Mental Health Act 1983

Debate between Julian Lewis and Jackie Doyle-Price

Thursday 25th July 2019 Westminster Hall

[Jackie Doyle-Price]

I cannot give the hon. Gentleman a straightforward answer to that question but I will write to him with a commitment. It is very boring, but Brexit has diverted officials in the Department. Obviously, no-deal preparations in the health service are a matter of public concern, so we need to make them, but we still need to get on with business as usual. It is an important issue.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned the case of Matthew Leahy. I will go away and reflect on that, but I will give the same message as I gave in response to Seni’s law. Generally, we need to get a proper grip on how we learn from deaths that happen when somebody is in the state’s care, because that is clearly unacceptable. We have coronial reports of all those occasions. People should not be waiting the length of time that they are waiting for inquests. When inquests happen, again, there is usually representation from the various institutions involved and the family can be left feeling very under-represented against a mass of organisations trying to avoid liability. We need to tackle that properly.

We have had those discussions at the ministerial board. My ministerial colleagues in other Departments and I want to get a grip on how we properly hoist in the learnings from coronial reports. I look forward to engaging with hon. Members on that, but I will write to the hon. Lady specifically on the issue of Matthew Leahy. It is worth noting that we are looking at the principles of sexual safety in wards, which is not just about getting rid of mixed-sex wards. People are very vulnerable in those situations and it is all about the care regime.

[Dr Lewis]

Can the Minister tell us in simple terms what the situation is regarding the continuation or discontinuation of mixed-sex wards in mental health acute units?

[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

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[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.

[Dr Lewis]

The Minister says that that seems extremely sensible but if, for example, somebody is seriously mentally ill and imagines that their parents mean them harm when they are actually doing everything they can in support, should the parents be locked out from knowing what is happening to their child?

[Jackie Doyle-Price]

We will have to have that debate. My right hon. Friend articulates the opposing position to what I have heard. I regularly hear his example when I chair the national suicide prevention panel. We have had dialogue with NHS organisations and there is a consensus statement setting out the framework by which reports can be given to family members. Equally, patients who are detained under the Act should be able to say which family members should not be consulted about their treatment. For example, we see women who are victims of domestic violence and abuse by their partner and find themselves detained under the Act; their partner would normally be their next of kin, but it would not do those women any good for that person to be contacted.

[Dr Lewis]

I quite agree, but my debate was nearly nine years ago. Is it not a bit late in the day for the Government to say, “Well, we are having a conversation about this?” At the time, there seemed to be some quite sensible rules, but the main problem was that the local mental health authorities were not applying them. If anything, it seems that we are further away from our objectives than we were nine years ago.

[Jackie Doyle-Price]

I think my right hon. Friend misunderstands me. We have a consensus statement that governs how NHS organisations and practitioners should deal with people at risk of suicidality, although there is concern among bereaved families that it is not always followed. Equally, in delivering a service that empowers patients, those patients should be able to identify their nominated person. Those discussions take place much more frequently when people set up new relationships with NHS practitioners. When they change GP, for example, they are invited to nominate a person, in case there are any safeguarding issues.

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[Dr Lewis]

I hesitate to intervene one last time. I fully accept the Minister’s point about abusive partners, but what if the person is desperately, seriously ill and delusional, and the mother is not allowed to be told information about their offspring, because they are technically an adult? At what point do you decide that the person has lost capacity to identify correctly with whom information should or should not be shared?

[Jackie Doyle-Price]

That highlights the importance of having a nominated person earlier in the journey. I do not disagree with my right hon. Friend, but he highlights the difficulty of our work to get the balance right between keeping someone safe and respecting their wishes. I fully anticipate that when we produce the White Paper on this issue, he and I will probably have another debate about it. It is important that we get it right, with the safety of the patient in mind while empowering them to make their own decisions.

I have already mentioned that we will end police stations being places of safety under the Act, and that will be included in any legislation. On equalities, we are working with the NHS to introduce the first ever race equality framework to ensure that mental health care providers work with local communities to improve the ways that patients access and experience treatment. An important point is that although we are concerned that under the Act there are far too many detentions of people from black and minority ethnic communities, it is possible that is partly because they find it difficult to access services. We need to address that properly.

To help to address that, we are also launching a pilot programme of culturally appropriate advocacy. Clearly, we will need to make that resource available to ensure that people have access to it. The review said that we need to learn a lot more about that whole issue, so we will work with the National Institute for Health Research, which will launch a call for research later in the year to give us more answers. Jacqui Dyer MBE is our Mental Health Equalities Champion, and she will play a leading role in taking forward the review’s recommendations on tackling the injustices faced by black and minority ethnic services users.

