Draft Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020

Rosena Allin-Khan Excerpts

Wednesday 18th November 2020 General Committees

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

The removal of these provisions from the Coronavirus Act is, of course, extremely welcome, and Labour Members will not seek to oppose it. When the Coronavirus Act was hastily drafted and enacted in light of the threat our country was facing in March, we accepted the inclusion of these regulations, to be used only as a last resort. It is a relief that the provisions have never had to be used, and we are pleased to see them dropped.

The legislation represented a significant reduction in the safeguarding of individuals subject to the Mental Health Act, and I am sure that the expiration of the provisions will be gladly received by those who are living with mental ill health and by their families. I thank all health and care staff for their hard work, and I am grateful for the work of the CQC and NHS England, whose response to the virus was robust enough that the provisions were never turned on.

Although the mental health provisions in the Coronavirus Act were never activated, that does not mean that the coronavirus has not had a significant impact on the mental health system in England. In March, at the very beginning of the pandemic, an additional 2,441 people were discharged from mental health hospitals. Compared with February, that is an increase of 26%. At that time, increasing bed capacity was a priority. Although it was necessary to take that step where it was safe to do so, it was vital that discharged patients continued to receive the care they needed.

Inevitably, the redeployment of staff to concentrate efforts on tackling the virus led to disruption to existing mental health services, with surveys from charities such as Rethink Mental Illness and Mind showing that many struggled to access support during the pandemic. That was especially true for those with existing mental health conditions, including many who were abruptly discharged. The needs of people who are living with severe mental illnesses are complex, and it is vital that they receive appropriate care in all settings.

As the number of cases and hospital admissions related to covid-19 continue to rise, so too does the prospect of having to empty beds again. In August, the Government announced a £588 million fund to support the safe discharge of patients in the event that it becomes necessary to free up space for coronavirus patients. That money is essential to prevent a repeat of the mistakes that were made in March, but I had it confirmed to me last week that mental health trusts are unable to access that funding. Similarly, alongside the announcement of that money guidance was published outlining the correct procedure for safely discharging patients from hospital settings. Again, mental health trusts were excluded from that, and there is currently no equivalent guidance for them. Will the Minister please outline why mental health trusts are excluded from this vital funding, and will she confirm what resources are being made available to trusts to support the safe discharge of patients and ensure that they receive ongoing care in the community?

Concerns have also been raised about patients who were not discharged. Many mental health estates were not built with social distancing in mind, and that has affected treatment and access to visits on and off site. Reduced contact with family and friends has undoubtedly had an effect on in-patients. Staying in a mental health ward can already be an extremely lonely experience, but the extra restrictions on social contact mean that it can feel truly, devastatingly isolating. Although many people accept that digital solutions are necessary, their success in such settings has been mixed. In-patients have stated that when social contact was facilitated virtually, it made a positive difference to their experience; however, when treatment was provided through digital means, many felt that the standard of care dropped.

It is important to remember that a large number of those who have lived in mental health wards throughout the pandemic are children who are living with severe mental health disorders, such as eating disorders or severe depression. They need a more intense level of care than would be possible in the community, but that does not make the experience any less traumatic for a child. The Children’s Commissioner found that there was a great deal of resilience on those wards throughout the pandemic, with staff working exceptionally hard to ensure that the standard of care and support provided to the children did not drop, but significant challenges remained. Although staffing rates stood firm in many children’s wards, visits from external professionals dropped alarmingly throughout the pandemic. The disruption to mainstream education filtered its way into hospitals, with many teachers stopping all face-to-face teaching on the wards, which left untrained hospital staff to deliver teaching in addition to caring for patients.

During this second spike of the virus, it is crucial that all mental health in-patients receive appropriate, high-quality care. Will the Minister outline the measures that are in place to ensure that people in mental health hospitals will receive the best care available to them, despite ongoing pressures from the coronavirus?

Entrenched inequalities in mental health treatment and access to services have existed for many years, but they are undoubtedly being deepened during the pandemic. The disproportionate impact of the virus on black, Asian and ethnic minority communities has put them at greater risk of developing mental health problems. That is especially concerning, because historical racism and experiences of inappropriate support have left many individuals from BAME communities distrustful of mainstream health services, highlighting the need for support in the community. Distrust should not come as a surprise to the Government, considering that in 2019-20 the rate of detentions in England under the Mental Health Act was more than four times higher for black or black British people than it was for white people. The racial disparity in detentions under the Mental Health Act underlines the need to address health inequalities and to ensure that provision is widely accessible and that support is suitable for all. I would be grateful if the Minister outlined what work is being done to address the inequality.

We need to be clear that for many people, community support is the most effective way to improve their wellbeing, and that has to be a priority as we look to the recovery period. What work is being done to strengthen mental health support in the community at this time?

The impact that covid-19 has had on the wellbeing of the nation has been profound. The Centre for Mental Health found that approximately 10 million additional people will require some form of mental health support as a result of the pandemic. It is important that the Government recognise the additional need and have a strategy to address it during winter and beyond. We know that the best mental health strategies are proactive and preventive. Early intervention is key to addressing mental health concerns before they develop into something more insidious. The Government must ensure that services are prepared and have the resources to cope with any rise in demand.

The expiration of the provisions today is a small but welcome step in ensuring that patients who rely on safeguards in the Mental Health Act are adequately protected. I urge the Government to not stop there. The next step must be to publish the long-awaited White Paper on the Mental Health Act and to stand by their commitment to reform the legislation to better support people who are subject to it. Only then can we be confident that those living with severe mental ill health will be properly supported by the system that is designed to protect them.