Mental Health Bill [ Lords ] (Ninth sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[The Chair]

I have a few preliminary reminders. Please switch electronic devices to silent. No food or drink, except the water provided, is permitted during the sittings of this Committee. Hansard would be grateful if Members could email their speaking notes or pass them on to the Hansard colleague in the room. Members are reminded to bob and catch my eye if they wish to speak in any debate.

New Clause 1

Reporting: racial disparities relating to community treatment orders

“(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must undertake a review of racial disparities which relate to the use and administering of community treatment orders.

(2) The review under subsection (1) must include, but is not limited to—

(a) an assessment of whether certain racial or ethnic groups are disproportionately represented among individuals subject to community treatment orders compared to their representation in the general population;

(b) a review of the outcomes and effectiveness of community treatment orders across different racial groups, including health outcomes, and patient experiences.

(3) The Secretary of State must lay a report of the findings of the review before Parliament within 18 months of the day on which this Act is passed.”—(Zöe Franklin.)

This new clause seeks to gauge the Government’s view on prevalent racial disparities as they relate to the use of community treatment orders under the Act.

Brought up, and read the First time.

[Zöe Franklin (Guildford) (LD)]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss new clause 3—Addressing and reporting on racial disparities and other inequalities in the use of the Mental Health Act 1983—

“After section 120D of the Mental Health Act 1983, insert—

‘120E Mental health units and services to have a responsible person

(1) A relevant health organisation that operates a mental health unit or community mental health service for qualifying patients must appoint a responsible person for that unit or service for the purposes of addressing racial disparities and other disparities based on protected characteristics related to functions discharged under the Mental Health Act 1983.

(2) The responsible person must—

(a) be employed by the relevant health organisation, and

(b) be of an appropriate level of seniority.

(3) Where a relevant health organisation operates more than one mental health unit or service, that organisation must appoint a single responsible person in relation to all of the mental health units or services operated by that organisation.

(4) A patient is a qualifying patient if they are—

(a) liable to be detained under this Act, otherwise than by virtue of section 4 or 5(2) or (4) or section 135 or 136;

(b) subject to guardianship under this Act;

(c) a community patient.

120F Policy on racial disparities and other disparities based on protected characteristics

(1) The responsible person must publish a policy on how the unit plans to reduce racial disparities and other disparities based on protected characteristics in that unit or service.

(2) The policy published under subsection (1) must cover the following topics—

(a) the application of the guiding principles to all aspects of operation of this Act;

(b) staff knowledge and competence in connection with promoting equality and anti-discriminatory practice in relation to this Act;

(c) workforce demographics, recruitment, retention and progression;

(d) implementation of the patient and carer race equality framework (England only) and any other requirements of relevant national policies;

(e) care planning and decision-making in the use of this Act including section 56A (making treatment decisions);

(f) the availability of alternatives to detention and involuntary treatment;

(g) take-up of independent mental health advocacy;

(h) the cultural appropriateness of independent mental health advocacy;

(i) access to and use of advance choice documents;

(j) what steps will be taken to reduce racial disparities and other disparities based on protected characteristics in that unit or service.

(3) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units or services.

(4) Before publishing a policy under subsection (1), the responsible person must—

(a) consult any persons that the responsible person considers appropriate;

(b) have regard to the following matters—

(i) the views, wishes and feelings of people from ethnic minority communities who have been detained;

(ii) the views, wishes and feelings of people with other protected characteristics who have been detained.

(5) The responsible person must keep under review any policy published under this section.

(6) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

(7) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.

120G Training in racial disparities and other disparities based on protected characteristics

(1) The responsible person for each mental health unit or service must provide training for staff that relates to addressing racial disparities and other disparities based on protected characteristics in that unit or service.

(2) The training provided under subsection (1) must include training on the topics covered in section 120F(2).

(3) Subject to subsection (4), training must be provided—

(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or

(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.

(4) Subsection (3) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—

(a) was given sufficiently recently, and

(b) is of an equivalent standard to the training provided under this section.

(5) Refresher training must be provided at regular intervals whilst a person is a member of staff.

(6) In subsection (5) “refresher training” means training that updates or supplements the training provided under subsection (1).

120H Annual report by the Secretary of State

(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State must conduct a review in consultation with relevant bodies with commissioning functions on the use of treatment and detention measures contained in the Mental Health Act 1983 broken down by race and other demographic information.

(2) Having conducted a review under subsection (1), the Secretary of State must publish a report on the progress made in reducing inequalities in treatment outcomes and the use of detention measures in the use of this Act on people who have protected characteristics under the Equality Act 2010.’”

This new clause requires mental health units and services to appoint a responsible person tasked with addressing racial disparities related to functions discharged under the Mental Health Act 1983.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Mr Vickers. New clause 1 seeks to ensure that racial disparities in the use of community treatment orders are properly understood, monitored and addressed. We have known for many years that black individuals are disproportionately subjected to coercive powers under the Mental Health Act 1983, including detention, restraint and community treatment orders, yet progress has been painfully slow.

The new clause would require the Secretary of State to undertake a review within 12 months of the Bill passing and to publish the findings within 18 months. It would look specifically at whether certain racial or ethnic groups are over-represented among those who are subject to community treatment orders, and whether there are disparities in outcomes—including treatment effectiveness and patient experience—across racial groups. The aim is not just to collect data, but for meaningful scrutiny of how coercive community powers are applied and whether they are serving all groups equally.

The 2018 independent review of the Mental Health Act found that black individuals were more than eight times more likely to be placed under a CTO than white individuals. That is not a minor discrepancy, but a structural injustice. The review also raised concerns that CTOs were not necessarily used because they are clinically effective, but because they are seen as a way to manage risk, particularly where racialised assumptions come into play. We must ask, are CTOs truly supporting recovery, or are they disproportionately used to control and surveil? Are they fostering trust or fear in mental health services?

The new clause would give Parliament the information we need to answer those questions. It would set a timeline for transparency and create a foundation for future policy reform that is rooted in fairness and equality. In the absence of this new clause, we risk continuing a system where racial injustice is baked into mental health practice, without sufficient oversight or accountability. If this Government are serious about tackling racial inequality in mental health, they will have no objection to this basic measure of review and reporting.

We have discussed specific disparities in previous clauses, but new clause 3 aims to ensure that systematic and sustained action is embedded in the way that mental health services are run. The disproportionate detention and coercive treatment of black and minority ethnic people under the Mental Health Act has been evidenced for decades, yet progress on addressing these inequalities has been too slow and too inconsistent across the country.

New clause 3 takes a structural approach. It would require each mental health provider to appoint a dedicated senior lead to take responsibility for reducing inequalities within their services—not in name only, but through published plans covering staff diversity, culturally appropriate advocacy care planning and the use of advance choice documents. It would also ensure that frontline staff receive ongoing training that equips them to recognise and respond to disparities and uphold anti-discriminatory practice, with regular refreshes to ensure that this learning stays live. Importantly, it would place a duty on the Secretary of State to publish an annual report breaking down how the Bill is used across racial and other demographic groups, and what progress is being made to close those gaps.

This is not about creating more paperwork; it is about requiring leadership, transparency and accountability at every level, from clinical teams through to Government. If this Bill is to earn the title of a reform, it must act decisively on the most pertinent inequalities in the system. I urge the Committee to support the new clauses.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Mr Vickers. Sadly, there are clear racial inequalities within the mental health system, as in other areas of health, and this must change. People from ethnic minority communities are more likely to experience a mental health problem, are less likely to receive support, and have poorer outcomes from services. It is very concerning that black and ethnic minority people are over-represented in detentions in our mental health system, and there are well-documented worries over disparities in the quality of care that they receive.

