Mental Health Act 1983

Lord Markham Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Bradley]

To ask His Majesty’s Government what plans they have to reform the Mental Health Act 1983.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are committed to improving the care and treatment of people detained under the Mental Health Act, including taking forward non-legislative commitments such as culturally appropriate advocacy, as well as continuing to expand and transform NHS mental health services. I am grateful to the noble Lord and his colleagues on the Joint Committee for their work on the Bill to date, and I assure him that it remains our intention to bring forward a Bill when parliamentary time allows.

[Lord Bradley (Lab)]

My Lords, for over six years, the Government have promised to reform the 1983 Act, from manifesto commitments to the Wessely report, draft Bills and consultations, and now the Joint Committee which reported to this House in January of this year— 11 months ago. Then, to the astonishment and no little anger of thousands of people with mental ill health, autism and learning disabilities, who have been supported by their tremendous advocates, there has been deafening silence from the Government. Now the proposed Bill has been completely dropped from the legislative programme. There is a real feeling of frustration across the country about this situation. Will the Minister now give a real explanation so that we can try and restore the breakdown of trust that has come about from this situation?

[Lord Markham (Con)]

I understand the frustration and disappointment about the fact that the Bill has not been brought forward. I am keen to focus on what we can do in the meantime. Of course the Bill is trying to decrease the rate of detention and, within that, decrease the racial disparities, such as the fact that a black person is four times more likely to be detained than a white person. There are a number of things that I hope we will be able to discuss more, particularly in the debates on Thursday as well, such as the things we have introduced in pilots, like the culturally appropriate advocacy. That really can make a difference here and now.

[Baroness Buscombe (Con)]

As the chairman of the inquiry, I reassure noble Lords that my noble friend the Minister is very aware of our frustration. However, I am pleased to hear—I am sure others are too—that, along with others in the department, he is looking to see what we can achieve without primary legislation. Could he and his officials focus on the further development and implementation of, for example, advanced choice documents, which would really make a difference to the dignity and choice that people with mental health issues thoroughly deserve? Could he also, as he touched on, really research and respond to why a highly disproportionate number of black men are unfairly detained?

[Lord Markham (Con)]

I thank my noble friend for her question and for her work on this. The advanced choice documents are a perfect example, like a birth plan, of where people can put in place what their hopes are for the future. There are good examples at King’s College and at South London and Maudsley of what they are doing in this direction, and I am really keen to learn from those and expand them further. I am also keen to invite all the participants to a round table that Mental Health Minister Caulfield has agreed as well, where we can really talk about the action that we can take on the ground to implement as many things as we can to rectify the problems in this space.

[Baroness Hollins (CB)]

My Lords, 40 years ago, as a young consultant psychiatrist, I argued against the inclusion of learning disabilities and autism in the 1983 Act—it is out of date; these are not mental disorders. Does the Minister agree that it is time to take this Bill forward seriously?

[Lord Markham (Con)]

We are all agreed on the intent behind what we were trying to do with the Bill. On learning difficulties and autism, the most important thing we are trying to do is to make sure that the CQC, within 48 hours of a person being put into segregation, is investigating and doing an independent review on whether that is the best place for them. Like the noble Baroness, I share the feeling—we all think it—that it is much better that they are treated in the community, where they can be.

[Baroness Barker (LD)]

My Lords, mental health legislation relies on good data; we do not have good enough data about the detention of people from different groups. Does the Minister agree with the committee that a step forward that could be taken now is the appointment of a responsible person in each organisation with a duty to record not only the detention of people under the Mental Health Act but the demographic data surrounding it?

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

[Baroness Merron (Lab)]

My Lords, the provisions of the Mental Health Act have no clear definition of a safe place in which a sectioned patient may be taken while awaiting medical assessment. That often results in vulnerable people being taken to police stations and forcibly detained by the police. What assessment have the Government made of the frequency of this continuing due to the Government’s failure to reform the Mental Health Act—something that Labour, if we win the next election, will put right? How will the Government ensure that patients are no longer detained in such inappropriate and punitive environments?

[Lord Markham (Con)]

I appreciate the feeling that our response on minimal standards—in our reply, I think, to the report by the noble Baroness, Lady Hollins —did not go far enough to make sure that those patients are in the right quality setting for them, so the noble Baroness, Lady Merron, has made an important point. I was going through with the team what we can do to make sure that that is right. As I mentioned before, the fact that the CQC now has responsibility for those independent reviews will mean that it will look not only at whether it is right that the patients are in those in-patient environments but at whether it is the right environment as an actual place.

[Baroness Berridge (Con)]

My Lords, the committee heard about disproportionality, particularly with community treatment orders, which are about 11 times more likely to be imposed on someone from an ethnic-minority background. Can my noble friend the Minister look at that, and maybe meet with colleagues in other departments to see whether there is a legislative opportunity to sort that out by putting that provision into a different piece of legislation?

[Lord Markham (Con)]

Yes. I have tried to get into this further, and my understanding is that lot of the trouble is that there is often a fear from black and ethnic-minority people of the existing institutions that can help people early on. As we all know, with mental health difficulties, we have to act quickly. A lot of this is about getting everyone in society open to the idea that the earlier they can go to these sorts of places, instead of trying to brave their way through, the better. That is one of the key things to do to make sure that we do not then see problems down the pipeline, including the disparity whereby a black person is 11 times more likely to have community reviews and the disparity in detentions.

[Baroness Watkins of Tavistock (CB)]

My Lords, I think that other noble Lords will welcome the idea of sitting down at a round table to look at the future. In particular, what do the Government intend to do to invest in children’s and adolescents’ mental health services to make them accessible in schools? Early intervention will prevent a high proportion of people needing to be sectioned later on.

[Lord Markham (Con)]

The noble Baroness is absolutely correct. With the mental health units to detect problems early, we are now at around 35%; last year it was only 25% but in the next 18 months or so we should be at 50%, which is higher than ever before. I freely accept that 50% is not 100% but it is clearly a step in the right direction. The £2.3 billion investment we are putting in means 350,000 extra places for young people as well.

[Lord Allan of Hallam (LD)]

The Government keep telling us that they plan to take other measures to improve mental health outcomes in the absence of the legislation. I hope the Minister will understand why, having been let down on the promised Bill, we want to see the colour of the Government’s money. Can he go back to his department and ask it to produce a list, with details and dates, of all the measures it intends to take to improve mental health practices via statutory instrument and new guidance in this parliamentary Session?

[Lord Markham (Con)]

Yes. I am happy for the noble Lord to come to the round table and put those points himself as well.

[Baroness Browning (Con)]

My noble friend will be aware that autism is not a mental health condition but a communication disorder. However, of course like everybody else, people on the autistic spectrum can develop mental health problems as well. What assessment has the department made or could it make, quite urgently, of just how able and experienced psychiatrists around the country are at disaggregating between an autistic person having a meltdown and a mental health condition? If they get it wrong, as often happens, the consequences of the treatment that follows are devastating.

[Lord Markham (Con)]

My noble friend is absolutely correct, and from personal experience I know the importance of getting that early diagnosis right. I am quite happy to write in detail exactly what we are doing in this space.