Mental Health Bill [ Lords ] (Seventh sitting)

Neil Shastri-Hurst Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

I accept the point made by the Minister and others that mental health advocates are perhaps not best placed to deliver an initiative similar to the Winchester Citizens Advice project, which supports mental health in-patients. I understand the point made that advance choice documents are potentially not the way to implement this type of support either. I want to press the issue again, because it is so important; it affects so many people and the economic viability of mental health care. If advance choice documents are not the appropriate mechanism through which to run a scheme to help people with their life admin and debt, whatis the way to deliver that support, in a way that is linked to the Bill in some way?

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I want to speak in support of amendment 46. It is eminently sensible and would give all eligible patients the statutory right to create an advance choice document to record their treatment preferences in a formal legal document. Those preferences would be enjoyed only in the event of a future mental health crisis or detention under the Mental Health Act.

The amendment would give important control to patients and to those around them to know that their future care decisions would be applicable at the point at which they become incapacious. It would quite rightly place a requirement on NHS England—for as long as it continues to exist—and ICBs to ensure that those individuals are aware of their rights and, more importantly, that they are not just aware of them but are supported in creating an advance choice document if they so wish.

The amendment is all about empowering patients. The more we can empower patients who face these challenges, the better. It would increase their autonomy and help with the planning of their future care. It would help both in the understanding and the honouring of patients’ wishes. Critically, it would reduce conflict. In these circumstances, tensions are high and pressures are acute, so conflict can arise in the most unintended of ways. Having an advance choice document minimises that risk.

If the Government will not support amendment 46, what reassurances can the Minister give in relation to the code of practice? How will this be accounted for in the code of practice to ensure consistency in the information imparted to patients across the country by NHS England and the ICBs? We must ensure that there is not a postcode lottery and that everybody, regardless of where they live in the country, gets the consistency of care that they are entitled to.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak in support of amendment 46, tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, which seeks to strengthen clause 45, an already welcome and progressive clause, by creating a statutory right for all eligible patients to create advance choice documents if they so wish.

Let me begin by saying that I think everyone on the Committee recognises the importance of advance choice documents. They are an excellent initiative, and I am glad that the Bill introduces a framework to support their use. I hope we can all agree that they represent a constructive and compassionate shift in how we think about mental health care—one that puts the patient’s voice at the centre. ACDs are fundamentally about empowerment. They allow individuals, while they are well and have full capacity, to record their wishes, preferences and concerns regarding their treatment, so that during future periods of unwellness, when they may lack capacity, their past self can still be heard and respected. As Bipolar UK has rightly put it:

“The idea behind an ACD is that you use your past to plan your future.”

That simple principle holds immense power. Individuals with lived experience of severe mental illness like bipolar disorder are often experts in their own care. They know what works, what does not and what signs to look out for. An ACD allows that hard-earned knowledge to be recorded, shared and used to guide clinical decisions. By identifying early warning signs and outlining preferred treatments, ACDs can enable families, friends and professionals to intervene earlier, potentially avoiding a crisis or reducing the severity of an episode. This is not just about better care; it is about safer care and, crucially, more timely care.

The research is persuasive. Studies suggest that ACDs can reduce rates of compulsory detention under the Mental Health Act by up to 25%. That is not a small statistic; it is a significant reduction in trauma for patients, in the use of force and in resource pressures on services. It is hard to think of a better example of a policy that both improves outcomes and reduces system strain. ACDs can also play a vital role in reducing inequalities, especially among racial minority groups, who, as we have all said, are statistically more likely to be detained under the Act. Ensuring that those patients can express their wishes in advance gives them greater agency and helps to address long-standing disparities in the system.

ACDs are not just a useful administrative tool; they are, as Earl Howe put it in the House of Lords,

“are a major component part of one of the Bill’s key strands, which is to give mental health patients better control over their own care—which, of itself, carries a therapeutic value.”—[Official Report, House of Lords, 27 January 2025; Vol. 843, c. 79.]

I absolutely agree, which brings me to amendment 46. The clause as drafted places duties on NHS England and integrated care boards to consider making information about ACDs available, and to help those people whom they consider “appropriate” to create one. That is a start, but it falls short of what is needed. The shadow Minister’s amendment would take us further and create a statutory right for eligible patients to create an advance choice document. It would define clearly who is eligible—for example, those previously detained under the Act, those diagnosed with a condition that may require future detention and qualifying informal patients—and would put a clear duty on NHS bodies to inform these patients of their right and to help them to exercise it. This is not about placing a burden on services; it is about ensuring that everyone who stands to benefit from an ACD knows that they can make one and is supported to do so if they wish.

I appreciate that the Government have tabled amendments 32 and 33 to clause 45, and I welcome the intention behind them. Amendment 32 requires that NHS England and integrated care boards must bring the availability of this information and help to the attention of such people “as it considers appropriate.” Amendment 33 expands on how that might be delivered, including through conversations with qualified individuals and by having specific regard to the benefits of ACDs in the 12 months following discharge from hospital.

Although these are improvements, I must respectfully say that they stop short of what is needed. They continue to frame the duty in terms of who the board considers appropriate, yet the very point of ACDs is that we should not be gatekeeping access. We should not be making assumptions about who would or would not benefit from having one. Every eligible patient should be offered the choice, not just those whom the system deems suitable. We are dealing here with people’s autonomy and right to shape their future care, and if we start from a place of selective provision, we immediately disempower many of the very individuals we claim to support.