Decades of evidence and lived experience testimony point to systemic injustice. Black British people suffer a 6% higher rate of common mental health problems than white British people, and black adults are twice as likely to show symptoms of post-traumatic stress disorder—at 8%, compared with 4% of the white British population. Black men are over 10 times more likely to be placed under community treatment orders, and black women are more likely than any other group of women to experience common mental health problems. Studies have shown that experiences of racism link to depression, psychosis and post-traumatic stress. When people are assaulted—not just physically, but emotionally and psychologically—by the structures around them, it leaves a lasting impact.

I have witnessed at first hand the racial disparities at a visit to my local in-patient mental health care at Rochford community hospital, where I could see a visibly disproportionate number of black men on the ward, compared with the percentage of black men I know live in my community. People from ethnic minority communities are more likely to come into contact with mental health services through crisis pathways, the police, accident and emergency, and detention. They are more likely to be restrained, isolated and subjected to coercive treatment. We must listen to what these communities are telling us.

Research by Mind identified nine key barriers to accessing care, from stigma and discrimination to Eurocentric models of treatment, language and cultural barriers. People feel othered by a system that was not built with them in mind. We need to rebuild trust and recognise that mental health cannot be separated from the broader social and political context. Austerity, Brexit, the Windrush scandal and covid-19 have all disproportionately affected the black, Asian and minority ethnic community. That has led to a decrease in trust towards the establishment, and that bleeds into general distrust of organisations and officials working in healthcare settings and mental health.

People from BAME communities have shared many examples of direct and indirect discrimination they have experienced within mental health services. Those negative lived experiences further erode trust in the system and often deter people from seeking help. Racial disparities in mental health are a pressing issue that requires immediate and sustained action.

New clauses 1 and 3, tabled by the hon. Member for Winchester and outlined by the hon. Member for Guildford, have good intentions, but we need to reflect on whether they fit in the Bill. I would suggest not. The drivers of disparity here are much deeper than the scope of the Bill, and it would be wrong to attempt to wrap up the solution to this issue within it. That does not mean that action should not be taken.

I am hopeful that this Government are doing wider work to drive down racial inequalities, including with the challenge we can see here with mental health. Perhaps the Minister will outline more about the Government’s work, and therefore why the new clauses are not needed. I support the intent of the hon. Member for Winchester, but I cannot support the new clauses as an addition to the Bill. I would be happy to meet the Minister and others to discuss further ongoing overall inequalities for the BAME community.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship this morning, Mr Vickers.

New clause 1, tabled by the hon. Member for Winchester, would require the Secretary of State to undertake a review of racial disparities in the use of community treatment orders. It is our view that the evidence base is already strong, and further reviews are not necessary. There are significant racial disparities in the use of community treatment orders. In 2023-24, black or black British people were issued with CTOs at seven times the rate of white or white British people. The use of community treatment orders as a proportion of overall detention numbers is higher for all minority ethnic groups compared with the white British population.

We are committed to reducing these disparities through our reforms and through the patient and carer race equality framework, which was a recommendation of the independent review. This includes a greater focus on prevention and early intervention, in part by promoting the use of advance choice documents, rather than an approach that simply makes it harder to impose CTOs. We are developing and monitoring an evaluation strategy, and we will continue to monitor and report on ethnic disparities via the published Mental Health Act statistics and our annual implementation report to Parliament.

New clause 3 would create the new “responsible person” role. They would have a duty to report on racial disparities and other inequalities in the use of the Mental Health Act. However, as drafted, the remit is significantly broader than that, to the extent that it would not be practical to combine all the stated functions into one role. We agree that there is a need to strengthen organisational leadership, improve data collection and change cultures across the mental health system. We also agree that it is important to have more targeted responsibilities to monitor and address racial disparities at board level in trusts, and that is already an explicit requirement of the PCREF.

The PCREF is a contractual requirement of mental health providers under the NHS standard contract. It builds on the statutory duties that apply already under the Equality Act 2010. These existing requirements cover the key responsibilities needed to monitor and address racial disparities. The PCREF can be updated more regularly than primary legislation, allowing us to take an iterative approach throughout implementation to ensure that we are capturing reporting and acting on the right data from frontline services. Ultimately, we feel that the PCREF will be more effective at reducing racial inequalities than the very broad remit outlined in this new clause, and that the addition of a responsible person in legislation is duplicative and unnecessary.

My hon. Friend the Member for Southend West and Leigh asked about implementation. The PCREF is the key instrument that we will use, but we are seeking to improve and strengthen decision making in three important ways: first, by requiring that an individual must be at risk of serious harm to be made subject to a CTO; secondly, by requiring the community clinician to be involved in all community treatment order decisions; and thirdly, by increasing the frequency of automatic reviews of patient cases by the tribunal, so that CTOs can be removed as soon as it is safe and appropriate to do so. I hope that that gives my hon. Friend some reassurance around the work that we are doing, but of course I would be happy to discuss these matters with him.

For those reasons, I ask the hon. Member for Guildford to withdraw new clause 1, on behalf of the hon. Member for Winchester.

[Zöe Franklin]

I thank the Minister for outlining the PCREF and the focus that it will have in addressing these issues. I was particularly interested in the explanation of the iterative approach that it will allow. I also thank the hon. Member for Southend West and Leigh for his insights into the issue. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 2

Mental Health Crisis Breathing Space

“(1) Any person detained under sections 3, 37, 41 or 47 of the Mental Health Act 1983 must be offered support from the mental health crisis breathing space debt respite scheme.”—(Dr Chambers.)

This new clause ensures that MHCBS, a debt respite scheme, is offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.

Brought up, and read the First time.

[Dr Danny Chambers (Winchester) (LD)]

I beg to move, That the clause be read a Second time.

The new clause relates to the mental health crisis breathing space debt respite scheme, and would allow it to be

“offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.”

The mental health crisis breathing space mechanism is another vital tool that can protect people in a mental health crisis from the impacts of problem debt, by pausing enforcement action, contacting creditors and freezing interest and charges on any debts.

However, the number of people benefitting from an MHCBS are significantly below its potential, largely because both patients and healthcare professionals do not know about it. Ensuring that everyone detained under the longer provisions of the Act would automatically be offered access to the scheme would ensure that many more people could benefit from it. We have discussed in previous sittings the impact of debt on mental health, and the work of Winchester Citizens Advice. I am really pleased to say that this week, I presented them with a huge award for best social enterprise at the Hampshire business awards, so my congratulations go to them.

--- Later in debate ---

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

The new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing in regard to any guidance published by the Secretary of State.

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

I thank the hon. Lady for giving way so early in her speech. I mentioned my concern about this provision on Second Reading: a rough road is not the same as a broken bridge. We are dealing here with the most severe mental health issues. The new clause talks about wellbeing, which affects everyone. Trying to report that and fit it into this criteria risks diluting the very aim of the Bill in trying to deal with the most severe mental health issues. I would be grateful for clarification on the difference between mental wellbeing, which affects everyone, and mental health issues, which not everyone has.

[Zöe Franklin]

When it comes to enabling the Mental Health Act to function, having an understanding on the ground of the picture across our communities regarding mental health wellbeing is very important. That is why we tabled the new clause, which would allow us to get community care right. That would then feed into the crisis care that we are discussing in this Committee.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for tabling the new clause. Like him, we are committed to preventing mental ill health and promoting good mental health. Achieving our vision for mental health requires a spectrum of interventions across the whole of society and across the life course, from prevention and early intervention through to treatment and specialised care for those with a severe mental illness in community and in-patient settings. We are committed to the shifts from treatment to prevention, hospital to community and analogue to digital, and our forthcoming NHS 10-year health plan will affirm those commitments.

