Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, my amendment is very closely aligned to the amendment just moved by the noble Lord, Lord Kamall, but it is in relation to children. This is an issue that I raised at Second Reading. A number of children and young people are admitted to mental health settings informally on the basis of their own consent or parental consent—notwithstanding what was just said by the noble and learned Baroness, Lady Butler-Sloss.

Research from the Children’s Commissioner for England suggests that around one-third of in-patients aged under 18 are informal. However, NHS Digital does not publish data on the number of young people admitted informally so it is impossible to accurately track the total number of young people in hospital or to identify trends. Concerns have previously been raised, particularly by the Children and Young People’s Mental Health Coalition, that young people who are informal patients are often under exactly the same conditions as those who are detained but without access to the safeguards that children formally detained have. Many children and young people who are informal patients are also often unaware of their rights and, as has already been acknowledged, do not feel that their voices are listened to.

The coalition believes that it is crucial that informal patients aged under 18 have the same safeguards as those detained under the Act. There are two key provisions in the Mental Health Bill that can be strengthened to improve care for children and young people admitted informally. The most important, the coalition argues, is extending care and treatment plans to informal patients aged under 18, which is what my amendment is designed to do.

The reason for that is, if you manage to get somebody who is under 18 to accept informal care, they have no mental health formal record for their future. Most of us who have worked with young people under 18 bust a gut to get them to accept an in-patient admission if it is really necessary—I am talking about families as well as professionals—in order to ensure that they get treatment.

If that treatment is not guaranteed on discharge through a care and treatment plan, in the way that it would be for a detained patient, can your Lordships not see that families would be put in such difficult positions? They would ask, “Would it be better if my child is sectioned and detained in order for them to get long-term care?” This brings me back to my continued, impassioned plea that we need to think about proper standards of elective care for people with mental health problems, most importantly for those under 18.

[Lord Davies of Brixton (Lab)]

My Lords, I remind the Committee of my entry in the register of interests that I am on the advisory board of the Money and Mental Health Policy Institute. I mention this particularly because the three amendments in my name, dealing with the financial implications for people who struggle with their mental health, have been based on the work of the institute.

As I have reminded the House on many occasions, these amendments speak to the undeniable but all too often overlooked fact that our mental health and money are closely linked. When someone is hospitalised for a mental health crisis, bills still need to be paid and debts can mount up, resulting in financial difficulties that greatly damage people’s prospects of recovery.

It is worth focusing on the numbers. In 2022-23, almost 90,000 adults were admitted to hospital for a mental health problem. The Adult Psychiatric Morbidity Survey indicated that around one-quarter of people experiencing a mental health problem are also in problem debt. The rate of problem debt is undoubtedly higher among people experiencing a mental health problem, which leads to hospitalisation. An earlier study from 2008 found that one-third of all people with probable psychosis are in problem debt.

The three amendments dealing with the link between finance and mental health deal with different aspects of the problem, and they are, quite rightly, being considered in turn in relation to the relevant parts of the Bill. Today, we start with my Amendment 59, and I thank the noble Baronesses, Lady Tyler of Enfield and Lady Neuberger, for their support for it. Like the other amendments in this group, it deals with care and treatment plans. Later, we will come to the implications of advance choice documents, which is currently in group nine, and then provision for mental health crisis breathing space, which is currently in group 17.

The Mental Health Bill provides an important opportunity to tackle the vicious cycle of poor mental health often leading to financial problems, and financial problems often leading to poor mental health. We must break that cycle and ensure that people’s financial needs are addressed as part of a supported recovery from a mental health crisis. That focus is missing from the Bill in its current form, and my amendments seek to address that gap.

As I have already indicated, these amendments are informed and supported by the independent charity, the Money and Mental Health Policy Institute, which has done considerable and excellent work in this area. They are small changes designed to improve the Bill and the outcomes for those it aims to help, by ensuring that a person’s financial situation is routinely considered and acted on as part of their treatment and recovery from a mental health crisis. Addressing a person’s finances is one of the many factors that mental health practitioners must consider in their assessment and care planning.