I have spoken for quite some time; I hope I have covered most of the aspects mentioned. On the issue of funding, I have probably bored everyone senseless by saying that we are determined to deliver a much-expanded service, and our focus must be on developing those community services. We have made resources available to do exactly that through the long-term plan, but that is not to say that the issue is not still challenging. However, I hope we will be able to do much more in the community for people with severe mental illness, so that we can treat them in the community rather than have them go into crisis care.

To illustrate that with an example, if we can get people out of beds and into the community, the ability to look after more patients is really stark, so it starts to pay for itself. I discussed that with a clinical director from the NHS, who said that if they remove three people from in-patient beds and have them in the community, the productivity is so much greater straightaway. We rely on good local leadership to crack that and make it happen.

I have covered most of the things I wanted to. I will just reiterate my thanks to all Members who have participated in a very good debate, and I look forward to having discussions on the White Paper as it develops.

Surgical Mesh

Debate between Julian Lewis and Jackie Doyle-Price

Thursday 19th April 2018 Commons Chamber

[Jackie Doyle-Price]

I can absolutely give the hon. Gentleman that assurance. It is crucial that we address the matter transparently—that is very much the spirit in which I want to take this forward.

[Dr Julian Lewis]

Before those interventions, the Minister said that if people are still not getting adequate treatment, it should be brought to her attention. As I mentioned, I have been contacted by constituents saying they felt trapped because the people who did the procedures were refusing to refer them elsewhere for a second opinion and for possible help from the very small number of people who specialise in the rectification and reversal of these procedures. What advice can she give my constituents about how to break out of this restriction on being referred to people in whom they can have more confidence?

[Jackie Doyle-Price]

I listened carefully to my right hon. Friend’s representations on behalf of his constituents, and they filled me with alarm, because we have given a clear indication on this point and have established 18 specialist centres to deal with the consequences of mesh. There is, therefore, no excuse for patients who require further intervention not being properly referred. Perhaps he and I could take this up offline to make sure his constituents get the support they deserve.

I want to put this in the context of our broader emphasis on patient safety. We have learned, through difficult experience, that there is never one measure or magic bullet to suddenly transform services for patients; it is about sensible dialogue between patients, clinicians and sometimes politicians—sometimes we can have a role in catalysing the debate. We all need to pull together to tackle all aspects of the issue. In some respects it is about the actual product—the vaginal mesh—but it is also about clinical practice and behaviour, as we have talked about. The most important thing, however, is the need to listen to patients, who, in this context, are of course women. We have to make sure that we listen to women when concerns are raised so that we can properly tackle those concerns as they arise. As I have said before, I am concerned about informed consent for patients, but the issues go much further, and generally we could do much to improve the performance of the NHS by placing a greater emphasis on that.

We need to consider the whole issue of clinical advice. We know that this product should not be routinely offered as a first intervention, yet clearly it is. I am horrified to hear of women in their 20s and 30s being treated with this product, when clearly it is not intended for them. It is obviously easy for me to make a superficial judgment on that without knowing about the particular cases, but on the face of it, it seems quite wrong.

The issue has been raised of what is an acceptable level of risk. I do not like to think about that in terms of percentages, because the acceptable level of risk will differ from patient to patient. If we are talking about some new mums, the level of risk clearly would not be outweighed by the benefits, but if we are looking at women suffering from horrendous conditions of incontinence, that is a very different debate. Again, we need to think about the broader issues. It all comes down to making sure that the guidance is properly applied and that clinicians who are recommending the use of mesh are properly making that assessment in discussion with their patients.

There has been a demand for a public inquiry. We have introduced the Cumberlege review, which is designed to make sure that we properly assess the interests of patients going forward. I know that many patients have felt that their views have been ignored. Baroness Cumberlege is very keen to hear directly from individual patients about their experience, and will be going round the country to do exactly that.

I could say much more, but I must conclude so that we can move on to the next debate. I will write to hon. Members, who I thank for contributing to the debate, to address some of their other points. We are determined to do our best for women who have been badly treated in having this procedure.

Cyber-bullying: Young People’s Mental Health

Debate between Julian Lewis and Jackie Doyle-Price

Monday 16th April 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank my hon. Friend the Member for Cheltenham (Alex Chalk) for securing this timely debate on the important issue of the effects of cyber-bullying on young people’s mental health. He articulated extremely well the challenges that we need to tackle, and I agreed with much of what he had to say about them.

I pay tribute to my hon. Friend for the report that was published recently. As he said, 1,000 young people participated in the inquiry and produced a useful body of evidence from which to draw conclusions. I also thank the Children’s Society and YoungMinds for their role in the inquiry. I met representatives of YoungMinds today, and I have regular dialogues with them on the broader issues relating to the mental health of children and young people. They are very important partners for us in this context.