With our commitment to neighbourhood health, we are encouraging stronger partnership working between local government, mental health services and the voluntary and community sector. As part of our shift to community, we have already launched six pilot neighbourhood mental health centres to deliver a 24/7 service, with open access to anyone who requires mental health support. Through the shift to prevention, we are putting more emphasis on early intervention and recovery to support people to live well and thrive, ensuring that we improve the conditions for creating good mental health.

Alongside that, I remind the Committee of the existing prevention concordat for better mental health: a voluntary agreement signed by local authorities and integrated care boards. Signing the concordat involves a commitment to take evidence-based, preventive and promotional action to support the mental health and wellbeing of their populations. The new clause would be duplicative of that existing programme, and could introduce an unnecessary resource burden on local authorities and commissioning bodies.

We are committed to moving to a meaningful partnership between central and local government, and to letting local leaders lead within their communities. For those reasons, I hope that the hon. Member for Guildford feels able to withdraw the motion.

[Zöe Franklin]

I thank the Minister for his comments. In particular, I was interested to hear about the mental health centre pilot schemes. I look forward to their further roll-out. They will be crucial in addressing the issues that we sought to address in the new clause. I was also very pleased to hear about the focus on a meaningful partnership between local government, national Government and mental health providers. On that basis, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 7

Funding and reporting

“(1) For each financial year until all sections of this Act have come into force, of the total health service expenditure by the bodies (taken together) in subsection (2), the proportion which relates to mental health spending—

(a) under the Mental Health Act 1983, and

(b) under this Act or which, in future, would be made under provision inserted into the Mental Health Act 1983 by this Act, (taken together) must not decrease.

(2) The bodies are the Department of Health and Social Care, NHS England and integrated care boards.”—(Dr Chambers.)

This new clause would require that mental health spending as a proportion of health service expenditure must not decrease in the implementation period of the Act.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

We are aware from the Darzi report that mental health cases account for about 20% of the NHS burden, and currently receive about 10% of the funding. Our mental health services urgently need investment. Children at risk of self-harm, anorexia and suicide often wait months to be seen. I keep thinking about a few people I spoke to in Winchester who have teenage daughters with anorexia. They have been told that their daughters have to reach a lower BMI before they hit the threshold for treatment. That is horrific for the individuals, and we know that their anorexia will be more difficult to treat, will require more intensive, longer treatment, and will cost the NHS more in resources and finances.

Many people cannot access the care in the community that they need. In a context in which suicide and mental ill health is on the rise, it is therefore disappointing to us that the Government have removed key NHS targets on mental health, such as physical health checks for those with mental disorders. Supporting those with mental health conditions is a fundamental pillar of the Government’s welfare reforms and economic agenda, but we know there were about 1 million people waiting in 2024 for mental health services. That is why we need to ensure that the spend on mental health care does not decrease and that, if anything, it increases.

--- Later in debate ---

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

The new clause would introduce a dedicated veterans’ mental health oversight officer, recognising that those who serve or have served in the UK or Commonwealth armed forces face distinct mental health challenges that are not always adequately met by the current system. Far too many veterans experience post-traumatic stress disorder, depression, anxiety or substance misuse that, sadly, is linked to their service. Yet they are often treated within a system that does not fully take account of those experiences, and they are sometimes detained under the Mental Health Act without the benefit of trauma-informed, veteran-specific pathways of care.

New clause 9 seeks to change that. It would create an independent officer, tasked with monitoring the use of the Mental Health Act in relation to veterans, advocating for tailored assessment and care linked to veterans’ service history, promoting alternatives to detention where appropriate, particularly through veteran-specific services, and reporting annually to Parliament on outcomes including rates of detention, recidivism and systemic barriers. It is not just about oversight; it is about respect and responsibility.

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

I am very sympathetic to the hon. Member’s concerns, but how does she see the new clause fitting in with the already established armed forces covenant, which protects and promotes healthcare for veterans across the country?

[Zöe Franklin]

I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service.

I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.

[Stephen Kinnock]

I am grateful to the hon. Member for Guildford for bringing the issue before the Committee. While most veterans lead healthy and successful lives following their service in the armed forces, we know that some may need mental health support. This Government are proud of the courage and dedication of our armed forces, and we are committed to ensuring that those who serve and served in the armed forces receive the best possible care.

All service personnel have access to mental health support throughout their career. The Defence Medical Services provide a responsive, flexible, accessible and comprehensive treatment service and, for leavers from the armed forces, NHS mental health services are available that are specially designed to support the unique needs of veterans. That includes veterans in mental health in-patient settings under the Mental Health Act and those within the criminal justice system. In England, these services are Op Courage and Op Nova, and in Wales there is Veterans NHS Wales. These bespoke services link with wider NHS mental health services to advocate for and support veterans to receive care tailored to their needs.

We are committed to giving veterans and armed forces personnel fair access to mental health care services and special consideration where appropriate. That is reflected in the core principles of the armed forces covenant, to which public bodies such as the NHS are legally bound to give regard. It is our firm view that a wealth of measures are already in place that respond to the unique needs and experiences of those who serve and have served in our armed forces. For that reason, I ask the hon. Member for Guildford to withdraw new clause 9.

[Zöe Franklin]

I thank the Minister for his comments—particularly about Op Courage, Op Nova and the armed forces covenant—and for his commitment to the veterans who have served this country and their courage, even when they face challenges with their mental health. The Liberal Democrats are willing to withdraw the amendment, but we will observe the passage of the Bill closely to ensure that it serves our veterans well across the UK. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 11

Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention

“(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983.

(2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made.

(3) The consultation must include input from relevant stakeholders, including—

(a) individuals with learning disabilities and autistic people;

(b) carers for people with learning disabilities and autistic people;

(c) healthcare professionals; and

(d) advocacy groups.”—(Dr Evans.)

This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Dr Chambers]

I thank the Minister for his reassurances, especially on the ongoing reviews. I will withdraw the new clause, but I make the obvious point that this is about not only the health and safety of the staff and patients, but the public perception of mental health, and the stigma surrounding it if we are treating people in Victorian-era asylums. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 15

Review of impact of this Act on detention

“(1) The Secretary of State must, within a period of 12 months following the day on which this Act is passed, commission an independent review into the impact of relevant provisions on reducing the number of people detained under Part 2 of the Mental Health Act 1983.

(2) In subsection (1), ‘relevant provisions’ include—

(a) sections 4, 5 and 6,

(b) section 8,

(c) section 21, and

(d) sections 46 and 47.

(3) The Secretary of State must, within 12 months of the publication of the review in subsection (1), publish a strategy to implement the recommendations of that review.”—(Zöe Franklin.)

This new clause would require the Secretary of State to commission a review into the impact of relevant provisions in the Act in reducing the number of people detained, in particular the provisions relating to people with autism or a learning disability, on grounds for detention and for community treatment orders, medical treatment, care and treatment plans, and on after-care, and to implement any recommendations within 12 months of the publication of the review.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss the following:

New clause 18—Report on the impact of this Act on patients with eating disorders—

“(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must publish a report on the impact of relevant provisions in this Act on patients with eating disorders.