However, services cannot rely on patients to tell them when they are facing financial difficulties. The experience is that people rarely take the initiative to tell mental health professionals about money problems, often because they are too unwell or because the stigma around both mental health and financial problems acts as a barrier to disclosure. Adding an explicit prompt about people’s financial situation in care and treatment plans will ensure that this is routinely and consistently considered by healthcare professionals and will open up more opportunities to safeguard patients from financial harm.

There is a precedent for this. In Wales, “finance and money” is already included as a section in the care and treatment plan template. That does not mean that busy healthcare professionals are required to support people with their money in a way that they are not trained or intended to do. Rather, this is a case of empowering them to identify those in need and refer them to the relevant welfare adviser in their service, so that healthcare professionals can focus on medical care. Ultimately, that could free up time for health professionals, as well as improving outcomes for patients.

I will illustrate the need for this proactive inquiry with testimony from someone with lived experience of money and mental health problems, as they do it so much more powerfully than I can. A participant in Money and Mental Health Policy Institute research shared:

“I didn’t realise how much my mental health affected my finances and vice versa. I lived for years in shame and horrific anxiety about money which caused my mental health to spiral. I thought there was no help out there for me and I didn’t want to be alive, as I couldn’t see a way out of my money troubles”.


Legislating to include a consideration of people’s finances, when they are in a mental health crisis and throughout their recovery, will help prevent further illness, support recovery and reduce waiting lists, and will help people return to daily life, including work, more smoothly.

I can imagine what my noble friend the Minister’s response will be, because she has already written to the institute. She said in her letter: “We intend to set out in secondary legislation the required contents of the statutory CTP. However, we plan to further consult stakeholders to make sure that the CTP covers all the information that is critical to an individual’s recovery and timely and effective discharge from the Act”. I hope that she does not mind me taking the opportunity to stress the importance of this issue. Does she agree with that, including the importance of its place in treatment plans?

[Baroness Neuberger (CB)]

My Lords, I will speak to Amendment 59, in the name of the noble Lord, Lord Davies of Brixton, to which I have added my name. I must declare rather a lot of interests. I am chair of the University College London Hospitals NHS Foundation Trust and of the Whittington Health NHS Trust, which provides child and adolescent mental health services. I was also one of the vice-chairs of the independent review of the Mental Health Act in 2018, which feels like a long time ago.

I am keeping my comments in Committee fairly short and sparse, because I feel that I have had quite a lot of say already, having been involved in that review. However, I want to speak about the issue of financial difficulties and mental health problems, because we should have looked at it in greater detail when we were conducting the review. It was an omission on our part, as we did not focus on it in any detail. The noble Baroness, Lady Barker, cited one of the people who spoke incredibly movingly to our review and who talked about how awful it is to be an in-patient. She said that she recovered and was given the care she needed, but she asked why it had to be such an awful experience.

One of the things that is becoming clearer—the noble Lord, Lord Davies, alluded to it—is that when you have had a mental health crisis and your finances are in an absolute mess, because you did not get it together to do anything about them, why does your recovery have to be so awful because nobody helped you and gave you the advice you needed at the time? That is why this is so serious. If you are in hospital, you may not even get access to your computer, you may not be using your mobile phone all the time, you may be in something of a mess and your cognition may be severely affected. If that is the case, you will not be paying your bills, claiming your benefits or paying your rent. When you recover, it will take you ages to get into a situation where you can live a normal life again and not be hugely in debt.

I was going to cite some of the experts by experience—the quotations have been given to me by the amazing Money and Mental Health Policy Institute, to which I am extremely grateful. However, since I do not want to take much more of your Lordships’ time, I shall just say that, although NICE stipulates that assessments in care and crisis plans at present should consider patients’ holistic social and living circumstances, which would include things such as housing and finance, mostly, in normal circumstances, the issues are too great. Often, the mental health needs are at crisis point and it just does not happen, and the same will happen with care and treatment plans unless we put this in the Bill.

