Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Monday 27th January 2025 Lords Chamber

[Lord Stevens of Birmingham (CB)]

I strongly support the amendments in this group, particularly that in the names of the noble Earl, Lord Howe, and the noble Lord, Lord Kamall. I share the concern, as I think I mentioned at Second Reading, that as currently drafted this proposition could amount to an unenforceable, verging on vacuous, set of requirements, be it noticeboards or helplines. I very much hope that, between now and Report, Ministers will look to adopt the alternative proposition that the noble Earl, Lord Howe, has put forward. If, for whatever reason, that is not the case, I hope that collectively we might return to the question.

I have two small further points. I think I am right in interpreting the Bill as saying that guidance will be issued as part of a Section 118 code of practice which will give clarity on the duties of ICBs and NHS England in relation to the ACD part of the new Bill. I hope that that will, among other things, specify in more detail the categories of people who must be offered an ACD in accordance with the new statutory right which we will, I hope, have created; by whom the offer may be made; the fact that it should be recorded digitally, for the reasons that the noble Baroness, Lady Barker, has set out; and a number of other elements. Expecting individual ICBs to figure it out is a recipe for a subtherapeutic dose, shall we say.

My third and final point is that early evidence suggests that if the benefits described in the impact assessment come to fruition in the real world then there will be a positive impact, including on reduced compulsory admissions. Admittedly these are small and non-UK studies, as the material makes clear, but there is nevertheless a case for getting on with ACDs at scale, if the benefits that are hypothesised might actually be obtainable. It is therefore surprising to see in Annex C III of the impact assessment the suggestion that ACDs will not actually come online until 2029-30. It will take relatively marginal additional staff costs and time to do this, for a relatively small number of people. The suggestion is that it will be a surprisingly precise 55,071 people who might get a new ACD in 2029-30 and about 8,000 people who will get an updated one. These are not huge volumes, and we may be under-egging the pudding, but if the benefits are potentially there to be had, why on earth should we assume that we do not get going on this until 2029-30?

For all those reasons, I support the amendments in this group, particularly that from the noble Earl, Lord Howe, and the noble Lord, Lord Kamall.

[Lord Davies of Brixton (Lab)]

My Amendment 121 seeks to add financial circumstances to the advance choice documents. I spoke in the last session of the Committee about the importance of the link between financial problems and mental health problems. I draw attention again to work that has been undertaken by the Money and Mental Health Policy Institute, which suggested this amendment, and declare that I am a member of its advisory committee.

It is very welcome to see, in Clause 40, that health commissioners will have a duty to ensure that services inform people about advance choice documents. I listened to the speeches of the noble Baroness, Lady Barker, and the noble Earl, Lord Howe, about extending the reach of these documents. I very much look forward to the reply from my noble friend the Minister, because they sounded pretty convincing to me.

Ensuring that everyone has access to an advance choice document is something that the Money and Mental Health Policy Institute has called for previously. We believe that this clause must go further to advance a specific prompt about people’s financial situation. It may seem a small matter, but for people who have been detained under the Mental Health Act, who are possibly too unwell to keep themselves safe, finances are understandably often the last thing on their mind. As I mentioned in a previous session, this does not stop bills needing to be paid, debts mounting and collections activities being escalated. Including a section on money in the document would help people have greater choice and control over their finances when they are in crisis.

A person recalling their experience of receiving treatment for their mental health shared this comment with the Money and Mental Health Policy Institute:

“I was never asked if there was anyone who was opening mail and keeping on top of my day-to-day living stuff … It’s always the same. I go in for treatment and come out to find my financial world is in a bigger mess than when I went in. The resultant terror, shame and guilt undoes all the work of the treatment and I am back in crisis again”.


This section should include explicit prompts which encourage people to reflect on and stipulate their preferences around finances. That can include consideration of how priority bills will be paid; preferences around access to credit; and advance planning to identify and empower a third party to manage their finances on their behalf, such as a lasting power of attorney or third-party mandate.

By including a systematic consideration of finances in ACDs and offering explicit prompts, people can be supported to have greater control and choice. It would better enable healthcare professionals, as well as the individual concerned, to put in place preventive measures to safeguard individuals from the financial harm that can be caused by, and exacerbate, mental health crises.

As mentioned previously, this is not about requiring healthcare professionals to support people with financial advice, or to deal with issues they have neither the expertise nor the capacity to deal with. It is about empowering them to identify people in need and refer them to the appropriate existing support.

[Baroness Browning (Con)]

My Lords, Amendment 122 is in my name and that of the noble Lord, Lord Patel. When I read through the Bill initially, it concerned me that there was no mention of lasting power of attorney, which, of course, is a legal document under the Mental Capacity Act. A registered lasting power of attorney for health and welfare will appoint attorneys chosen by the patient—the donor—at a time when they had capacity, to speak and act on their behalf if they lose capacity. This is particularly important for people who may periodically lose capacity due to mental disorder. The attorneys, of course, could also provide information about the patient, which is essential in distinguishing behaviours that may be associated with autism or learning disability but are not mental disorders. This does not, of course, apply to children, who cannot make lasting powers of attorney, but it would be remiss of me not to raise it with the Committee, because I have become rather concerned.