(2) In subsection (1), ‘relevant provisions’ include—

(a) section 5 (Grounds for detention),

(b) section 11 (Making treatment decisions),

(c) section 17 (Urgent treatment to alleviate serious suffering),

(d) section 21 (Care and treatment plans), and

(e) section 47 (After-care services).”

This new clause would require the Secretary of State to report on the impact of this Bill on patients with eating disorders within 12 months of the passage of this Bill.

New clause 23—Impact assessment: children and young people in temporary foster care—

“(1) The Secretary of State must, within 18 months of the passing of this Act, publish and lay before Parliament an impact assessment on the impact of this Act on children and young people who are in temporary foster care.

(2) The impact assessment under this section must consider—

(a) whether the ordinary residence provisions result in delays or inequities in accessing treatment or after-care under this Act;

(b) the effect of transitions between placements on continuity of treatment under this Act; and

(c) any unintended consequences for children and young people in temporary foster care arising from the application of subsections (3) to (5) of section 125G of the Mental Health Act 1983.”

This new clause would require the Government to publish an impact assessment on the impact of this Act on children and young people in temporary foster care.

[Zöe Franklin]

New clause 15 calls for an independent review of whether the legislation achieves one of its core aims: reducing unnecessary detention under the Mental Health Act. People with learning disabilities and autistic people are still far too often detained in hospital settings, sometimes for months or years, despite clear evidence that community-based support would be more effective and humane. The Bill’s provisions—including those on grounds for detention, care and treatment planning and aftercare—are supposed to address that, but if we do not review their impact, there is a risk that they remain warm words without real change.

The new clause would ensure that the Government must review how well the new law is working, in particular for those most vulnerable to inappropriate detention, and then act on that evidence within a year. If we are serious about reform, which I believe the Government are given the content of the Bill, then the new clause would ensure serious scrutiny and accountability.

I turn to new clause 18. Eating disorders are complex, often misunderstood and frequently mismanaged in the mental health system. Too many patients face delayed interventions, inappropriate detention or a lack of tailored care, particularly when their condition does not fit into a narrow clinical threshold. The Bill introduces reforms to detention criteria, treatment decisions and care planning, but we must ensure that the changes actually work for people with eating disorders.

The new clause would require the Secretary of State to publish a report within 12 months that assesses the Bill’s impact on patients with eating disorders, including whether it is has improved access to appropriate treatment, safeguarded against unnecessary detention and strengthened aftercare. This is a matter not just of policy but of real people’s lives. We owe it to this vulnerable group to ensure that the reforms deliver real change, and that they are not left behind in a system that is still too often shaped by other conditions.

Finally, on new clause 23, children and young people in temporary foster care are some of the most vulnerable in our system. They often face multiple disruptions in care, placement and support, all of which can significantly impact their mental health. The new clause asks for a focused impact assessment on how the changes in the legislation will affect them. In particular, the new clause looks at whether the ordinary residence rules delay or block access to mental health treatment, whether placement changes disrupt continuity of care, and whether the provisions in section 125G of the Mental Health Act unintentionally harm this group.

Foster children should not fall through the cracks of bureaucracy. If we are serious about improving mental health services for all, we must understand and address the unique risks that face those who are moved frequently, often with little warning or support. An impact assessment is a necessary first step to ensure that their needs are not overlooked.

I commend all the new clauses to the Committee and look forward to hearing from the Minister.

[Stephen Kinnock]

On new clause 15, we want more people cared for in the community and fewer people reaching a point of crisis and detention, but we do not think it is right to use the legislation to drive down the numbers in an arbitrary way that could interfere with clinical decision making and create a risk that people do not receive the help that they need. An evaluation of the relevant clauses should therefore focus not purely on the reduction in detentions, but on the overall improvement of experience and outcomes. Such improvement is predicated on the independent review principles of choice and control, therapeutic benefit, and the person as an individual, as well as the principle of least restriction.

The timescales suggested in new clause 15 are not feasible. Following Royal Assent, our priority will be to update the code and for staff to be trained on the new legislation and code, before commencing the first phase of the reforms. The first phase of significant reforms cannot take effect until the work on the code and the training of staff are completed. Few, if any, of the sections mentioned in new clause 15 could therefore be commenced within 12 months, and it would be premature to commission a review of their effect on detention rates within that time period.

We plan to commission an independent evaluation of the reforms, subject to funding and fundable research applications. This will be a long-term, staged exercise, given the long period over which different reforms are expected to be sequentially commenced following the initial primary legislation. We will monitor the impact of the reforms on the number of detentions and disparities in detention rates, all of which are already published under the monthly Mental Health Act statistics. We have also committed to providing Parliament with an annual update on the implementation of the reforms. As we already plan to commission an independent evaluation of the Bill, and as the timescale set out in new clause 15 would not be feasible, I ask the hon. Member for Guildford to withdraw the new clause.

On new clauses 18 and 23, we have already published an impact assessment alongside the Bill, which was scrutinised by the Regulatory Policy Committee and rated fit for purpose. We have also committed to laying an annual report on the Bill’s implementation, through the written ministerial statement. We are committed to monitoring and evaluating the reforms to understand their impact on different groups affected by the legislation.

On new clause 18, we recognise the devastating impact that an eating disorder can have on someone’s life. The earlier treatment is provided, the greater the chance of recovery. The implementation and evaluation of the reforms will be a long-term, staged exercise. It would not be possible to assess the impact of the reforms on people with eating disorders within 12 months, as not all reforms will have been implemented. We will continue to work closely with NHS England to improve access to appropriate and timely care and treatment for people with an eating disorder.

On new clause 23, we recognise that there are inequalities in mental health prevalence and outcomes for children and young people in care. We are committed to ensuring that all children are able to access the care and treatment they need. We plan to develop bespoke guidance in the revised code on the care and treatment of children and young people, to account for the specific needs of that cohort. I hope that hon. Members will not press their new clauses.

[Zöe Franklin]

I thank the Minister for his comments; it was really helpful to hear about how he sees the timings in our new clause fitting with the ongoing work to implement the Mental Health Act and the commissioning of the independent review. I am concerned about his comment that the work will be dependent on funding. I hope that the funding for the important independent review will be ensured. However, on the basis of the Minister’s comments, I am happy not to press any of the new clauses. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 16

Transfer of patients: out of area placements

“(1) The Mental Health Act 1983 is amended as follows.

(2) After section 19 (transfer of patients), insert—

‘19A Transfer of patients: out of area placements

(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of patients transferred to a hospital outside of the area in which the patient is ordinarily resident.

(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”—(Dr Chambers.)

This new clause would require the transfer of patients to hospitals outside of their area to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

The new clause would require the number of patients transferred to hospitals outside their area to be reduced to zero within five years, and the Secretary of State would have to produce a report on how this would be achieved. We should not underestimate the harm and distress caused to patients and their families when they are allocated an out-of-area mental health placement. At the end of March 2024, there were 900 active out-of-area placements in England, of which 89% were deemed inappropriate.

Patients must be treated in a centre close to their home and family, and that can be achieved by increasing capacity and co-ordination between services. The new clause calls on the Secretary of State to publish guidance within six months of the Bill’s passage, setting out what processes and funding will be available for that purpose. Vulnerable people deserve to be treated near to their families and home, and the new clause would ensure that happens.

--- Later in debate ---

[Dr Chambers]

I thank the Minister for his comments. He recognises the issue and is taking steps to address it, so I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 19

Report and Guidance: Improving Outcomes for LGBT Patients

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and lay before Parliament a report on the mental health outcomes of patients who are treated under the Mental Health Act 1983 and who identify as lesbian, gay, bisexual, or transgender (LGBT).

