Mental Health Bill [Lords]

Luke Evans Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

Members will have noticed that many people are standing to speak and there is not a significant amount of time for the debate, so with the exception of Front-Bench contributions, there will be an immediate four-minute time limit. I call the shadow Minister.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

When we last debated the Bill on Second Reading, I said that protecting someone’s freedom for their own safety is not a licence to own their life, but a duty to help them find it again. That principle still guides us today, because good intentions alone do not mend a troubled system. Compassion without competence is not care; it is sentiment without substance.

On Second Reading, I spoke of bridges and rough roads, and of how resilience and recovery depend on the strength of the structures that carry people through their hardest times. Tonight, we return to that bridge. The question before us is not whether we believe in reform—after all, there is cross-party agreement on that—but whether the Government have built the foundations to make it stand. Warm words are plentiful, but the reality is that too many people are still falling through the gaps: detentions are still present, community services are stretched, and families are left navigating a maze of bureaucracy while waiting for help that may never come.

We all know that reform cannot be delivered on aspiration alone. It requires a delivery plan, a workforce and a system capable of learning from its own mistakes. We know the chapter on delivery is missing from the 10-year NHS plan and there is further risk tonight that we miss another opportunity. After all, the principles in the Bill are the right ones. They are even on the face of the Bill—choice and autonomy, least restriction, therapeutic benefit, and treating the person as an individual—but those principles need power behind them and that power lies in delivery.

This Report stage is our chance to turn those words into commitments. New clause 31 requires the Government to publish a fully costed delivery plan within 18 months of the Act passing into law, setting out how integrated care boards and local authorities will deliver adequate community services. Crucially, the plan must be developed through consultation with those who know best. That is vital, because although we support the many aims of the Bill, the Government already have a pretty dismal record of announcing reforms without any credible plan to deliver them.

Let us take the ongoing NHS reorganisation. In March, Ministers made a surprise announcement of the abolition of NHS England and its absorption into the Department of Health and Social Care, yet six months on they cannot say what it will cost, how many staff will be lost or how it will be paid for. The Health Service Journal reports growing confusion inside the system and warnings from NHS leaders that the lack of clarity risks paralysing decision making. Written questions to the Government simply receive the answer

“some upfront cost in the millions”

yet independent estimates say the cost is over £1 billion. Even the chief executive, Sir Jim Mackey, points out that the Treasury must agree funding for integrated care board redundancies within weeks or the NHS will have to turn to a plan B.

The same chaos is playing out across integrated care boards, with local leaders warning that there is already destabilisation due to the 50% reductions. If Ministers cannot manage their own top-down reorganisation, why should anyone believe they can deliver a more ambitious overhaul of mental health services without a clear costed plan, especially when waiting lists have risen in the last three consecutive months?

This Labour Government have already cut the proportion of spending on mental health. As Dr Lade Smith CBE, the president of the Royal College of Psychiatrists, said at the time:

“It is illogical that the share of NHS funding for mental health services is being reduced at a time of soaring need and significant staff shortages.”

Going on, she said that:

“The proportion of NHS funding allocated to mental health services will decrease”,

which will

“equate to these vital services missing out on an estimated £300 million or more that they would have received if their share…had been maintained.”

[Layla Moran (Oxford West and Abingdon) (LD)]

It is a decrease in the proportion of the mental health investment standard for the first time in, I believe, nine years. It is incredibly concerning. It was hard-won, cross-party support that made that proportion go up over time. It was incremental, but it was starting to make a difference to the system. Does the hon. Gentleman agree that it would be helpful if the Government clarified whether that will continue in 2025-26? When Baroness Merron came to our Committee, she could not confirm that. If there is not going to be a continuation, the system needs to know by now, frankly, so that it can prepare adequately for it.

[Dr Evans]

The Chair of the Health and Social Care Committee is absolutely right. A simple answer from the Minister today, on Report, would go a long way to alleviating those fears from the mental health sector. I look forward to his response on that.