As my hon. Friend recognised, a number of Departments have an interest in this matter. I have often said that silo culture is the enemy of good policy making, and I am pleased to say that the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport are all approaching the issue from their own unique perspectives, and attacking it from different angles. We are all committed to tackling the scourge of cyber-bullying, although, as my hon. Friend pointed out, it is an emerging issue that requires careful consideration of the evidence and joint working to enable us to start stemming the flow. He was right to say that we need to draw conclusions in a timely way to ensure that we have the appropriate tactics for prevention.

It is important to recognise that the term “cyber-bullying” is often misleading. We are talking about two separate elements. Bullying is a kind of behaviour that can take many forms, and social and other cyber-media are tools for that bullying. As my hon. Friend and my right hon. Friend the Member for New Forest East (Dr Lewis) have said, this has become a particularly acute problem to tackle as those tools can be anonymous. That dehumanises both the bully and the victim, and if we do not get it under control more effectively it will become the epidemic my hon. Friend has warned of.

Turning to what the Government are doing, the Department of Health and Social Care is focusing on improving services for children and young people’s mental health. We know that children and young people’s mental health services need to improve, and we have a programme of work under way, supported by more than £1.4 billion of additional funding, to achieve just that. As my hon. Friend the Member for Cheltenham will know, the Department of Health and Social Care and the Department for Education recently published a joint Green Paper on children and young people’s mental health, which was supported by a further £300 million.

Through that Green Paper, we acknowledged the potential impact of social media and the internet on children and young people’s mental health, but, most significantly, we identified that effective mental health care for young people does not have to take place in a clinical setting. That reinforces the importance of getting the right support in schools, which underlines my hon. Friend’s priority of preventive measures. That is why we are placing much more support in and around schools, where young people spend so much of their time.

We are also taking action to use the digital world to our advantage, using positive digital interventions for mental health. For example, NHS Digital is producing an apps library that brings together a number of digital tools to help improve health, including mental health and wellbeing, for all ages. Over time, many more tools will be added to the library to support more health needs and drive up quality.

Turning to the online world, where I think my hon. Friend is more interested in holding other agencies to account, the Department for Digital, Culture, Media and Sport last year published our internet safety strategy Green Paper. A response to the consultation process will be published imminently, and I am sure my hon. Friend will be first in the queue to read its conclusions. It will include a number of preventive initiatives to tackle cyber-bullying so that all users of all ages feel confident in being online. For example, during the consultation we proposed a voluntary social media code of practice. The intention is for the code to provide guidance to platforms about how they should tackle abusive behaviour and content and support all users, because adults can be bullied just as much as children on social media platforms.

I personally think the providers can do a great deal more. My hon. Friend referred specifically to Facebook. While Mark Zuckerberg’s comments to which he referred are welcome, I think a lot more can be done. Given that reporting to social media companies is low among those who recognise that they have been cyber-bullied, and that children have little confidence in social media companies to resolve cyber-bullying, the internet safety strategy Green Paper also involved consultation on annual online safety transparency reporting by companies. That reporting is intended to both develop better understanding of the extent of bullying behaviours and encourage those who are being bullied to make referrals to those companies. Social media companies must do more to raise awareness and improve the clarity of their reporting mechanisms in relation to cyber-bullying, and we hope that improving transparency reporting will help improve the likelihood of young people reporting these issues in the future.

As I have said, however, this is not an online-only issue, and the Department for Education is taking action to prevent bullying in general as well as cyber-bullying. All schools are legally required to have a behaviour policy with measures to prevent all forms of bullying. The Government have already put in place a number of powers and a range of support to enable schools to prevent and tackle cyber-bullying. For example, headteachers have the power to regulate pupils’ conduct when they are not on school premises. Where bullying outside school is reported to teachers, it must be investigated and acted on. We have also ensured that schools have the power to ban, limit the use of, or search mobile phones in school, and the Government Equalities Office funded the UK Safer Internet Centre to develop cyber-bullying guidance for schools and an online safety toolkit to help schools deliver sessions about cyber-bullying, peer pressure and sexting. I can advise the House that the Department for Education is also providing £1.75 million of funding over two years to support schools in tackling bullying, with cyber-bullying being an integral element of that.