(2) The report under subsection (1) must include an assessment of—

(a) any differences between non-LGBT patients and LGBT patients in—

(i) the extent of the use of detention measures under the Mental Health Act 1983; and

(ii) treatment outcomes following detention, and

(b) the availability and accessibility of ‘culturally competent’ mental health treatment under the 1983 Act for LGBT patients.

(3) Following publication of the report under subsection (1), the Secretary of State must publish guidance for responsible bodies and individuals working with patients under the Mental Health Act 1983, including but not limited to those working in—

(a) mental health hospitals;

(b) places of safety;

(c) crisis accommodation; and

(d) relevant community mental health services.

(4) The guidance under subsection (3) must include—

(a) provisions about updated training standards for staff regarding the specific mental health needs and experiences of LGBT individuals, including training on non-discriminatory practice and inclusive communication approaches;

(b) steps to improve safety for LGBT patients in relevant mental health settings, with particular regard to addressing discrimination and harassment; and

(c) a definition of ‘cultural competent mental health treatment’ for the purposes of subsection (2).

(5) Responsible bodies and individuals working with patients under the Mental Health Act 1983 must have regard to guidance published under subsection (3).

(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—

(a) patients with a mental disorder who identify as LGBT;

(b) the families or carers of patients with a mental disorder who identify as LGBT;

(c) relevant professional bodies;

(d) integrated care boards;

(e) local authorities;

(f) providers of mental health treatment; and

(g) such other persons as the Secretary of State considers appropriate.

(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”—(Zöe Franklin.)

This new clause would require the Secretary of State to report on mental health outcomes and disparities for LGBT patients in treatment under the Mental Health Act 1983 and publish guidance covering training and safety for this specific group.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

New clause 19 would require the Secretary of State to report on mental health outcomes for LGBT patients detained or treated under the Mental Health Act 1983, and to publish clear guidance to improve staff training, patient safety and inclusive care for that group. We all deserve appropriate support when experiencing poor mental health, and that support must be fair and respectful, no matter whether the patient identifies as lesbian, gay, bisexual or transgender. Members of the LGBT community should have confidence that they will be treated with dignity and should not face unequal or inappropriate treatment because of who they are. Unfortunately, we know that that is not always the reality.

Stonewall’s “LGBT in Britain—Health” report revealed deeply concerning findings: almost one in four LGBT individuals had heard discriminatory or negative remarks about them from healthcare staff, one in eight had experienced unequal treatment, one in 10 had been outed without their consent in healthcare settings, and one in seven had avoided treatment altogether for fear of discrimination. That is unacceptable anywhere in our health system, but it is especially alarming in mental health settings, where patients are already in distress and often detained, and may not be in a position to advocate for themselves.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for bringing this issue before the Committee. This Government are committed to tackling health inequalities. The NHS continues to pursue its advancing mental health equalities strategy, which sets out plans to address inequalities in access, experience and outcomes in mental health care, including for LGBTQ+ people. However, we do not think that a review within 12 months of the passage of this Bill is the right approach. First, there are known data quality issues with the recording of sexual orientation in the mental health services dataset, which, combined with small numbers, limits our ability to monitor outcomes accurately and reliably.

Secondly, we do not need a review before acting to improve patient experience under the Act. We will update the code of practice following the passage of this Bill, including the statutory guidance to the Mental Health Act, and will work with patient groups to consider what further guidance is needed to reduce disparities in use of the Act. That consideration will cover issues based on sexuality, gender, race and other protected characteristics. We are also committed to monitoring and evaluating the reforms, which will include an assessment of whether new safeguards and support mechanisms are being equitably accessed through different groups. For those reasons, I ask the hon. Member to withdraw the new clause.

[Zöe Franklin]

I thank the Minister for his comments, for the recognition that individuals in the LGBT community clearly have concerns about the way that mental health care is provided, and for the commitment to addressing those. I hope that at some point he will be able to advise on the timeline for looking to resolve the issue of the unreliability of data; it is crucial that we have accurate data in order to ensure good outcomes and improvements in mental health care. However, in the light of the Minister’s comments and commitment on the issue, we will not press the new clause, although I look forward to observing closely, as this Bill continues through the House, how it will address the current inequalities for the LGBT+ community. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 22

National strategy on mental health units

“(1) The Mental Health Act 1983 is amended as follows.

(2) In Part VIII (Miscellaneous Functions of Local Authorities and the Secretary of State), after section 118, insert—

‘118A National strategy on mental health units

(1) The Secretary of State must, within 12 months of the passing of the Mental Health Act 2025, publish a national strategy to set out how the Government will ensure that all relevant mental health units meet or exceed ‘good’ safety standards as assessed by the Care Quality Commission (CQC).

(2) A strategy issued under this section must address the following matters—

(a) recruitment, retention and training of mental health staff,

(b) patient-to-staff ratios, and

(c) safe staffing levels during crises and night shifts.

(3) Following publication of the strategy, a report on implementation progress must be laid before Parliament annually.

(4) For the purposes of this section, a ‘relevant mental health unit’ is a facility used for treatment under this Act.”—(Dr Chambers.)

This new clause would require the Secretary of State to publish a strategy, followed by an annual progress report, on how the Government will ensure that all mental health units used for treatment under the Mental Health Act 1983 are rated “good” or above by the CQC.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

New clause 22 is quite similar to new clause 14, on the state of in-patient facilities. It would require the Secretary of State to publish a national strategy to ensure that all mental health units meet or exceed a good rating for safety, as assessed by the Care Quality Commission. It would also mandate annual progress reports to Parliament. We all know that far too many mental health settings fall below acceptable standards. The CQC has repeatedly flagged serious failings in in-patient mental health services, including unsafe staffing levels, poor physical conditions and risks of harm to patients. These are not isolated issues but persistent and systemic problems.

The new clause calls for a proper, co-ordinated response. It would require the Government to set out how they will address staffing shortages, improve recruitment and retention, and ensure safe staffing levels, particularly at night and during crisis periods, when the risk is often highest. It is not enough to rely on reactive inspections or piecemeal initiatives; we need a national strategy backed by data, accountability and regular reporting to the House. Too many vulnerable people are currently treated in mental health units that are overstretched, understaffed and, in some cases, unsafe. The new clause would begin to change that by setting clear expectations on monitoring progress and holding the Government to account. I commend the new clause to the Committee.

Mental Health Bill [ Lords ] (Seventh sitting)

Zöe Franklin Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak to new clause 21, which would place a clear statutory duty on integrated care boards to offer advice and support to families or carers of patients receiving aftercare under section 117 of the Mental Health Act.

I thank the Minister for his comments about the new clause. I acknowledge what he says about the statutory guidance and code of practice, but I hear from far too many patients and their families living in my constituency of Guildford that advice and support is often not being provided and that authorities are falling short.

This new clause is rooted in a very simple principle: good mental health care does not end at the point of discharge. Recovery is often long, fragile and dependent on support at home, yet families and carers—the people holding things together day in, day out—are often left behind with little or no guidance. This clause seeks to change that: it would ensure that carers are given clear information about the patient’s condition and recovery journey, supported in helping to prevent relapse and readmission, linked to relevant support systems, including housing and social care, and provided with a route to raise concerns if they believe that someone is at risk in future.

[Jen Craft]

Having looked at new clause 21, I have a rather large concern about consent. The hon. Lady is setting out what the integrated care board would have a duty to do, including giving information about a “person’s condition and recovery” to

“the family or carers of the person discharged”.

