Mental Health Bill [ Lords ] (Sixth sitting)

Debate between Neil Shastri-Hurst and Gregory Stafford

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Dr Shastri-Hurst]

It is a pleasure to serve under your chairmanship this afternoon, Mrs Harris. I rise to speak on clauses 30 to 33, which go to the core of the rights architecture that surrounds mental health law in this country—namely, the oversight and challenge mechanisms available to individuals subject to detention, supervision or conditional discharge. I think we are all aware that the 1983 Act, although fit for its time, has failed to keep pace with the evolving understanding of mental health illness and modern expectations of legal accountability or procedural fairness. The clauses, although technical in nature, seek to rectify a number of the long-standing shortcomings in the operation of the mental health tribunal system.

Clause 30 will extend and clarify the time period within which patients may apply to tribunals. Essentially, it will do two things. First, it will extend the application window for section 2 patients—those detained for assessment—from 14 to 21 days. Secondly, it will reduce the initial waiting period for section 3 patients and those under guardianship from six months to three months. Those are sensible and overdue changes, because 14 days is a narrow window for any legal action, let alone one initiated by an individual who may be experiencing acute psychological distress.

Extending the application window to 21 days provides a fairer opportunity to seek representation and prepare a meaningful application. Equally, the reduction of the initial period for section 3 and guardianship patients to three months offers an important safeguard against prolonged detention without scrutiny. It restores a measure of clarity between the gravity of the detention order and the speed with which it may be challenged.

The clause will also clarify the rights of conditionally discharged restricted patients who are subject to deprivation of liberty conditions—that is, those who are discharged from hospital but required to comply with supervisional residence requirements that are so restrictive that they cross the legal threshold for a deprivation of liberty. At present, those individuals occupy a legal grey zone: they are not formally detained, yet the liberty they enjoy is so curtailed that it raises significant questions as to their article 5 rights. Clause 30 will properly address that anomaly by creating a defined, regular route of appeal, initially between six and 12 months from the imposition of the deprivation of liberty conditions, and biannually thereafter. Those are measured and proportionate changes that enhance access to justice, improve compliance with human rights obligations and restore clarity to a field that has suffered, at times, from legal opacity.

The reforms are not without consequences. A wider cohort of eligible applicants and more frequent review periods will inevitably increase the burden on the tribunal service, on legal aid provision and on clinical teams who must prepare documents and attend hearings. That challenge is not to be dismissed lightly.

[Gregory Stafford]

Does my gallant and learned hon. Friend have any information on the current waiting times for tribunals? What does he expect the effect of the changes proposed in these clauses to be on waiting times?

[Dr Shastri-Hurst]

My hon. Friend makes a pertinent point. We all know, from our casework or personal experiences outside of this place, about the pressures on the Courts and Tribunals Service. Mental health tribunals are not exempt from that pressure. Changing the timeframe on which tribunals operate, and the frequency with which reviews take place, will inevitably increase the burden on the service. Therefore, although these changes are broadly welcome, it is important that we are cognisant of their impact on the resources that will be required, the number of judges and wing members that will be needed, and of course the hard standing of the court and tribunal infrastructure that will need to be made available. Other issues, such as those around the digitalisation of the service, will also need to be addressed.

Clause 31 will recast the regime for automatic tribunal referrals, replacing the prior six-month structure with the concept of “a relevant period”. For detained patients, referrals will now occur at three months, then 12 months, and annually thereafter. For community patients, they will occur at six months, then 12 months, then annually. Most significantly, hospital managers will be under a new duty to refer a case when no review has occurred in 12 months, regardless of whether an application has been made. That is a sound reform.

The clause will introduce coherence to a previously fragmented system, and establishes a minimum standard of legal oversight. The inclusion of a backstop provision—that no individual should go more than 12 months without review—is essential. In a system in which patients may not always have the means or capacity to apply for a review themselves, it offers a critical safety net. Clause 31 will also repeal section 68A of the 1983 Act, which has become unwieldy and duplicative. By streamlining the referral process, the Bill enhances legal clarity and administrative efficiency, but I would caution that the increased complexity of the new timeframes may require significant training of those responsible for their implementation.

Clause 32 will provide for restricted patients who are subject to deprivation of liberty conditions. It goes further than clause 30 by imposing mandatory referral duties on the Secretary of State. Under the clause, a tribunal must be convened after 12 months, every two years thereafter, and at four years if no review has occurred. Crucially, the clause also codifies the tribunal’s powers. It may now vary or impose conditions, including those that constitute a deprivation of liberty, provided that they are necessary to protect the public from serious harm and are no more restrictive than hospital detention. That clause introduces a principled, proportionate framework for balancing public protection with patient liberty, and avoids vague or discretionary use of such powers.

