Mental Health Bill [HL]

Lord Bradley Excerpts

Tuesday 14th January 2025 Lords Chamber

[Baroness Whitaker (Lab)]

My Lords, I first apologise for not having been able to speak at Second Reading; I would have welcomed the Bill. In speaking to Amendments 2, 49, 52, 60, 112, 114, 118, 119 and 126 in my name, I declare my interests as honorary vice president of the Royal College of Speech and Language Therapists, as a former member of the Tavistock and Portman NHS Foundation Trust board, as a patron of the British Stammering Association, and as a stammerer myself. I thank the Royal College for its briefing and my noble friend Lord Bradley and the noble Lord, Lord Patel, for their support. I also warmly support Amendment 1 in the name of the noble Baroness, Lady Tyler. I shall add amendments consistent with it in a later group.

My amendments, which are supported by 49 professional, charitable and training organisations, are all based on the premise that speech and communication difficulties are an insufficiently recognised component of a very great number of mental ill-health symptoms and that professional speech and language therapy could—and should—enable more successful treatment. One study found that 80% of people accessing mental health services had a difficulty with language and 60% with communication or discourse. Especially in the case of children and young people, those with a mental health disorder report having five times more speech or language problems than those without. One study found that 81% of children with social, emotional and mental health needs had significant unidentified language deficits.

One of the problems with the lack of specialised staff to help such children is the demoralisation or challenging behaviour that comes from frustration with unmet communication needs, quite apart from the impediments to treatment. I could quote many examples of this, as well as some success stories—for instance, where speech and language therapy effected a sizeable reduction in the use of restraint in a secure children’s home, or enabled psychological treatment to work and give the inestimable benefit of the ability to cope. I must emphasise that most of us take the ability to communicate for granted, perhaps without realising how essential it is to our lives. It is when it is lacking that you notice what it means. I am therefore sure that it must underpin the principles of this excellent Bill.

Amendment 2 does that. Without a rider of that kind to the principles, we will not have effective treatment in very many cases of acute distress and challenging behaviour. Amendment 49 puts the speech and language therapist squarely in the frame of responsible clinician, so that where communication difficulties are the key problem, that can be tackled. Amendment 52 does the same for treatment decisions and Amendment 60 for care and treatment plans.

Amendment 112 provides the same safeguard for detained patients who need to complain and Amendment 114 is to make sure that patients can understand their information on discharge, which is surely essential. Amendments 118, 119 and 126 have a similar function: to make sure that advance choice documents are properly understood and properly made.

[Lord Bradley (Lab)]

My Lords, I rise to speak in support of Amendment 2, to which I have added my name, but first I declare my interests as listed in the register, especially as honorary vice-president of the Royal College of Speech and Language Therapists and as an honorary fellow of the same organisation. I am able to speak briefly as a result of the excellent explanation of these amendments by my noble friend Lady Whitaker, which I am pleased to support.

As we have heard, the lead amendment would place a requirement in the statement of principles to specify in the table the communication needs of the individual and recognise the disability, difficulty or difference to ensure they will be identified and supported. This requirement then flows throughout the Bill—as evidenced by the number of amendments to which I have also added my name—ensuring a thread of consistency for this vital area of support. These include, as we have heard, Amendments 49, 60, 112, 118 and 126, but I will not speak specifically to each of those and test the patience of the Committee.

The importance of Amendment 2 is clearly laid out in the excellent briefing, as we have heard, prepared by the Royal College of Speech and Language Therapists and endorsed by at least 46 related organisations representing this crucial area of work and service.

As we know, communication is fundamental and foundational to human life. It is central to how we express ourselves, how we understand others and how we interact. It is also fundamental and foundational to the aims of this Bill. It underpins the principles to inform decisions and is key to the matters to be addressed. Crucially, it ensures the individual is properly involved in the decisions taken as a consequence of this legislation. As we know, many people accessing mental health services have some form of communication disability, difficulty or difference. This can affect whether they are able to make themselves understood, understand what is being said to them, and how they interact with people. Left unidentified and unsupported, it can subject people to a range of negative outcomes, including inaccessible referrals, assessments, treatment and care and, potentially, unnecessary detentions and detentions longer than necessary.

I first recognised this issue when I undertook my independent report for the then Government, published way back in 2009, about people with mental health problems or learning disabilities in the criminal justice system. At that time, I identified appropriate adults as a key group to support people with communication issues and recommended that they should receive specific training to ensure the most effective support. They still play an invaluable part in such communication. I also recommended the establishment of liaison and diversion services, and I am pleased that in the subsequent years they have been rolled out across the country and we now have 100% coverage for that service.

