Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Robert Neill Excerpts

Thursday 20th January 2022 Commons Chamber

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I am grateful to my right hon. and learned Friend for giving way, and for the passion and knowledge that he brings to this topic. He refers to out-of-date legislation and how things have moved on. He will know from his experience as Justice Secretary that if we thought that we were applying the same regimes in terms of detention and use of restraint to people who had been convicted of offences after the passing of 60 years, we would rightly be outraged. Should we not be rightly outraged now that this is being done to people who have committed no offence and have not had the protection of due process that those going through the justice system have?

[Sir Robert Buckland]

I have good news, because it is Government policy to update the Mental Health Act. That is the plan that I and others, when I was in Cabinet, agreed on and I know that it is what the Minister will speak about. Reforming the Mental Health Act is Government policy because, goodness me, we have work to do. Between 2006 and 2016, the number of detentions rose by a staggering 40%. We owe thanks to the work of people such as the outstanding Sir Simon Wessely, whose independent review in 2018 gave the Government the clear course that I know they are adopting and following.

I particularly welcome the disaggregation of autism and learning disability from mental health in law and the end to their being classed as a mental disorder under section 3 of the existing Act. According to the Government’s policy, there has to be a clinically established concurrent mental health condition before detention can be allowed, and there will be a 28-day limit. All that makes immense sense, and I particularly look forward to the Government’s introducing a statutory duty to provide adequate community-based services, such as supported housing. In the White Paper that the Minister introduced before Christmas, we saw really healthy and useful reference to supported housing. It is my belief that, without that, we cannot create effective community-based services.

We still do not have a fully clear picture of the current commissioning landscape across England, but we know that people are being left in NHS-funded detention, because the lack of resources for local government means there just are not enough local government-commissioned community services for people to go home, back to their families and back to their local areas. Legislative change cannot come soon enough, so I would be extremely grateful if my hon. Friend the Minister could confirm the Government’s intention to bring forward that legislation, whether it will be first via the pre-legislative scrutiny process and, if so, when we can expect its introduction.

As time is short, I want to speak briefly about the Transforming Care agenda. We know that, when all agencies work together at the same pace, it is excellent, but the trouble is that we still have agencies dragging their heels or causing problems that mean people are spending longer in detention than they need to. The readmission of patients who are being discharged is another depressing example of our failure to break the vicious cycle in many cases.

We know what “good” looks like; we have the NHS England “Building the Right Support” service model and National Institute for Health and Care Excellence guidance. We know that there are pockets of good practice that the Government are actively promoting and supporting, but more needs to be done to join that up. If we are to see these figures starting to come down, consistent with the Government’s own priorities, the time for action is now.

There are, therefore, two things that the Government can do. They can not only bring forward the legislation, but fulfil their pledge to add more substance to the strategies they have outlined. The £74 million, pledged in the 2020 Budget to help with what are known as the double running costs when people with a learning disability or autism are discharged into the community, is extremely welcome. I know there are funding commitments in the NHS long-term plan to help the development of community support. However, as the recent Health and Social Care Committee inquiry noted, we still are not in the place we need to be. We still do not have that level of support that will make the discharge of patients a much more seamless and successful process. I know that ending those perverse incentives and this artificial division between the NHS and local government is part of the integration agenda, and I look forward to the White Paper that my hon. Friend will be publishing very soon, but I want everything to be joined up, in a way I was acutely conscious of when I was Justice Secretary.

I will end on this note: I was acutely conscious of the need for greater speed when it came, for example, to the approval of the recommendation of clinicians, which was the responsibility of my Department. Prior to the onset of covid, I collaborated directly with the then Health Secretary to jointly pursue the Mental Health Act reform agenda. My abiding regret is that I was not able to do more, and I want to say that I am sorry that I was not able to do more, but here I am in my place asking my friends to carry on the work, to pick up the ball and to take it further for all the people we represent and their families. By calling this debate and by making that direct request to Government to act, I hope that together we can make the necessary changes and save lives.