Finally, clause 33 will apply the same principles to restricted patients not subject to deprivation of liberty orders. Such individuals, although under fewer constraints, are none the less subject to significant legal orders. The new requirement for a tribunal review at two years, and every four years thereafter, ensures that oversight is regular and non-discriminatory.

All four clauses are united by a clear objective to rationalise tribunal access, enhance procedural safeguards and bring the Mental Health Act into alignment with modern standards of fairness and proportionality. However, I will close with a caveat: rights without resourcing are hollow. If we are to place greater demand on the tribunals service, and to rely on it as the guardian of liberty for thousands of individuals, it must be adequately funded, staffed and supported. Legal representation must be accessible. Tribunal members must be properly trained. Hospital managers must be equipped to meet their new responsibilities.

With those reservations, I broadly welcome clauses 30 to 33 as a necessary recalibration of our mental health law. They reflect the dignity of the individual, the demands of public safety, and the enduring principle that no one should be deprived of liberty without fair or timely review.

Mental Health Bill [ Lords ] (Second sitting)

Debate between Neil Shastri-Hurst and Gregory Stafford

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Gregory Stafford]

Thank you, Ms Furniss. I was coming to my closing remarks on amendment 47. Suffice it to say that some of the concerns that I raised on amendment 8 about the administrative burdens, the data sharing, and the potential safeguarding and privacy concerns transfer through. Again, perhaps the hon. Member for Winchester could give some reassurance on that when summing up.

Amendment 9, as far as I can tell, would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.

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

Does my hon. Friend agree that, although the intention behind the amendment may be worthy, there is a lack of clarity in the drafting? In particular, it is unclear what “seek to ensure” means and how that would be legally defined.

[Gregory Stafford]

My hon. Friend is right; although a number of the Liberal Democrats are entirely worthy, there are some concerns about the drafting, which could give rise to ambiguity, legal loopholes and definitional issues. In that example, I do not think that “seek to ensure” is helpful. When the hon. Member for Winchester is summing up, perhaps he might explain how “seek to ensure” can be robustly defined within the law, or if it cannot be, suggest a different form of wording that he may wish to use in a future amendment if this amendment fails to be agreed.

Part II of the Mental Health Act 1983 covers the powers to detain individuals for assessment and treatment. Detention can clearly be traumatic, especially for children and young people. Amendment 9 reflects a growing consensus that detention should be the last resort— I think hon. Members on both sides of the House agree with that—and that community-based preventive and therapeutic alternatives should be prioritised. Again, I think it would be very hard to disagree with that ambition.

On the positive side, community-based care is clearly better than detention in most cases, and, if we can get to a point where people are assessed earlier, as is the intention of some of the other amendments, clearly—hopefully—that would lead to community-based care and not detention. The amendment would also protect children’s rights and support the trauma-informed approaches to mental health that were raised previously regarding amendment 47.

The amendment could also reduce the long-term harm associated with institutionalisation and potentially coercive treatment. As we have heard from Members on both sides, that would align with best practice in child and adolescent mental health services and it would promote and encourage a system of accountability by making ICBs and local authorities responsible for proactive care planning. All of that is extraordinarily laudable.

On the potential downsides, there is an ambiguity about the enforcement of the amendment, as my hon. Friend the Member for Solihull West and Shirley said, because of the lack of legal force or clarity in some of the phraseology. There would be also resource implications and, if there are resource limitations at the ICB or local authority level, that might hinder their ability to provide adequate, community-based alternatives.

I do not say that as an excuse for not supporting the amendment, but the hon. Member for Winchester has to understand the reality of the world we live in. Although I want local authorities and ICBs in every area to be entirely fully funded and resourced—and frankly, I do not think the Government’s cut of 50%, or indeed more in some ICBs, will do anything to help community-based care—there would be resource challenges. There would also be implementation challenges in areas where mental health services are already underfunded or overstretched that could lead to delays in care.

This is the key question that I ask the hon. Member to respond to in his summing up. Members on both sides of the House want to ensure that all people of all ages get the best, most appropriate mental health care as early as possible. But in an imperfect world, if there are potential delays in care because community services are struggling to find alternatives to detention, the unintended consequence could be that someone may not be treated at all because of the onus on defined community-based care rather than detention. Will the hon. Member explain how that would work?