These liaison diversion teams, placed in police stations and the courts, identify, assess and support people with complex needs, including mental health problems, to try to divert them away from the criminal justice system and support them along the criminal justice pathway. I recognised during this rollout that certain key additional services should be connected to the teams, including speech and language therapists, to enhance the support required for these people with communication difficulties in a variety of settings and circumstances. As the speech and language therapists who I have met over the years themselves identified, these many situations and settings include significant unmet communication needs among individuals on mental health wards, challenging behaviour relating to communication needs, lack of staff knowledge and skills in relation to communication needs in people with mental health conditions, and many more.

Although it is welcome that the Bill’s Explanatory Notes highlight that a care and treatment plan

“may also contain other information, for example, how the patient’s communication needs will be met”,

clearly this is not sufficient. The Bill must therefore be strengthened to make it explicit both that communication is central to the Bill’s aims and that

“communication disability, difficulty, or difference”

must be identified and supported. This would help to ensure that people receive the best possible treatment and care to support their recovery, including through the necessary reasonable adjustments that should be made. It would also help to reduce the risk to them, including of their being unnecessarily detained, and to assure the wider public. These issues must also be fully covered in the code of practice. I hope therefore that the Government will recognise the importance of such communication being in the Bill and look forward to the Minister’s response on these points.

--- Later in debate ---

[Lord Stevens of Birmingham (CB)]

I too am supportive of the spirit and intention behind Amendments 19 and 20, but I want to raise two textual questions relating to whether they would give effect as was intended.

In respect of Amendment 19, I am not sure that the explanatory statement accurately characterises what the amendment proposes. It says that the amendment ensures that ICBs and local authorities would

“have a duty to carry out”,

whereas at the point at which those words would be inserted it appears that the duty would also then fall to the patient’s responsible clinician. Amendment 19 by itself would essentially see CETRs overriding the judgment of the responsible clinician, which I think is quite a significant step to take.

In any event, I wonder whether Amendment 20 undoes any of the good work that Amendment 19 proposes in the first place. It says that you can ignore the exhortations of Amendment 19 if there is a “compelling reason” to do so. My question to the drafters of Amendment 20 would be: what statutory interpretation should be placed on “compelling reason” and how might the courts be expected to adjudicate in the event of judicial review?

[Lord Bradley (Lab)]

I support and have added my name to Amendment 13, tabled by the noble Baroness, Lady Tyler, around communication issues. As she rightly pointed out, this could have been linked to Amendment 2, which has already been debated at some length. I will not repeat the same arguments, but they apply to this amendment, which is why I support it.

I also very strongly support the amendment on housing tabled by the noble Baroness, Lady Barker. I am chair of NHS England’s health and justice advisory board and have worked on the development of RECONNECT, the service to support people coming out of prison back into the community, which is very much a health-based initiative. Unless their housing needs are met at that point, their treatment, their support and their care plan can fall apart very quickly. Consequently, they are very quickly back in the criminal justice system. The same comparison can be made with this amendment. I strongly support housing being at the core of all issues relating to health and social care.

[Baroness Berridge (Con)]

My Lords, I rise to support the noble and learned Baroness, Lady Butler-Sloss, on Amendment 9. I know that there are other amendments in relation to the inclusion of parents and guardians. I raise just two small points in relation to this.

When one looks at where this amendment is inserted in the list, the last of the persons currently listed who would receive the report is

“the local authority in whose area the patient is ordinarily resident”.

That potentially will not always be the local authority where there is a care order. Therefore, in those circumstances, the local authority is caught with an

“other person who has parental responsibility”.

However, that is not how this is drafted in other parts of the Bill, where an

“other person who has parental responsibilities”

means guardians et cetera. For consistency of drafting, we need to look at that.

I know that the Minister has been very generous in the time that we have had with her and her officials, but we need a consistent phraseology within the Bill because with this amendment, if there was a special guardian the report would also go to the person with what is informally known as residual parental responsibility. Normally they are informed only, for instance, of the change of name of the child or if the child is going to leave the jurisdiction. We need to look at everybody with parental responsibility and have some consistent phraseology within the Bill when we are meaning the local authority when there is a care order and parental responsibility, to include all the different circumstances in which a child may have their status changed from the ordinary situation of living at home with parents when a court order is in place.

Mental Health Bill [HL]

Lord Bradley Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Bradley (Lab)]

My Lords, it is always a pleasure to follow the noble Baroness, Lady Hollins, with her expertise in this area. I declare my interests as listed in the register and am pleased to make a short contribution to this debate. It has been some time coming.

Following the excellent review of the Mental Health Act, initiated by the noble Baroness, Lady May, Sir Simon Wesley produced his report in 2018 and a draft Bill was published by the last Government, as we have heard. This was followed by detailed scrutiny by the Joint Committee of both Houses, which I was pleased to be a member of and which was so admirably chaired by the noble Baroness, Lady Buscombe. It was disappointing at that point that the deliberations were paused, but I was delighted that the new Government, following a manifesto commitment, immediately introduced this Bill, which everyone has welcomed today.