I have a significant concern that the person being discharged may not have the kind of relationship with their family or carers that would make that helpful. The clause, as drafted, does not seem to make allowance for consent, except where

“the person is at future risk of detention”

under part II of the Mental Health Act. I would welcome the hon. Lady’s thoughts on that.

[Zöe Franklin]

The hon. Member makes a really good point. There is definitely a place for ensuring that we work on this further to make sure that it covers that. I will come on to that later, if she will allow me.

We know that early intervention is key. We know that families, carers and those around an individual are often the first to spot the warning signs, and that they need to feel empowered, not sidelined. I hear time and again, as I am sure hon. Members across this Committee Room have heard, from people who have been left out of the discharge planning for their loved ones. They say that they have received no clear information and that they feel unsupported and unable to fully support their loved one when they return home.

Importantly, the new clause sets out a process whereby, if a family member wants to raise a concern, the team must consider whether that individual should be added to the register of persons at risk of detention under part II of the Mental Health Act. We believe that this is a sensible, joined-up approach to prevention, spotting risks early and acting before a crisis point is reached. Finally, the new clause would require the Secretary of State to publish national guidance and ensure consistency and clarity across the system.

We often speak of carers as the invisible workforce of our NHS. The new clause would make their contribution visible by recognising their role and giving them the information and support they need to fulfil it well.

[Dr Evans]

Forgive me if I missed it, but I did not hear any discussion of this point. I am slightly concerned about the way the new clause is written, as it could be a duplication of the support, protections and duties put in place through the Care Act 2014. Could the hon. Member set out how the new clause would run in parallel with the Care Act? Is it complementary, or does it work against it?

[Zöe Franklin]

In my final comments, I was going to say to the Minister that, having considered the points he set out in his opening statement in relation to this clause, I am prepared not to press the new clause. I appreciate that some of the information already exists in the Bill and in the existing documentation to which the shadow Minister referred. I also acknowledge the point made by the hon. Member for Thurrock, that some aspects around consent must be dug into.

However, I ask the Minister to work with me, my hon. Friend the Member for Winchester and other hon. Members with an interest in the issue, so that he can hear our constituents’ experiences of where the current guidance is clearly not working, and ensure that appropriate additions are made to the supporting documents for the Bill to address the concerns that we have raised in the new clause.

Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

Mental Health Bill [ Lords ] (Eighth sitting)

Zöe Franklin Excerpts

Committee stage
Thursday 19th June 2025 Public Bill Committees

I therefore commend clause 54 to the Committee, and hope that the hon. Members will not press their new clauses.

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the Minister for his comments on new clause 17, but I will speak to it briefly along with new clause 20, and then consider not pressing it later.

New clause 17 aims to end the harmful and inappropriate practice of detaining children on adult mental health wards. We know that children in mental health crises are among the most vulnerable in our care system. Placing them in an adult ward is not only developmentally inappropriate; it risks causing further trauma and harm. The practice continues not because it is clinically justified but because of a lack of specialist child and adolescent mental health provision.

Despite the existing statutory guidance under section 131A of the Mental Health Act, hundreds of children are still admitted to adult settings each year. That is a systematic failure. The new clause sets a clear goal: reduce the number of children detained on adult wards to zero within five years. It would also require the Secretary of State to publish within six months a concrete plan of how this will be achieved, including how children’s mental health services will be expanded. It is a question of not just capacity but political will. I urge the Committee to support the new clause if we press it to a Division. I say to the Minister that we are still looking for timelines. We need to protect young people from going into inappropriate adult mental health settings, as I have heard too often from residents in my constituency.

New clause 20 would place a statutory duty on the Secretary of State to report within 18 months how to improve transitions between in-patient settings for children and young people and those for adults. I heard a particularly distressing case in my constituency recently, where an individual turned 18 and almost the next day was placed in an adult mental health setting. It was completely inappropriate for that individual, and no real transition work had been done. I appreciate that the Minister says that there is clear guidance, but that guidance has clearly not been adhered to at all times.

The new clause would require statutory guidance for integrated care boards, local authorities and providers, covering essential components, such as clear pathways and timelines, joint working across services, early identification of those needing transition support, and updates to care plans that reflect changing needs. We believe that the new clause is clear, proportionate and achievable. It asks for a plan and for consultation and guidance that can support more stable, person-centred care at a critical point in a young person’s life.

The Minister has indicated that he will not support the new clause. If he is unwilling to do so, my request is that he sets out how the Government will ensure the issues around transitioning between child and adult mental health services are addressed—particularly a clear timeline. He has mentioned a number of documents coming forward that start to address these issues, but as I have expressed, clearly the guidance already exists but it has not been adhered to in all cases, so we would like to see the timeline.

[Josh Dean (Hertford and Stortford) (Lab)]

It is a pleasure to serve under your chairship once again, Mrs Harris. The Minister has set out in detail the function of clause 54, so I will not cover that in detail for reasons of time. I welcome the clause, which represents a step forward in regulating the placement of children and young people in adult treatment settings, and in ensuring their safeguarding. I welcome the fact that it recognises the need to review the existing safeguards available to young people.

The independent review of the Mental Health Act made recommendations in this area, including that when an under-18 is placed on an adult ward, the CQC should be notified within 24 hours, and that the reasons for and the proposed length of the placement should be recorded. I would be grateful if the Minister would set out what consideration the Government have given to those recommendations, and whether they will form part of the review.

I turn to the important matter of children and young people who are under 18 placed in adult treatment settings. I think we all recognise the extremely difficult context in which these detentions take place. We know that there is a serious shortage of specialist in-patient beds for children and young people, which means that places are often full or may not be available at a time of urgent crisis.

When someone under 18 is placed in an adult treatment setting, they are more likely to witness or even experience high levels of restraint, be denied support from their peers, and lack access to educational opportunities. These placements can actually cause further harm to children and young people’s mental health, and therefore be detrimental to their recovery. I will be grateful if the Minister can assure me of the actions that the Government will take to further safeguard those children and young people who hit crisis point and find themselves in adult treatment settings because of the shortage of beds. How will we ensure that they are protected from being placed in inappropriate treatment settings?

I do not wish to test your patience, Mrs Harris, but before I conclude I want to examine the point about children and young people a little further, given the interaction of clause 54 and associated new clauses with their treatment. I welcome the Government’s consistent restatement of the importance of getting the Bill right for children and young people. I know that the Minister takes such matters incredibly seriously, and I have listened carefully to what he has said this afternoon and throughout the Committee.

The Minister has stated that a number of the reforms relating to children and young people will be addressed in the code of practice, but that contrasts with the approach of many of the welcome safeguards set out for over-18s in the Bill. Will the Minister clarify why these issues are being addressed differently when it comes to children and young people, compared to adults? Children and young people are a uniquely vulnerable group.

On the point about the code of practice, I note that any deviation from that would need to be justified, but my understanding is that the code cannot impose duties on practitioners or require them to exercise their functions under the Act. I am concerned that putting safeguards for under-18s on a different footing from those for adults could make it harder for young people to access those safeguards. I welcome much of the work being done by the Bill, and I want to make sure that children and young people can also access its safeguards. I will be grateful if the Minister can address those points in his response.

In conclusion, I welcome the step forward that clause 54 represents, because it addresses an important issue that we need to get to grips with. I look forward to the Minister’s response.