I draw my remarks to a close by saying I, certainly, and the Opposition, entirely agree with the ambitions of the amendments. However, some practical and legal issues would need to be ironed out before I could wholeheartedly support them.

--- Later in debate ---

[Gregory Stafford]

I rise to speak to amendments 52 and 53, tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull West and Shirley. Clearly, both my hon. Friends have significant clinical experience, and I bow in many ways to their expertise. However, the amendments cause me some concerns.

Amendments 52 and 53

“would add to the grounds for admission to hospital for assessment or treatment that the patient must lack the capacity to consent to that admission, if they would not be detained due to being a risk to others.”

Clearly, both amendments would introduce a capacity-based distinction in the grounds for detaining a person for medical treatment under the Mental Health Act, as my hon. Friend the Member for Hinckley and Bosworth mentioned. That would ensure that, for patients who lack capacity or competence, detention is justified if serious harm may be caused to themselves or others unless they receive that treatment. For patients who have capacity or competence, detention is justified only if serious harm may be caused to others unless they received that treatment.

The amendments build on the principle of autonomous individuals, which we have talked about and which, as my hon. Friend said, is in the Bill. People should not be detained solely for their own protection if they are capable of making informed decisions about their care. As my hon. Friend said, that aligns with the Mental Capacity Act and broader human rights principles, aiming to ensure that detention is used proportionately and, most importantly, ethically.

Where the two amendments improve the current legislation is around the strengthening of patient autonomy by limiting the detention of capable individuals to cases where others are at risk. The amendments align the Bill with the human rights principles and the Mental Capacity Act, and clarify a number of legal thresholds for detention, reducing ambiguity in clinical decision making. That will help clinicians to make more sensible and consistent judgments when it comes to who should or should not be detained. Obviously, the amendments promote a proportionality element in the use of coercive powers, and support the person-centred care that we want.

However, I am concerned that the amendments may increase complexity when assessing capacity in applying the correct legal tests. It will absolutely require training and guidance. Government Members have been concerned about mandatory training, and I make no apologies for hoping there would be significant training on this for clinicians when acting in this role, to ensure consistent application of these services. While I accept that the provisions clarify the legal thresholds, I think there is a potential for legal challenges if the distinction is misapplied or misunderstood, hence the need to return to my point about having the correct training. I hope the Minister is able to address some of those concerns, rather than just dismissing the amendments outright.

New clause 24 was tabled by my hon. Friend the Member for Runnymede and Weybridge and moved by my hon. Friend the Member for Solihull and West Shirley—

[Dr Shastri-Hurst]

Solihull West and Shirley.

[Gregory Stafford]

I am doing my best—I will get it right by week three, I promise.

New clause 24 would allow people who have attended or been brought to hospital to seek help or admission as a patient to pursue an application for admission under the Mental Health Act. As other Members have mentioned, section 5(1) of the Mental Health Act allows for the detention of individuals who are already in-patients. However, there has been ambiguity about whether that applies to individuals who are on hospital grounds but not yet formally admitted; for example, those who arrive voluntarily or are being brought in during a crisis. New clause 24 seeks to close that gap by explicitly allowing applications for detention to be made in such circumstances, ensuring that a timely intervention can occur when necessary for safety or treatment, according to my hon. Friends the Members for Solihull West and Shirley and for Runnymede and Weybridge.

I listened carefully to my hon. Friends on the benefits of the new clause, and I accept some of them. However, I have some concerns about deterring people from turning up to a hospital setting, either for some other treatment or to visit friends or relations. I am worried that people would be concerned that they would be forcibly sectioned or detained without their consent by just turning up. There is a real risk of overreach in new clause 24. If we go back to the point about autonomy, people need to have assurance about when and where they will potentially be detained when they seek voluntary help.

The line between voluntary attendance and involuntary detention is the nub of the new clause. While I accept the arguments that have been made by my two hon. Friends, I am not thus far convinced that the balance in the clause is correct, but I am hopeful that the Minister can give some clarity.

Mental Health Bill [ Lords ] (First sitting)

Debate between Neil Shastri-Hurst and Gregory Stafford

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Gregory Stafford]

I agree. Even if the Government build the number of houses that they propose—I have some scepticism—there will always be the potential conflict or disagreement on prioritisation in the housing register and list. As my hon. Friend says, that might well lead to local authorities having to change their criteria, which are not necessarily consistent across local authorities, and, as in his example, potentially pitting a homeless person against someone with mental health needs.

The amendment would also have the potential for scope creep. I have a lot of sympathy with what it is trying to achieve, but expanding CETRs to include housing might dilute their focus and overburden the process. I am interested to hear from the mover and supporters of the amendment how they would ensure that the CETR continues to have that core focus on the health and wellbeing of the individual, rather than potentially be bogged down in the mire of housing issues.