In the time available I will focus on only a few areas, the first of which is the proposed changes under Part 3 of the Bill—essentially, the interface between mental health and the criminal justice system. I am delighted that Clause 35 proposes a statutory time limit of 28 days for the transfer of acutely mentally ill patients held in prison to appropriate hospital provision. It is now well recognised that the prison environment and care capacity is detrimental not only to the prisoner but to other prisoners and the staff who care for them. I made a similar recommendation in my independent report to government in 2009, nearly 16 years ago—albeit with the perhaps unrealistic time limit of a 14-day transfer. Clearly, you have to be patient and persistent to achieve legislative change.

Secondly, on Clause 46 and the removal of police stations and prisons as places of safety, I made related recommendations back in 2009, and I am obviously now pleased that there is overwhelming recognition that both facilities are not appropriate as places of safety. Clearly, detailed examination of these proposals will be required in Committee to ensure that the wording delivers their intention. For example, when will the clock start on the 28-day limit?

Thirdly, for this to be effective, investment in alternative community-based healthcare provision will be required for places of safety, as will investment in liaison diversion services, to ensure that only those who need to obtain a place of safety. Otherwise, as we have heard, A&E departments will continue to be the default position, at huge cost to the NHS and to the police service. We also need additional acute mental health beds in every local area to ensure timely transfers and to make the legislative changes a reality.

There is also concern, well articulated by the Children & Young People’s Mental Health Coalition, that children and young people are still inappropriately placed in settings outside their local area, and on adult wards. It is imperative that the Bill strengthens safeguards against this and recognises the Joint Committee’s recommendation for stronger procedural requirements where such inappropriate placements are considered, including a requirement that such a placement is demonstrably in the child’s best interest.

There are many positive elements of the Bill, as the Minister clearly outlined in opening this debate, including improving the patient experience, improving patient choice and autonomy, and limiting the detention of people with learning disability and autistic people without qualifying co-recurring mental health conditions—all of which and much else, as we have heard, will be carefully considered in Committee.

However, I believe we need further debate on where the principles outlined by Simon Wessely are placed in the Bill. I am particularly disappointed that the Government have not currently accepted the recommendation to establish the role of a mental health commissioner and seemed silent on the issue when the Bill was introduced. As we have heard, the Joint Committee recommended that this post be statutorily positioned and that the mental health commissioner should be created with a number of roles, which I would like to briefly elaborate on.

The mental health commissioner should be a voice at a national level, promoting the interests of those who are detained and who are likely to be detained under the Mental Health Act, as well as the interests of their families and carers, raising awareness of their needs and challenging stigma and stereotypes. They should work in conjunction with the Care Quality Commission and other bodies to make recommendations on further reforming mental health law in the direction of more rights-led and fused legislation, such as we have heard on the Mental Capacity Act.

Critically, the commissioner should be a mechanism for tracking the implementation of the reforms in and associated with this Bill and other legal changes, essentially and particularly with the inclusion of the provision of data to understand how the Bill is operating. We saw the role of the commissioner as primarily to act as a watchdog to oversee the direction of travel for the key reforms in the Mental Health Act and mental health policy generally, overarching the whole government system. This has been supported by many organisations working in the mental health field, including the Centre for Mental Health, of which I am an ambassador. The centre added that, in addition to overseeing the reforms to the Mental Health Act, a commissioner could play a wide-ranging strategic role across all government departments.

Finally, I will say a few further words about resourcing and implementation, which will be crucial to the success of this legislation. Again, the Joint Committee recommended that the Government publish a comprehensive implementation and workforce plan alongside the Bill with key milestones detailing the implementation of the Bill and, crucially, how they link to milestones in the implementation of the NHS 10-year plan and other government initiatives. These should include milestones on workforce development, not only for mental health staff but allied health professionals, such as speech and language therapists. I declare my interest as honorary vice-president of the Royal College of Speech and Language Therapists.

The plan should also include milestones on training, advocacy and community care capacity, as well as on numbers of detentions, length of stay and, critically, reducing racial and ethnic inequality. There should also be a statutory duty to report annually to Parliament on the progress against these milestones during the implementation period. Disappointingly, unless I have misunderstood the Explanatory Notes to the Bill, the Government have so far offered only a financial assessment over a 20-year period, which is not at all coherent with the NHS 10-year plan.

However, in conclusion, I am very pleased that we are debating this incredibly important Bill now and in the coming weeks and months to try to ensure that we go a long way to producing a progressive Mental Health Act which is fit for 2025 and years beyond. I look forward to the Minister’s response at the end of the debate.