Amendment 40 would add a simple but important requirement that each care and treatment plan must include an assessment of the levels of risk to public safety posed by the patient in the community. The purpose of the Bill is right; the Government want to make the system more compassionate, therapeutic, patient-centred and modernised, and we strongly agree with that ambition. However, modernisation must go hand in hand with public confidence, and the public and patients themselves must know that every plan for treatment and discharge is rooted not only in care, but in safety.

In Committee, I argued that the framework still omits one dimension, which is public safety. As far as I can see, there is still no explicit requirement in the Bill for clinicians to assess and record the level of risk posed to the public.

[Joy Morrissey (Beaconsfield) (Con)]

My hon. Friend is making an excellent point. Constituents have come to me about patients with schizophrenia, for example, who had been released before their psychosis had fully passed, with one such instance tragically ending in the death of another resident. All of these situations could have been prevented if the patient had been kept safely in a bed until they were at a proper level of medication and the psychosis had passed. Does the shadow Minister agree that that is something we need to take forward in this Bill? It is a win-win for all parties.

[Dr Evans]

I thank my hon. Friend for raising that tragic case. Those are the kind of cases that this amendment seeks to deal with. We have only to look at the tragic cases of Nicola Edgington and Valdo Calocane to see how escalating risk happens, with huge consequences for the families, patients and victims.

When I raised this matter in Committee, the Minister gave a very thoughtful answer. He said that:

“if any risk at all to public safety is perceived, that must be documented… It is a basic expectation of the professional management of a particular patient that any risk identified to public safety and protection must be in there.”

I welcome that.

With amendment 40, I am simply asking, if that is indeed the Government’s position, why not make it clear in the Bill? The Minister conceded in Committee that

“I take the hon. Gentleman’s point on whether or not it should be in the Bill. I will come back to him on that, because I would be rather surprised if it were not made very clear somewhere that that is a basic expectation; if it were not, that would obviously need to be looked at, but I am reasonably confident that it is.” ––[Official Report, Mental Health Public Bill Committee, 12 June 2025; c. 171.]

Unfortunately, expected in practice is not the same as required in law. We know from past reviews that there is a gap in the risk assessment and that communication can be too inconsistent. Putting such a requirement in statute would not be bureaucracy; it would simply clarify that. The Minister may argue that it already exists in professional codes, in the Mental Health Act code of practice or even in risk management frameworks, but the statutory duty does not. Our amendment would put that duty squarely in the Bill.

Talking of safety, I will turn to new clause 29, which would ensure that no child is placed on an adult mental health ward except in truly exceptional circumstances, and only when it is demonstrably in their best interests. The Government argue that guidance already covers that, but this guidance has no teeth; it can be ignored or inconsistently applied. Again, guidance without legal backing is too easily ignored. That was why the Joint Committee on Human Rights argued in its letter that this part of the Bill needs strengthening. The Minister also said that placing these safeguards in legislation would remove flexibility for clinicians in emergencies, but new clause 29 does allow for exceptional circumstances; it simply requires that they are justified, recorded and subject to oversight.

Research from University College London found that there has been a 65% increase in the number of children and young people admitted to adult wards for mental health disorders, and this increase is sharpest among teenage girls with eating disorders. They are the most vulnerable, and they are the ones who bear the brunt of this.

[Joy Morrissey]

That is another reason why I am shocked that the mental health budget is decreasing. I am seeing an increase across my constituency—and I am sure it is the same in many others—of girls in secondary school presenting with severe mental health issues, suicidal tendencies and eating disorders, and they are desperately crying out for additional mental health support.

[Dr Evans]

My hon. Friend is absolutely right that that support needs to be there. Fortunately, it is not the budget that is reducing but the proportion of funding, and it shows the priorities of this Government when it comes to mental health.

I am concerned that without new clause 29, a child may be harmed or traumatised and placed in an adult ward without proper justification—and it will be little comfort for the family to hear that guidance was breached.

Amendment 41 stands up for the simple but vital principle that when a child is detained under the Mental Health Act, the person legally recognised to act for them—their nominated person—should hold parental responsibility. Only where there are legitimate safeguarding concerns should that be set aside. At first glance, this may seem technical, but it speaks to something profound about how the law views childhood, family and the balance between protection and autonomy.