I ask the Minister—I have already heard what the noble Lord, Lord Davies, has said—whether she will think quite hard as to whether this could be in the Bill, along with parental involvement. I agree with all the amendments in this group. There are some things that need to be in the Bill that would make sure that, when we see treatment in place—and I see a lot of it in what I do in the other part of my life—those things are taken into account. If it is in secondary legislation, it is much harder and much less likely.

Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[The Lord Bishop of Manchester]

My Lords, I support all the amendments in this group. I also want to communicate the support of my right reverend friend the Bishop of London, who apologises that she cannot be in her place this evening.

Turning to the amendments led by the noble Baroness, Lady Whitaker, on culturally appropriate care, I appreciated the noble Baroness’s references to the Gypsy, Roma and Traveller community. I have worked with that community much over many years and very much enjoyed my interactions with it.

These amendments highlight issues that my right reverend friend has spent a lot of time considering, particularly from a faith perspective. I do not think we have heard that in the debate so far tonight. It is sometimes hard to grasp just how differently our health, especially our mental health, is culturally understood across different communities and faith groups. While our ability to discuss our own and others’ mental health may be generally improving—I think it is—it remains an extremely difficult discussion point for many cultures and many communities.

When you combine that with the extensive inequalities of outcomes that we find, and many people’s experiences of culturally inappropriate care in mental health and other settings, it is inevitable that many people are reluctant to engage with preventative services. It was said at Second Reading that minoritised communities are likely to engage at a crisis point rather than seek early interventions. My wife worked for many years as a maths specialist in the home and hospital tuition service of a large urban authority. She regularly found that she was working with pupils whose mental health needs had been picked up late, if at all, because the culture of the parental home saw mental health issues as shameful, and not something you could raise with external service providers. So culturally appropriate care is a crucial step if we are to build the trust that is ultimately vital to reducing health inequalities.

In order that culturally appropriate care is deliverable, training on faith literacy, as well as different cultures and beliefs, will be crucial. Again, I have found that myself; I have been working with my fellow faith leaders in Greater Manchester, including the excellent Caribbean and African Health Network. I make no apology for banging on about religious literacy in your Lordships’ House on yet another occasion: it does really matter. Service providers in all sectors do us a huge disservice when, through their own faith illiteracy, they operate with a presumption that religion matters only in the realm of private affairs. Getting it right in this Bill will of course necessitate additional resource. In supporting these amendments, I hope that sufficient resources will be allocated to this work.

I turn finally to Amendments 65, 133 and 138, in the names of the noble Baroness, Lady Tyler, and the noble Lord, Lord Kamall. I am a statistician by background. We know the importance of good and useable data to ensure that we have an understanding not just of the gulfs of inequality of outcomes but of the more nuanced and complex patterns that lie underneath them. Amendment 133 recognises the need for regular training and has a consultation element as part of the policy. I hope this will be taken up and I hope that will include consultation with faith groups. We must commit to work with such groups to build trust with communities that service providers are wont to call hard to reach. I do not believe we should call any group in our society hard to reach. What we do have, all too often, are service providers who just do not make enough effort to reach. So instead, let us work with organisations such as CAHN, which I mentioned earlier, to ensure earlier interventions than those we often see.

I also warmly welcome Amendment 138, which, as others have said, highlights an appalling scandal in our society. I thank the noble Lord, Lord Kamall, for tabling that amendment.

[Lord Davies of Brixton (Lab)]

I know the hour is late, but I want to note the irony that the issues covered by these amendments are central to the whole process of why we have arrived at this Bill. In a sense it is unfortunate that, because of the hour, there are so few of us present. I want to stress that we cannot assume it is job done. It is really important to keep this whole area under review, whether we do it precisely in the terms of the amendments before us or not. I urge my noble friend the Minister to give an assurance that this issue will not be left for another 17 years before we decide that we have got it right, and that the workings of the Bill in this central area will be kept under close and continued review.

