a clear goal: reduce the number of children detained on adult wards to zero within five years. It would also require the Secretary of State to publish within six months a concrete plan of how this will be achieved, including how children’s mental health services will be expanded. It is a question of not just capacity but political will. I urge the Committee to support the new clause if we press it to a Division. I say to the Minister that we are still looking for timelines. We need to protect young people from going into inappropriate adult mental health settings, as I have heard too often from residents in my constituency.

New clause 20 would place a statutory duty on the Secretary of State to report within 18 months how to improve transitions between in-patient settings for children and young people and those for adults. I heard a particularly distressing case in my constituency recently, where an individual turned 18 and almost the next day was placed in an adult mental health setting. It was completely inappropriate for that individual, and no real transition work had been done. I appreciate that the Minister says that there is clear guidance, but that guidance has clearly not been adhered to at all times.

The new clause would require statutory guidance for integrated care boards, local authorities and providers, covering essential components, such as clear pathways and timelines, joint working across services, early identification of those needing transition support, and updates to care plans that reflect changing needs. We believe that the new clause is clear, proportionate and achievable. It asks for a plan and for consultation and guidance that can support more stable, person-centred care at a critical point in a young person’s life.

The Minister has indicated that he will not support the new clause. If he is unwilling to do so, my request is that he sets out how the Government will ensure the issues around transitioning between child and adult mental health services are addressed—particularly a clear timeline. He has mentioned a number of documents coming forward that start to address these issues, but as I have expressed, clearly the guidance already exists but it has not been adhered to in all cases, so we would like to see the timeline.

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

It is a pleasure to serve under your chairship once again, Mrs Harris. The Minister has set out in detail the function of clause 54, so I will not cover that in detail for reasons of time. I welcome the clause, which represents a step forward in regulating the placement of children and young people in adult treatment settings, and in ensuring their safeguarding. I welcome the fact that it recognises the need to review the existing safeguards available to young people.

The independent review of the Mental Health Act made recommendations in this area, including that when an under-18 is placed on an adult ward, the CQC should be notified within 24 hours, and that the reasons for and the proposed length of the placement should be recorded. I would be grateful if the Minister would set out what consideration the Government have given to those recommendations, and whether they will form part of the review.

I turn to the important matter of children and young people who are under 18 placed in adult treatment settings. I think we all recognise the extremely difficult context in which these detentions take place. We know that there is a serious shortage of specialist in-patient beds for children and young people, which means that places are often full or may not be available at a time of urgent crisis.

When someone under 18 is placed in an adult treatment setting, they are more likely to witness or even experience high levels of restraint, be denied support from their peers, and lack access to educational opportunities. These placements can actually cause further harm to children and young people’s mental health, and therefore be detrimental to their recovery. I will be grateful if the Minister can assure me of the actions that the Government will take to further safeguard those children and young people who hit crisis point and find themselves in adult treatment settings because of the shortage of beds. How will we ensure that they are protected from being placed in inappropriate treatment settings?

I do not wish to test your patience, Mrs Harris, but before I conclude I want to examine the point about children and young people a little further, given the interaction of clause 54 and associated new clauses with their treatment. I welcome the Government’s consistent restatement of the importance of getting the Bill right for children and young people. I know that the Minister takes such matters incredibly seriously, and I have listened carefully to what he has said this afternoon and throughout the Committee.

The Minister has stated that a number of the reforms relating to children and young people will be addressed in the code of practice, but that contrasts with the approach of many of the welcome safeguards set out for over-18s in the Bill. Will the Minister clarify why these issues are being addressed differently when it comes to children and young people, compared to adults? Children and young people are a uniquely vulnerable group.

On the point about the code of practice, I note that any deviation from that would need to be justified, but my understanding is that the code cannot impose duties on practitioners or require them to exercise their functions under the Act. I am concerned that putting safeguards for under-18s on a different footing from those for adults could make it harder for young people to access those safeguards. I welcome much of the work being done by the Bill, and I want to make sure that children and young people can also access its safeguards. I will be grateful if the Minister can address those points in his response.

In conclusion, I welcome the step forward that clause 54 represents, because it addresses an important issue that we need to get to grips with. I look forward to the Minister’s response.

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to speak in support of clause 54, but with the caveat that it would be much more effective if new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, were added to the Bill.

Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 requires healthcare providers to notify the Care Quality Commission of certain serious incidents. However, it may not comprehensively cover all mental health-related admissions of minors. Clause 54 responds to concerns about transparency and safeguarding in child and adolescent mental health services, and aims to ensure that all relevant incidents are properly monitored and reported.

Like other hon. Members who have spoken, we welcome the Government’s shift to improve these standards; there is support for that across the Committee. The clauses about children and young people are some of the most vital parts of the Bill. They are vital not only to get the Bill right but, more importantly, to ensure that children are protected. That is why new clause 12, in the name of my hon. Friend the Member for Hinckley and Bosworth, is so essential to strengthen the Bill.

The new clause would amend section 131A of the Mental Health Act 1983, which governs the accommodation of children in mental health settings. It responds to ongoing concerns about the inappropriate placement of children on adult wards, which can be distressing and unsafe, and which is clearly contrary to best clinical practice. The new clause would introduce a requirement that hospital managers must justify such placements in writing, including an explanation of why no alternative was available, and the steps being taken to ensure the child’s safety and transfer to more suitable accommodation. The new clause would also introduce mandatory reporting to regulatory authorities when a child was placed on an adult ward for more than 24 hours, and to local authorities when the placement exceeds 28 days, or involves an out-of-area admission.

The new clause would ensure that children are placed on adult wards only when absolutely necessary. It requires the written justification and formal notification of placements. It involves local authorities and regulators in monitoring prolonged or out-of-area placements, and strengthens and clarifies existing provisions of the Mental Health Act. Most importantly, it aligns with clinical guidance on age-appropriate mental health care.

I turn to new clauses 17 and 20, tabled by the Liberal Democrats. I think that their purpose is in some ways similar to that of our new clause 12. However, they put the cart before the horse, or the horse before the cart —it depends on which way round we are. We are trying to fix the system by ensuring that nobody enters an inappropriate place unless there are exceptional circumstances; new clauses 17 and 20 try to exclude those circumstances, but without necessarily fixing the problem in the first place. Although I understand, as ever, the motivations and sentiments of the new clauses tabled by the Liberal Democrats, I do not think they will have the intended consequences; at least, I do not think they will be effective.

I have two questions for the Minister about clause 54. First, will the Department publish regular summaries of the notifications mentioned in the clause showing trends and disparities across the services or regions? Secondly, will the Care Quality Commission be resourced and empowered to act swiftly where patterns of overuse or misuse emerge?