The Government are right to use the Bill to modernise the old “nearest relative” system, which was too rigid, too bound by bloodline and at times blind to the complexities of family life. Under the Bill, however, a child under 16 deemed competent could nominate any adult—that could be a 19-year-old boyfriend or peer or someone exercising control—and once nominated, that person gets full control. It is a legal authority. We need to ensure that protection is there for the person if there is a breakdown on the family side. [Interruption.] I see that Madam Deputy Speaker is encouraging me to wind up, so I will solidify my comments into a more erudite approach.

The point is that in law this principle is already clear in the Children Act 1989, which defined it as the foundation stone of what families should look like. With this amendment, I believe we have solved the concerns the Minister had at Committee stage about the state of a family in the modern era. In any other walk of life the legal framework exists, so why would we weaken it when it comes to mental health?

We discussed the issues with A&E and the grey area there in Committee, and I was grateful to the Minister for meeting beforehand to discuss them. I know that he took on my comments about solving the practicalities, and I hope he will look at them seriously.

For this House, there is no greater moral burden than deciding for someone who cannot decide for themselves—where care ends and where control begins. That is exactly what the House is addressing with this Bill: how to protect without diminishing, how to act with compassion without surrendering precision, and how to empower without imposing. Involuntary care must never be the reflex of a system, be it under pressure or out of principle. The House agrees on this position; the challenge is delivery. Compassion demands more than good intentions. It demands delivery, discipline and detail. With this Bill, the Opposition lays the challenge of delivery. It must be not just a pledge but a plan. The public will judge us all not just on how kindly this House speaks, but on how faithfully it serves those who depend on us most.

[Mr Richard Quigley (Isle of Wight West) (Lab)]

I will speak to new clauses 28 and 36 and amendment 39, which I tabled not just as an MP but as a father. After what my family have been through, I believe that any parent would do the same.

Yesterday, alongside the right hon. Member for Salisbury (John Glen), I had the privilege of hearing Dr Kate Szymankiewicz speak about her daughter Ruth. She shared not only the tragic circumstances of Ruth’s death but the type of person Ruth was: her dream of becoming a vet, her kindness, and how friends described her as a character straight out of an Enid Blyton novel. That is the Ruth her family remember and cherish. As parents, we became part of a world we never wanted to know. I am privileged to have met Kate, but we agreed that we wished our paths had never crossed because of what that meant.

Ruth was admitted to an in-patient facility for treatment of an eating disorder, but instead of receiving the care she needed, her family were shut out and allowed only two two-hour visits per week. They spent more time travelling than they did with their daughter. Ruth was just 14 years old when she fatally self-harmed, just five months into her stay.

Three months from that date, my family were faced with the same hospital, Huntercombe, as the only choice of a bed for our daughter. At that same hospital, when a child asked if they could have an extra type of jam for breakfast in the morning, they were told it did not have the budget, and when asked why Minstrels were no longer part of snack time, they were told that they were eating too many. That is the problem with NHS-funded private provision: even at £900 a night, the operators plead poverty.

My wife and I have two vivid memories of our youngest being prised from us without any warning. We thought that was normal. Six months of nasogastric tube feeding—we thought that was normal. Illegal restraint so bad that it caused post-traumatic stress disorder—we thought that was normal. Forgetting to feed our daughter 11 times—we started to realise that that was normal, but not acceptable. Instead of wishing to improve its practice, the hospital has accused me of making this up.

If a child is facing any other physical illness such as cancer, or even something more short-term that requires a hospital stay, parental visits and involvement are quite rightly seen as a means of enhancing care. I genuinely struggle to understand why our clinical consensus around mental health continues to support a model where already vulnerable children are isolated from their parents—the very people who know and love them most. Children on these wards are treated as wilful—they are not; they are children—and without empathy or sympathy. Many consultants we encountered opted not to apply the National Institute for Health and Care Excellence guidelines. Staff were poorly trained and in fear of psychiatrists, who ruled the roost and prevented people from speaking up. The private equity firms are focused not on long-term treatment but just on turning mental health into money.