Mental Health Bill [ Lords ] (Third sitting)

Zöe Franklin Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

Grounds for community treatment orders

[Zöe Franklin (Guildford) (LD)]

I beg to move amendment 11, in clause 6, page 13, line 6, at end insert—

“(c) after subsection (6) insert—

‘(6A) Any person subject to a community treatment order must be informed orally and in writing at the time of the making of the order of their right to an independent mental health advocate under section 130A of this Act.’”

The amendment would ensure that people who are to be subject to a community treatment order would receive information about their right to advocacy.

[The Chair]

With this it will be convenient to discuss the following:

Government amendment 30.

Clause stand part.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Ms Furniss. Our amendment would ensure that people who are subject to community treatment orders receive information about their right to advocacy. People under CTOs should not miss out on advocacy because they were not aware. CTOs can have a significant impact on how people are able to live their lives, and ensuring that those who are subject to them are effectively represented is crucial. I am delighted that advocacy is a crucial part of the Bill, but this seems something of an oversight.

Not being aware of mental health advocacy could lead to a damaging lack of autonomy and voice for an individual. This simple change would ensure that people receive the support to which they are entitled. People in this situation are in acute mental distress, so the idea that they must actively seek out information on advocacy seems an unfair burden that will make the welcome provisions around mental health advocates far less effective.

We also need to be aware that CTOs have consistently been shown to be a point of disparity in care for black and minority ethnic groups. Clearly pointing towards an advocate may help to alleviate that and ensure that the patient is adequately supported on leaving the hospital.

Is the Minister satisfied that people subject to CTOs will have adequate access to advocacy under the Bill? Is he satisfied that information on rights to mental health advocates will be clear enough? My Liberal Democrat colleagues and I are concerned that the answer to those questions is no, which is why we tabled the amendment.

[Dr Evans]

I rise to speak to clause 6 and Government amendment 30. Clause 6 will make important amendments to conditions for community treatment orders under the Mental Health Act. CTOs are a tool that allows certain detained patients to receive ongoing treatment in the community rather than in hospital, providing continuity of care and supporting recovery outside institutional settings. Since their introduction in 2007, they have offered a mechanism to maintain contact with mental health services and prevent relapse while balancing the patient’s right to live more freely.

However, CTOs have not been without controversy. There is concern about their overuse and their disproportionate effect on black and ethnic minority patients. There are also a number of questions about the evidence for their effectiveness in reducing relapse or readmission. Moreover, concerns about coercion and the infringement of patient autonomy have been raised repeatedly. The 2018 independent review recommended tightening their use. Some also argue for going further by abolishing them completely.

Clause 6 seeks to address many of those concerns. It will introduce stronger safeguards, clear risk-based criteria and a maximum 12-month duration to prevent indefinite or inappropriate use. It will mandate patient involvement through consultation and regular review, promoting shared decision making. Accountability is enhanced by aligning CTOs with a code of practice and introducing external oversight. Crucially, CTOs will now be used only when there is a clear and necessary risk, focusing on clinical need and safety.

Challenges remain. The new requirements bring complex administration and an increasing workload for clinicians. Despite reforms, CTOs remain a form of compulsory treatment, raising concerns about ongoing coercion. Their success depends heavily on the availability of community services, which are not always adequately resourced. Finally, terms such as “serious harm” may be open to interpretation, risking inconsistency. To unpack all that, we must take a closer look.

Clause 6 rightly seeks to update and clarify the legal framework governing CTOs to ensure that their use is proportionate, justified and consistent with evolving standards of care and risk management. It does so primarily by aligning the grounds for making and renewing a CTO with the new, more precise risk criteria for detention. It specifies that a CTO should be made only if there is real risk that

“serious harm may be caused to the health or safety”

of a patient or others without treatment, and if that treatment is necessary given

“the nature, degree and likelihood of the harm”.

Again, there is an argument about the definition of “serious harm”, and the same discussion as the one we had under clause 5 about escalation of behaviour or cumulative concerns applies here.

In the light of that discussion, it might be helpful if the Minister clarified the interface between CTOs and grounds for detention. Is there scope for the code of conduct to cover the management of risk, both to the public and to patients themselves, across both? Given the emphasis placed on real risk of serious harm, clause 6 aligns CTOs more clearly with the threshold for detention, with the aim of reducing the inappropriate use or overuse of CTOs, which is much more welcome. It will help to safeguard and protect patients from unnecessary restrictions on their liberty, while maintaining the ability of a responsible clinician to act decisively when there is genuine risk.

Mental Health Bill [ Lords ] (First sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

It is an honour to serve under your chairmanship, Mr Vickers. I will speak to amendments 1, 51 and 4 together, as they all relate to housing. Amendment 1 ensures that housing needs are considered as part of care, education and treatment reviews. Amendment 51 ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities. Amendment 4 ensures that housing needs are considered as part of care and treatment reviews.

Appropriate housing is critical for people’s wellbeing and cannot be viewed as separate from effective and safe care. Ensuring that housing or any temporary or crisis accommodation supports the safety and independence of people with a learning disability should be a key part of care, education and treatment reviews. We believe that it is essential for fulfilling the duties of the Bill.

Without that provision, it will be far harder for patients to leave detention and for care to be facilitated in the community. If people with learning disabilities who are detained risk being discharged into insecure or inappropriate housing, their recovery from mental ill health could be jeopardised. Patients should be viewed in their whole context, not just as a collection of conditions or symptoms. Housing is among the most fundamental social needs that should be considered.

[Zöe Franklin (Guildford) (LD)]

I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.

Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.

[Gregory Stafford]

I have a lot of sympathy with what the hon. Lady is trying to achieve with these amendments. My question is about how she would ensure, within the context of the provisions, that the patient’s confidentiality would be maintained where it needed to be.

[Zöe Franklin]

The hon. Member raises an interesting and pertinent point. There will always need to be balance when addressing the issues around patient confidentiality. I have seen from my own casework that when families who have been through mental health crises with their loved ones have not been involved in that process, unfortunately the crisis has lasted much longer and been more significant because those around them have been unable to support the individual. I do not have the answer, but we need to work collectively to find a way to strike that balance in order to address the needs of the patient.

[Gregory Stafford]

Moving on from the confidentiality point, if there is going to be sharing—again, I have a lot of sympathy with the amendments—how would the hon. Lady ensure that disagreements between family members and the patient are safeguarded against?

[Zöe Franklin]

That presents challenges, but again, I would refer back to my own casework, and I am sure there are Members on the Committee who will have had the same experience. There are examples across the UK where health boards and providers find ways to appropriately share information with families and other carers to get the best outcomes for patients. I simply ask that, when the Minister and colleagues in this space have those examples, they share them. I know that there are some areas where this is already done effectively, particularly in Scotland, and I seek to reference those examples.

My final point on amendments 2 and 5 is that we need to ensure that those around a patient are given the opportunity to raise concern or the alarm when part of the report does not meet the patient’s needs. We need to address the patient’s full needs, and to ensure that they are both reflected in the reports and met.

[Aphra Brandreth]

Like my hon. Friend the Member for Farnham and Bordon, I have a lot of sympathy with some of the things that the hon. Lady is trying to achieve through the amendments. If there is to be an additional requirement for six-monthly rather than annual checks, how will the balance be struck to ensure that there is a focus on care rather than on the administrative burden that might be required?

[Zöe Franklin]

Helpfully, I was about to move on to a point about amendments 3 and 6, which would shorten the length between care and treatment plan reviews from 12 to six months.

