Mental Health Bill [HL]

Lord Scriven Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, it is a pleasure to follow the noble Lord, Lord Bradley, who was the MP for the constituency I lived in when I was a student. In those days, I campaigned against him, but, from listening to his speech today, I am sure that we will campaign together in Committee on some of the reforms that may be required in the Bill.

This Bill is a welcome direction of travel for mental health legislation in the United Kingdom, but it is only an extra stop. As other noble Lords have said, sometimes we have to look at the bus we are on—the underlying legislation. That bus was built when I was 17 years old, if we go back to the 1983 legislation, and it had its last MOT 17 years ago, in terms of its amendments. I believe that, although these measures are welcome, there is still a fundamental issue in terms of the basis of what we are traveling on. I understand the problems with that.

The questions we are really asking in this Bill are quite limited in the sense of the balance between individual freedoms and public protection when it comes to the detention of individuals. Because we look at such legislation infrequently, we must do our best in Committee to ensure that the balance is at its best and that, wherever we can, we take a person-centred, rights-based approach to this legislation. Having said that, there are some pleasing points in the Bill, including the tightening of the criteria for the detention and compulsory treatment of individuals. It is welcome that the four key principles are mentioned but it is a shame that they are not on the face of the Bill and are down as guidance only. It is important that those of us who really support the principles fight for them to be on the face of the Bill in Committee.

The advance choice documents are a welcome provision but, as many noble Lords have said, they need to be fully accessible 24 hours a day, 365 days a year to those who care for people who have given an advance choice document. I question why they are only for people aged 18 and over. If we are looking at Gillick competence, there are issues around those who are younger, who should be able to provide an advance choice document. I worry that they are not a right or a duty but are only to be given as a consideration.

I welcome the right to a nominated trusted individual but many people who have been involved in healthcare will know that it is not just about having that person as a right; it is about the way in which professionals listen to them and carry out the advocacy that they provide. I am not sure, as we start with this Bill, that the balance is correct; I believe that certain issues will have to be addressed in Committee.

I have also looked at the potential implementation of the Bill. It is always good to start with the impact assessment. It has in it some quite startling issues that I think we will want to look at in Committee. For example, community treatment orders are not meant to change for at least another seven years, but the implementation start is in seven years. The existing CTO regime will last for another seven years and, from the Government’s impact assessment, it looks as though the new regime will start in seven years at the earliest.

I will come back to people with learning difficulties and autism in a second, but the implementation of the measures for them not to be held for more than 28 days and for other provision in the community to have to be available will be in three years’ time, according to the impact assessment. However, there is no money in the next two years to start to provide for those community facilities. It is as though they will come on stream the second the implementation date is reached; I question the Government’s planning on that and whether it is a realistic adaptation for people with learning difficulties and autism.

My passion and focus in Committee will probably be learning disabilities and autism, because they are personal to me. I have close family members who are loving and warm but very misunderstood by those who do not have a close relationship with them. It is scandalous that, in 2024, having those labels attached to you means that you could be detained under the Mental Health Act for more than 28 days. I welcome the fact that the Bill’s provisions will move away from Section 3 and towards Section 2 detention, but I worry that it will not stop detention of people with learning disabilities or autism. For example, DoLS will be used, because these people are misunderstood. The legislation in itself will not change what happens to them. Individuals who are seen not as a threat but as difficult will be detained. As other noble Lords have said, fused legislation needs to be used to ensure that those individuals are not detained using different pieces of legislation.

As other noble Lords have said, it is also worrying that people with learning disabilities or autism who are under a Section 2 detention or detained under the Mental Capacity Act will not have access to Section 117 community facilities. It is quite fascinating that the very things under Section 117 that need to be in place to ensure that these people are not detained are the very facilities that they do not have a statutory right to. That needs to be looked at in this legislation.

There are many things to welcome, but many further questions need to be asked and drawn out, particularly regarding some of the contradictions in different parts of the legislative process on mental health provision within the UK and around the rights-based approach, which the Government seem not to have in place. We will want to explore that as we go forward.