[Baroness Berridge (Con)]

My Lords, I will speak briefly in support Amendment 133. I know the hour is late. As I asked the Minister, why is it that issues relating to this focus, which was the focus of the Bill, seem always to end up at the end of our debates? I am not sure why, but they are some of the most important issues. I reflected at Second Reading and earlier in Committee on the Joint Committee’s work and our concern about the strength of civil society and media focus on this issue. Although what we saw seemed expert, we then saw a comparison with what I would call Premier League—which was learning disabilities and autism in terms of that focus.

I turn to new Section 120H, which the noble Baroness, Lady Tyler, mentioned, and the statistics I cited before. The right reverend Prelate mentioned the importance of data. It is very concerning that, when we talk about the data on under-18s, we are not quite clear about what is going on in relation to it. The data on under-18s that I mentioned has three subgroups: those who are detained, those who are in the cohort because their parents have consented and those who have consented themselves. It is imperative that we know exactly which subgroup is which in the under-18s group—which, thankfully, is a small group of about 1,000.

Even in the data I cited from the UCL study, of the 23.6% of under-18s that were detained, three times as many black young people were detained as their counterparts. That issue is starting early. What is happening even at that early stage—the disproportionate number detained under the Act—was also reflected in the data on the lack of parents consenting to children going into hospital for the treatment that they need.

Mental Health Bill [HL]

Lord Davies of Brixton Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Barker (LD)]

My Lords, in speaking to my Amendment 49A, I thank the noble Baroness, Lady May, for her amendments. Those of us on the joint scrutiny committee spent a lot of time focusing on the fact that, in truth, a lot of what happens to people who are having mental health crises depends entirely on where they are, who is there and who somebody passing in the street and tries to help them thinks is the right person to call at a moment of emergency.

We are all in agreement that the police have for too long been the default answer to a problem but are not the right answer to a problem. The police know they are not the right answer to a problem—I say that as somebody who has lots of police officers in my family. A lot of people having a mental health crisis will end up in A&E just because the lights are on and that is where people go. We are still dealing with one of the problems the Wessely review touched upon, and that is lack of timely access to an accurate diagnosis.

My amendment, which I admit was suggested by practitioners in the field, tries to deal with the fact that we do not have an abundance of consultant psychiatrists who are there at the drop of a hat to make assessments. The amendment probes whether we might help things by opening up the eligibility to make diagnoses under Section 12 to people who are health professionals but not necessarily medical practitioners. Back in 2006-07, we had the massive argument about bringing in approved mental health professionals. That was a big battle and there was a lot of rearguard action on the part of consultant psychiatrists, who saw it as a downgrading. Approved mental health practitioners are now very much part of our mental health services and they are a good part of our mental health services.

The amendment is trying to open up the making of assessments, simply in order to speed up access to appropriate services. We all understand, and are talking about, the fact that, although we can see the effects of waiting lists and so on on physical health services, waiting lists and the lack of access to appropriate treatment in mental health services are much more hidden. People end up in limbo unless and until there is some kind of outrage, or, to go back to the noble Baroness’s point, until they do something sufficiently serious.

We ought to be freeing up the capacity of consultant psychiatrists in particular, because not only is demand growing but there are also particular areas of specialist demand—young people with eating disorders, for example. I frequently hear of worried parents being told that their children are not sufficiently ill to get treatment. They are not alone; there are other people in that same situation. My modest amendment is an attempt to open up and make better use of the skills we have within the NHS workforce.