My amendments do not seek to undermine the Bill’s strengths, nor the important work undertaken by the Department. In fact, the cross-party support I have received, including from the right hon. Member for Salisbury, reflects how uncontroversial they are.

The Minister and I have had robust and constructive discussions on the matter, but I ask him to confirm that he will do everything in his power to ensure the following. Parents must not be shut out of their child’s care, as evidence shows that regular parental contact enhances care outcomes. The placement of children on adult mental health wards under the Mental Health Act must be limited strictly to exceptional circumstances, and practitioners must be actively compelled where appropriate to involve themselves in the development and delivery of a child’s care and treatment plan.

We have a duty to ensure that the tragic circumstances surrounding Ruth’s death are never repeated. The Government were elected with a phenomenal majority, winning places we never thought possible—including my own constituency of Isle of Wight West—on a platform of meaningful change. If we do not use this moment to do the right thing and acknowledge that children in mental health services need their parents more often than not, I fear that we may never get another chance.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

I begin by thanking colleagues across the House who have worked so constructively on this long-awaited Bill. There has been a shared recognition that the current mental health system is failing too many people and that reform is urgently needed. I thank the Minister for engaging with us so constructively throughout the process, including as recently as yesterday; it is much appreciated.

When I speak to people in Winchester—I know that hon. Members have very similar stories—mental health is one of the issues that comes up the most. We have families waiting months or even years for treatment, we have parents watching their children deteriorate, and we have people languishing on waiting lists when they would rather be working or studying.

The Bill represents the biggest reform of mental health care in over 40 years. It strengthens patient autonomy, modernises detention procedures and rightly removes police stations from the definition of places of safety. These are vital and much needed steps forward and I know that Members on all sides welcome them.

I will speak briefly to several new clauses tabled in my name, each aimed at strengthening the Bill’s impact for some of the most vulnerable people it seeks to protect. New clause 26 would ensure that every hospital has a dedicated liaison service for the carers of patients detained under the Mental Health Act. This is a vital step to support carers during what can be an unimaginably difficult time and to close blind spots that too often exist when someone is caring for a loved one with serious mental illness.

We know that parental mental health concerns are now the most common factor in children’s social care assessments, and that those children are at much higher risk of developing mental ill health themselves. Yet only about a third of mental health professionals in in-patient settings ask whether a patient is a parent. These children and the carers who support them are too often invisible. By identifying and supporting carers properly, new clause 26 would help close those gaps and ensure that no family has to struggle in silence.

[Dr Luke Evans]

We did not discuss this specifically in Committee, but I would be interested to know about the interaction between the independent mental health advocates, which are being expanded and which we all agreed with in Committee, and a new liaison service. I worry about the duplication. Will the hon. Member explain how that crossover would work in practice?

[Dr Chambers]

That is a prescient point. At the moment, there is no responsibility to ensure that children in particular, and other carers too, are identified. Even if they are put in advance choice documents, if the person making those decisions does not identify them, that will not come about. We would have to be careful that there is not unnecessary duplication; however, the initiative the hon. Gentleman puts forward is not a belt-and-braces approach to identifying young carers and other carers who are struggling.

New clause 7 seeks to end the detention of children on adult wards, requiring the number to be reduced to zero within five years—other Members have discussed that today—and the Secretary of State to set out how that will be achieved. It simply cannot be right that children are still being treated on adult wards. It is unacceptable and can seriously hinder recovery and effective care.

Although the Bill rightly focuses on hospital-based treatment, the process has also laid bare how fragile our wider mental health services have become, with the lack of early support in primary and community care and the shortage of initiatives that help people long before they reach crisis point. That is why new clause 14 would place a duty on integrated care boards to ensure that community services have the resources they need to meet the demand and report on that regularly. Keeping people well in their communities must be at the heart of any modern mental health strategy, because if we get the community care right, we prevent crises, reduce pressure on hospitals and help people live healthier, more independent lives.

