Mental Health Bill [HL]

Lord Patel Excerpts

Committee stage
Tuesday 14th January 2025 Lords Chamber

[Lord Patel (CB)]

My Lords, I will speak briefly in support of all these amendments, including Amendment 114 in the name of the noble Baroness, Lady Whitaker. I apologise for having to scratch my name from the speakers’ list at Second Reading, as I had been struck down by the dreaded virus.

In all areas of healthcare, communication between patient and healthcare professionals is extremely important for diagnosis and treatment, and to achieve the necessary outcomes. This is drummed into medical students and other health professionals daily.

I declare an interest: I am an honorary fellow of the Royal College of Psychiatrists—an honour awarded to me by the noble Baroness, Lady Hollins, who is not in her place, when she was its president. The citation of unknown accomplishments in mental health on my part was read out by the noble Lord, Lord Alderdice, who is also not in his place.

I remember, however, that although my professor at the time, Sir Ivor Batchelor—a well-known psychiatrist—was a quiet man, during our psychiatry clinical attachments he used to drum into us that not all mental health patients can communicate well. We had to be patient to learn and understand their ways of communicating to help them communicate their problem. I had forgotten that I was taught that; at the time, I think he hoped that he would make us all psychiatrists, but that did not happen.

The noble Baroness, Lady Whitaker, has highlighted the extent to which patients with mental health problems have communication disability, difficulty or difference. NHS Digital research has shown that children and young adults with mental health problems are five times more likely to have communication problems, and that in 81% of children with social and emotional needs their needs remain unidentified. Even without communication disability, difficulty or difference, people with chronic acute mental health problems also show communication problems.

As the number of people with complex mental health needs increases, so does the need for more speech and language therapists. Very few multidisciplinary teams include such professionals and, where they do, most of the professionals work in in-patient settings. NHS Digital research suggests that there are about 256 such professionals, mostly working in in-patient secure settings. The provision of such services in community settings is patchy or non-existent, leading to long waits.

--- Later in debate ---

[Baroness Murphy (CB)]

My Lords, I shall speak to Amendment 49 on this issue. I do not disagree with anything that has been said about the vital need for communication and to ensure that the patient understands what is happening and has access to specialist help. But I particularly want to comment on the proposal that speech and language therapists should become responsible clinicians.

The role of responsible clinician under the Mental Health Act is really quite onerous. Of the 50,000 or so clinicians who take on the role and are appointed the responsible clinician when somebody is detained, the vast majority are consultant doctors. Fewer than 100—0.002%—have been psychologists or nurses. The appetite for taking on this role is low and, of all the members of the team who could take it on, it would be appropriate only in a very small minority of cases for it to be speech and language therapists. I do not want to rule them out because I know how valuable these people are, but we must see that, in practice, this will probably not fly very far. It is important that we concentrate on how we get proper communications, but this particular amendment would probably not find favour. I do not think that profession is yet trained to the full extent of what would be required for that role. Although I hope that it will be one day, this Bill is maybe too early for it.

[Lord Patel (CB)]

My Lords, with the greatest respect to the noble Baroness, I did not suggest—and I did not hear any other noble Lord suggest—for a minute that language and speech therapists would become clinicians in their own respect. I said that they would be part of a team that would help to establish appropriate communication. As doctors, we are not the best people for that—so I do not see how the amendment cannot fly, when there is a need for such people.

[Baroness Murphy (CB)]

I entirely agree with the noble Lord. However, the reality is that the responsible clinician, as mentioned in Amendment 49 to Clause 10, has a wide range of roles. It is very onerous and specific, so this is not likely to be a good idea for a speech and language therapist. I agree with the rest of what everybody has said.

Mental Health Bill [HL]

Lord Patel Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I want briefly to make a couple of comments on this important group. As everyone has acknowledged, an absolutely vital change to the Bill is that, in the future, people with learning disabilities and autism will not be detained by the Bill and their needs are to be met in the community. I am sure we can all agree on and gather around that.

The noble Lord, Lord Beamish, made the point that, far too often in the past, people with learning disabilities and autism have been overlooked. I see the Bill as a real opportunity to do something substantive about that. That is why I note some of the amendments we have heard about in this group—certainly those in the names of my noble friends Lord Scriven and Lady Barker, and others—about the importance of having properly trained staff with up-to-date knowledge and expertise, as the noble Baroness, Lady Bennett, has just mentioned.

For any of this to happen, it is important that there is a proper plan, that is costed; the resources need to be available, and properly trained staff with up-to-date expertise need to be available in the community. To ensure that there is some sort of accountability around all this, I reiterate the question that my noble friend Lord Scriven asked the Minister: when will we see new targets—we have not got any at the moment—to reduce the number of detentions of people with learning disabilities and autism? It would be helpful to know that those targets will be put in place and that there is some way of monitoring the progress on all the important things we have been talking about in this group.

[Lord Patel (CB)]

I agree with what has been said: we need a definitive plan for how things will work out. We cannot rely on it being in five or 10 years because, as the noble Baroness, Lady Murphy, said, it then just becomes an ambition rather than a target to achieve.

I support the amendment of the noble Baroness, Lady Browning, which strongly asks that the people who look after children with autism and learning disabilities are properly assessed by properly trained and accredited people. We know that, currently, children are ending up in detention inappropriately because they are assessed to have a psychiatric condition such as schizophrenia—as the noble Baroness, Lady Browning, said—when, although they might have some psychiatric sub-condition, they fundamentally have autism or learning disability problems.

I am sorry that the noble Lord, Lord Adebowale, is not here to speak to his Amendment 150, which asks quite powerfully for a clear plan to be laid out, with resources tied to it, to achieve the ambitions there are in the Bill. I would have supported his amendment probing the Minister as to how resources will be allocated to achieve the ambitions for those targets to be met.

[Lord Kakkar (CB)]

My Lords, I support Amendment 42A in the name of the noble Baroness, Lady Browning, and I ask the Minister what justification there could be for refuting the amendment. It seems entirely appropriate, and indeed essential, that in taking such an important, far-reaching decision, one of the two registered medical practitioners who is responsible for that decision, taken at one point in the management of the natural history of disease in that individual, has the specialist skills and training to be able to make an appropriate assessment, one that will affect interventions on all future occasions for that individual.

I hope that, in addition to accepting this important principle, the noble Baroness might outline how His Majesty’s Government will go about ensuring that the development of such medical practitioners and their training is adequately resourced to ensure that, in future, as a result of the Bill being enacted, what we have seen in the past, regrettably on repeated occasions, does not remain the norm for managing patients with autism and learning disabilities.