[Lord Davies of Brixton (Lab)]

This is the first time I have spoken in Committee on the Bill, so I declare my interest as a member of the advisory panel of the Money and Mental Health Policy Institute. I shall speak to my Amendment 158, which, as the noble Baroness, Lady May of Maidenhead, said, covers essentially the same ground as hers, and they both aim at the same endpoint. Her elegant and compelling speech has left me in the position of just having to emphasise issues; the case made was compelling, and I hope the Committee will agree. In particular, I hope the Minister will be able to make some sort of positive response.

This proposal does not flow specifically from the independent review, but it is in the spirit of what was in that review. The background to the changing nature of mental health services is the significant material increase in the demand for mental health services over the past few years, and the growing number of people on the mental health waiting list or seeking community support.

This unmet need has consequences, which are felt by front-line medical staff. My amendment seeks to address that by giving additional powers to paramedics and appropriate mental health professionals. It would extend the reach of Section 136 of the Act, currently confined to constables—or police officers, as I say in my amendment. As previous speakers have said, that needs to be shared more widely.

The unfortunate reality of the current situation is that those detained under Section 136 get suboptimal care; we just do not have the resources available for them. There is inadequate provision of suites for Section 136 detention, and there are simply not enough clinicians. We all applaud and support the practice of “right care, right person”, but we must acknowledge that that only increases the demands on the service.

The result of all this is that, as we have heard, police officers are taken away from front-line policing duties for many hours. That is bad for everyone involved—for the police officers, for the health service, and particularly for the patients. At the same time, the skills of non-medical health service staff have increased. They are now moving towards the sort of training that equips them to handle such situations. Obviously, giving staff extra powers will not resolve the situation, but we can learn from experience abroad, especially in Australia and New Zealand, where a range of health service staff have a practice called emergency care orders, with the intention of providing greater dignity, removing the sense of criminalisation, and providing appropriate care.

As my noble friend the Minister said, what we are looking for is beneficial interventions at the earliest possible stage. A key element in achieving that aim is extending the powers under Section 136 to wider professions. That is not to say that there is no role for police officers—there will always be occasions when their intervention is required—but saying that the single source of entry to services of someone suffering an acute mental health problem is through the intervention of the police is just wrong.

There have always been concerns when the powers of medical staff are extended, but this will be an issue of training, guidance and codes of practice—clearly, those will have to be provided—so that the additional powers can be used effectively.

To conclude, I emphasise the point that the noble Baroness, Lady May, made in opening the debate. We have moved beyond the point when the powers in Section 136 were essentially about public order—which is, quite rightly, a role for the police. We must ensure that now, commitments under Section 136 are the first stage of a process of medical treatment, in which the unfortunate individual suffering an acute problem with their mental health must be considered first. This is not about public order; it is about appropriate healthcare, where a range of health service professionals can exercise their trained judgment to the benefit of the patient.

--- Later in debate ---

[Lord Scriven (LD)]

I have listened very carefully to the debate on this set of amendments. Those in the name of the noble Baroness, Lady May, would create a specialism within the relevant professions which is not there at the moment, based on a change of law. The Minister’s response was focused on the skills of people now, based on their generic roles. My question is this: in responding to the noble Baroness, Lady May, did officials and the Minister look at the potential change that would happen to the skill set, and at the skills and professionals that would be specific for this purpose? In practice, if the law changed, that is exactly what would happen to those professions: a subset of skills would develop, which would allow the gap to which my noble friend alluded to be closed.

[Lord Davies of Brixton (Lab)]

With your Lordships’ permission, I want to respond to what the noble Lord has just said. On the front line in this are the paramedics; they are the ones who will have to deal with this issue, most of the time. They need recognition for the additional work that they are already doing. The noble Baroness referred to the gap—the gap is being filled, but in a very inefficient and unrecognised way. We need to recognise that this is something that needs to be dealt with properly, with the staff involved being given the appropriate powers to deliver.

[Baroness Watkins of Tavistock (CB)]

To add to that, the key thing about paramedics is that they do not have long-term therapeutic relationships with the people we are talking about. Therefore, an intervention is totally appropriate.