Finally, new clause 22 would establish a veterans’ mental health oversight officer. That dedicated role would ensure that those who have served our country receive the understanding and tailored care they deserve when they come into contact with mental health services. Too often, veterans experience mental ill health, sometimes linked to their service, and they find themselves in systems that do not fully recognise their unique experiences. The proposal would help change that by providing proper oversight; encouraging joined-up working across the NHS, veterans’ services and the third sector; and ensuring that compassion and accountability sit at the heart of how the Mental Health Act is applied to veterans.

Taken together, the proposals are about making our mental health system even more humane, more joined up, and more focused on prevention and recovery. I hope the Government will take them in the spirit in which they are intended, which is to strengthen this important Bill, which we very much support, and deliver a system that truly supports those who need it most.

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

As a member of the Bill Committee, I had the opportunity to closely examine the development and scrutiny of this Bill alongside my Opposition colleagues. We sought to strengthen the legislation, particularly in relation to safeguarding children and ensuring robust protections for those admitted under the Mental Health Act framework.

Given the shortness of time, I will speak only about amendments 41 and 42. They make the vital clarification that the nominated person for any patient under the age of 16 must have parental or guardian responsibility unless there are clear and established safeguarding concerns. In essence, that would ensure that the parents remain the lawful decision-makers and the first and most natural safeguards for their child’s welfare.

Let us consider, for a moment, what is at stake. Imagine a vulnerable 14-year-old girl, frightened and confused during a psychiatric admission. In that moment of distress, a well-meaning adult—or, worse, someone with a hidden agenda—could persuade the child to nominate them as their representative. That individual would then gain legal powers to object to treatment or discharge decisions, while the parents—the very people who know the child best and have both a moral and legal duty to protect them—could be sidelined.

Once such a nomination is witnessed, it carries legal force. The rights and responsibilities of parents could, in effect, be overridden. Although that may sound hypothetical, it is not. Family courts have seen precisely how manipulative individuals exploit vulnerable young people. Groomers, traffickers and abusers thrive in the legal grey zones. If we are not crystal clear that only a court may displace parental responsibility, we risk leaving the door ajar for such exploitation. I ask the Minister to assure the House in winding up that no child under 16 will be permitted to override parental authority simply by nominating someone else, without a full and proper judicial process.

The Bill does have fallback provisions, which are of course welcome, but they are not watertight unless the law explicitly confirms that only a court can transfer or restrict parental rights.

[Dr Luke Evans]

My hon. Friend makes an excellent point. The only protections that I can see in schedule 2 are an age requirement, a stipulation not to be disqualified by a previous court order, and the presence of a witness. There is therefore no pre-emptive way of protecting people, which is why amendment 41 is so important.

[Gregory Stafford]

My hon. Friend is absolutely right. Both he and I made those points in Committee. I am surprised that the Minister does not see the risks here. The safeguard that my hon. Friend talks about must be beyond any doubt. The amendment in his name provides exactly that clarity. It would prevent unrelated or loosely connected individuals from stepping into a role that rightfully belongs to those with both a legal duty and an emotional bond—the parents or guardians—and it would preserve the fundamental principle that parents should not find their role diminished by accident or administrative oversight.

As I was saying, this is not an abstract risk; it is a very real and foreseeable consequence of the unclear drafting. These amendments do not weaken the rights of patients. They strengthen the protections around them. They ensure that in modernising this law, quite rightly, we do not inadvertently undermine the oldest and most important protection of all: a parent’s duty to safeguard their child. We must ensure that the state can only curtail that right under the strictest judicial scrutiny, with evidence tested and the child’s welfare paramount. In doing so, we will make this legislation not only legally sound but, in my view, morally right.

New clause 31, tabled by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), would require local authorities and ICBs to supply a fully costed plan to ensure they are able to provide adequate community services for people with learning disabilities and autistic people. I support that entirely. As vice-chairman of the all-party parliamentary group for special educational needs and disabilities, and from speaking to groups in my constituency such as Last Wednesday and Growing Hope, I know that the process around SEND is complicated and not fit for purpose. Fortunately, we have a chance to help it slightly with this Bill, so I ask the Minister to support new clause 31.