Returning to the role of social media companies, we really believe that they have a central role to play. That is why we set up a joint working group with the Department for Digital, Culture, Media and Sport to discuss how to make progress in specific areas, particularly that of age verification. My hon. Friend said that many young people are spending a great deal of time online—more than was good for their health—and we want to explore time limits. On the question of age verification, I am clear that the social media companies could do a lot more to protect young people. The reality is that if they can collaborate on developing apps that allow people to harvest data, they can use the intelligence on their platforms to identify young people and communicate with them. We recognise that some companies have existing work in place, and we congratulate them on that, but a lot more can be done. There are significant challenges to overcome, and there remains a need for further action to be taken. We are actively encouraging companies to work with us and to make tangible progress in this area.

We have heard what the Government are doing to tackle these problems as they arise, but we also need to recognise that, without further research, our efforts will not reach the level that we need and that young people deserve. We have heard the statistics already this evening. Social media and the internet are an ever-growing part of children’s and young people’s lives. As my hon. Friend has said, some individuals are spending an inordinate amount of time online. More than half of 12-year-olds have a social media profile, and those are the people who really need our protection. However, although evidence has shown links between increases in social media use and poorer mental health, it is not clear whether that increased use causes poorer mental health, or whether poorer mental health drives an increase in use of social media. We need to develop more evidence on that.

We should also recognise that there are positive impacts of social media use that can really improve the lives of children and young people suffering with mental health issues. It can build a community that they can access to increase their self-esteem and get social support. In practice, that could mean children collaborating on projects through better online communities—for example, a homework WhatsApp group for people in the same class or a Twitter hashtag for those studying for school or university exams. So let us keep a balance here: there are some positives. Young people also take advantage of being able to access supportive online networks of people with similar health conditions, which could be more difficult in the offline world.

I should also like to welcome the Science and Technology Committee’s recently launched inquiry into the effects of social media on young people’s health. I am sure that my hon. Friend will be watching that with interest too. I look forward to contributing to the inquiry and to hearing its outcomes, which will add to our evidence in this area. I can also advise the House that, in order to better understand the relationship between social media and the mental health of children and young people, the chief medical officer is leading a systematic review to examine all relevant international research in the area. For the review, existing literature will be searched extensively, which will enable Professor Davies to build a map of research activity, identify the areas for in-depth review and subsequently allow her to examine the areas in detail. This will allow her to assess the relative strengths and weaknesses of the evidence base, as well as considering the positive and negative impacts of social media.

In conclusion, across Government, we are as clear as my hon. Friend is about the need to take action to tackle and prevent the increase in cyber-bullying, as well as the need to improve the support available to those suffering as a result of it. We are incorporating such action within related work streams across the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport. It is clear that a cultural shift is needed to ensure that future generations do not accept cyber-bullying as the norm, and that they know when and how to access support and help. We need to make it clear what online behaviour is acceptable and what is not. We have made it clear as a Government that we are prepared to work with social media and technology companies in this area, and, like my hon. Friend, we expect them to take significant further steps. However, the buck stops with them. The ball is in their court and they need to do much more. We will continue to maintain the dialogue on that basis. I thank my hon. Friend again for raising this important issue. I have no doubt that we will come back to the subject again.

[Dr Julian Lewis (New Forest East) (Con)]

On a point of order, Mr Speaker. With the blessing of the Government Whip here present, may I ask whether any steps have been taken to reinstate the curtain-and-commode system that used to envelop the Chair, so that on occasions like today, when you have sat there continuously from when the House first met until the House adjourns this evening, you might be able to do so in a little more comfort?

Contaminated Blood

Debate between Julian Lewis and Jackie Doyle-Price

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

As I mentioned, no firm view has been taken as to which Department will run the inquiry, but as the Minister with responsibility for this area the House would consider it amiss if I were not having meetings and discussions with those affected about the inquiry’s remit. When the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), made the statement to the House about the inquiry, we made it clear that we wanted to progress as soon as possible. The Secretary of State called this meeting because we want to hear directly from the victims about what they want from the inquiry. We are very much in listening mode. A decision has not yet been taken as to which Department will run the inquiry but ultimately, as a Minister, I am accountable to Parliament for what happens in the Department of Health in those areas for which I have responsibility, and I want to be leading from the front, having those discussions.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for saying that no decision has yet been taken about which Department will run the inquiry. Does she agree that perception is as important as reality in this matter, and therefore will she gain from this occasion a mindfulness of the weight placed by hon. Members, on both sides of the House, on the idea that the inquiry perhaps would be perceived to be more objective if some other Department took the lead?

[Jackie Doyle-Price]

I say to my right hon. Friend, and I have repeated this in other discussions as well, that the Cabinet Office is very closely involved in this, and this opportunity has given me the time to make that clear to the House. The Government are listening; we want to consult as widely as possible. No decision has yet been taken, but the Cabinet Office is closely involved in all the consultation we are currently having.