Moving on, amendment 51 would ensure that the care and treatment of individuals with autism or learning disabilities explicitly considered the impact of accommodation and relocation in the planning and decision-making process. Again, I have a lot of sympathy with that. It would promote holistic care planning, reduce trauma and disruption, support continuity of care and, I think, align with the person-centred principles throughout the Bill, which all of us support. Again, however, amendment 51 might complicate discharge planning, if suitable accommodation were limited.

[Dr Shastri-Hurst]

Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.

[Gregory Stafford]

I agree entirely. That could be the unintended consequence of amendment 51: in essence, if the housing provision is not there, discharge will be delayed. From my understanding of the amendments in the group, those who tabled them are trying to speed up and improve discharge. My hon. Friend is absolutely right that we need to think about the practical implications of the Bill.

The amendment would require co-ordination among health, social care and housing services, which may be challenging in under-resourced areas. Frankly, because parts of those organisations are not used to working in the ways that the amendment would require, it might fall over without suitable training, the necessary lead-in time and a practical understanding of how it will work.

Amendment 4 would ensure that housing needs are formally considered during the care and treatment review meetings for adults with autism or a learning disability, without an EHCP. I understand that the aim is to support more effective discharge planning and reduce the risk of unnecessary or prolonged hospital stays. That is entirely in keeping with what we should be trying to do in the Bill. Holistic care planning reduces delays in discharge, improves cross-sector collaboration and supports community-based care, which we all support.

Once again, however, there is potential for complexity in the implementation. New processes may be required to involve the housing authorities. Resources and local housing shortages could limit the amendments’ practical impact. Another layer of complex review processes could add to that administrative burden. If there is inconsistent local capacity, the effectiveness of the amendment will almost certainly vary depending on the local housing infrastructure, which could lead to a postcode lottery, for want of a better phrase, in who receives the adequate care and housing.

Amendment 2 would ensure that children and young people with autism or learning disability, as well as their nominated persons and independent mental health advocates, receive a copy of the care, education and treatment review meeting report. I have a lot of sympathy with that. It potentially increases empowerment and transparency, ensuring that patients and their advocates are fully informed, which could enable better participation in care decisions. It has a legal and ethical alignment with the principles of the Mental Capacity Act 2005 and the UN convention on the rights of persons with disabilities, both of which emphasise supported decision making. It might also improve advocacy, as independent mental health advocates can more effectively represent a patient’s interest when they have access to the full report.

--- Later in debate ---

[Dr Shastri-Hurst]

Not quite: Solihull.

[Gregory Stafford]

I knew it began with S and was somewhere that is not Surrey or Hampshire—because where else would you want to be, Mr Vickers? The amendment would potentially increase the workload, because more frequent reviews place additional pressure on professionals and services.

[Dr Shastri-Hurst]

Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?

[Gregory Stafford]

My hon. Friend is entirely correct. We operate in a resource-confined area. It does not matter what the resource envelope is; it will always be confined. If we use resource to service the very laudable aims of the amendment, it will take resource and money away from another area.

Terminally Ill Adults (End of Life) Bill

Debate between Neil Shastri-Hurst and Gregory Stafford

Friday 16th May 2025 Commons Chamber

[Dr Shastri-Hurst]

I am grateful to the hon. and learned Gentleman for his intervention. These are individuals who are making this ultimate choice for themselves. My fear is that this well-intentioned new clause would make the Bill so unusable as to become ineffective. We are not prosecuting a crime here; we are enabling a choice under tightly prescribed circumstances.

While I accept that each of these new clauses in their own way seeks to improve the Bill, we must be cautious about layering protections to the point of paralysis. The Bill as drafted is not a blank cheque—it contains safeguards, panel oversight and rigorous eligibility criteria. Let us not bury its moral clarity under legal clutter. In defending this legislation, we are not abandoning care; we are affirming dignity. Let us do so with confidence and reject these amendments.

[Gregory Stafford]

On a point of order, Madam Deputy Speaker. I would like your advice. Mr Speaker said that more than 90 people wish to speak in the debate. We have been debating the amendments for an hour and a half and four speeches have been made. If we go to 2 o’clock, that will mean fewer than 20 speakers. I understand that whether a closure motion can be moved is at the discretion of the Chair. If we have not got past, let us say, 20 or 30 Members speaking in the debate, can you give us any indication of whether, if you are still in the Chair, you would accept a closure motion at that point?