We need to reflect on the fact that sometimes we do not get it right when we support an individual. In such circumstances, it is particularly important that we are able to have reviews every six months, rather than 12. It does not have to be a detailed, full-scale review. If all involved in the patient’s care come to the conclusion that the care needs are being met, that review could be incredibly short. If someone’s care is inadequate or inappropriate, it is not right that they should have to suffer unnecessarily for a year without the changes that are needed. Halving the time between the care and treatment reviews ensures that patients are not left languishing and instead have care that truly reflects their individual needs. I would reiterate that a six-month review can be incredibly short, and it also benefits patients by making them aware of where their care is not working for them, so that it can be reviewed.

[Dr Shastri-Hurst]

I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.

[Zöe Franklin]

I return to my point that a review can be short when clinicians and those involved in a patient’s treatment deem it appropriate. Again, where the system is working for a patient, it is good and proper that we do a short review, and they can then carry on with their treatment. When it is not working, why should the patient struggle on for 12 months alongside their families, who will also be struggling?

[Dr Shastri-Hurst]

Will the hon. Lady give way?

[Zöe Franklin]

No, I will move on to amendment 7, which I also want to cover. This amendment is very important, as it would ensure that the integrated care boards and local authorities responsible for a patient’s treatment and care would have a duty to implement the recommendations arising from a care and treatment review. The legislation states “must have regard to”, but we believe that that is too weak and could see crucial parts of care and treatment reviews left unimplemented.

As it stands, this part of the Bill could be considered to be implemented even if no adequate resourcing was required, with the care and treatment review left as an empty exercise. One of the key parts of this legislation is to ensure that resources are there to implement treatment for patients. Will the Minister reassure us that adequate resources will be provided to ensure that patients’ treatment needs are met, that training for clinicians and others supporting an individual is made available through resourcing, and that we do not again find ourselves in a situation like the current one, in which patients too often struggle because there are not the resources to meet their care needs?

[Dr Evans]

I rise to speak to Liberal Democrat amendments 1 to 7 and 51 to clause 4. I welcome the intention behind the amendments, which aim to enhance the care and treatment review process for people with autism and learning disabilities, particularly by addressing housing and accommodation needs and ensuring that key advocates receive reports.

There are positive elements of the amendments that are worth highlighting. I understand the good intent of including housing and accommodation considerations explicitly in reviews, as it recognises that a person’s living situation is often central to their wellbeing and recovery. Additionally, ensuring that nominated persons and independent mental health advocates receive reports promptly promotes transparency and patient advocacy. Shortening the review intervals from 12 to six months could lead to more responsive care planning.

However, I have some significant reservations about the statutory implications of blurring housing, for example, so directly with the care and treatment review process. Housing is traditionally managed under separate statutory frameworks from health and social care, so to embed housing as a statutory element within these reviews risks creating confusion about which agency holds responsibility and may expose health bodies or commissioners to legal obligations that they are neither funded nor structured for.

I have a few questions for the Liberal Democrats. In their eyes, how would the Government ensure clarity over the statutory duties applied to housing recommendations arising from the reviews? Would that not risk delaying or complicating discharges if housing issues became a statutory sticking point within health-led care reviews? Moreover, housing provision often depends on local authorities and housing departments that have their own complex eligibility criteria and resourcing constraints. Are we confident that ICBs and responsible commissioners would be able to co-ordinate effectively across these boundaries, especially given the patchwork of funding and powers in play?

Mental Health Bill [ Lords ] (Second sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 10th June 2025 Public Bill Committees

Division 1

Ayes: 2

---

Liberal Democrat: 2

Noes: 9

---

Labour: 9

[Zöe Franklin (Guildford) (LD)]

I beg to move amendment 20, in clause 4, page 9, line 38, at end insert—

“125ZF Registers: duty to maintain crisis accommodation

(1) In exercising its functions under section 125E, an integrated care board must seek to ensure that there is appropriate crisis accommodation for people with autism or a learning disability within its area.

(2) For the purposes of this section, ‘appropriate crisis accommodation’ means accommodation which—

(a) is designed to meet the specific needs of people with autism or learning disability during periods of acute mental health crisis;

(b) is staffed by persons with specialist training in supporting people with autism or a learning disability;

(c) maintains appropriate staffing ratios determined by guidance issued by the Secretary of State; and

(d) provides a safe alternative to detention under section 136 of this Act.

(3) The Secretary of State must issue guidance about the exercise of functions under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism or learning disability as one of its duties in relation to registers of people at risk of detention.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 10, in clause 4, page 10, line 5, at end insert—

“125FA Report: sufficient commissioning services for people with autism or learning disability

(1) Within four months of the day on which the Mental Health Act 2025 is passed, the Secretary of State must lay before Parliament a plan to allocate sufficient resources for commissioning services regarding the treatment and detention of autistic people and people with learning disabilities to ensure operability of provisions in this Act.

(2) The plan must include—

(a) revised assumptions of the number of autistic people and people with learning disabilities who may require detention under this Act;

(b) the actions that the Secretary of State will take to ensure community services are available to meet demand after the 28-day detention period;

(c) plans for data collection to support commissioning sufficient services;

(d) plans to allocate appropriate resource to ensure operability of services, including, but not limited to, financial resource;

(e) plans to ensure that responsible bodies and individuals receive the necessary training to carry out support, diagnostic, and treatment plans.”

This amendment requires the Secretary of State to present a plan within four months to ensure sufficient services, resources, data, and training are in place to support autistic people and those with learning disabilities under the Act.

Amendment 22, in clause 4, page 10, line 5, at end insert—

“125FA Assessment: provision of services for people with autism or learning disability

(1) Each financial year, an integrated care board must—

(a) conduct an assessment of the availability and adequacy of services within its area for people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act;

(b) publish the results of the assessment; and

(c) publish an action plan to address any gaps in provision identified.

(2) The assessment under subsection (1) must include consideration of—

(a) the availability of appropriate crisis accommodation;

(b) the availability of appropriate community support services;

(c) the adequacy of training for responsible bodies and individuals to carry out support, diagnostic and treatment plans; and

(d) the experiences of people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers.

(3) The integrated care board must consult the following in conducting the assessment—

(a) persons with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) the relevant local authority or authorities;

(c) providers of relevant services; and

(d) such other persons as the integrated care board considers appropriate.

(4) The Secretary of State must issue guidance about the conduct of assessments under this section, and integrated care boards must have regard to this guidance.”

This amendment would require integrated care boards to conduct and publish annual assessments of the provision available for people with autism or learning disability at risk of detention and to prepare action plans to address any identified gaps.

Amendment 24, in clause 4, page 10, line 5, at end insert—

“125FA Report: services for people with autism or learning disability

(1) The Secretary of State must, within 12 months of this section coming into force and annually thereafter, prepare and lay before Parliament a report on—

(a) the availability of appropriate accommodation for people with autism or learning disability detained under this Act;

(b) the number of instances where appropriate accommodation could not be found within statutory timeframes;

(c) the progress towards implementation of sections 3 and 4 of the Mental Health Act 2025 and the impact of any delays to implementation on people with autism or a learning disability; and

(d) progress made towards meeting the needs of people with autism or a learning disability without detaining them under Part 2 of this Act.

(2) In preparing the report, the Secretary of State must consult—

(a) people with autism or a learning disability who have specified risk factors for detention under Part 2 of this Act and their families or carers;

(b) integrated care boards;

(c) local authorities; and

(d) such other persons as the Secretary of State considers appropriate.”

This amendment would require the Secretary of State to report annually to Parliament on the availability of appropriate placements for people with autism or learning disabilities and on progress implementing the relevant provisions of the Act.

Amendment 21, in clause 58, page 68, line 15, at end insert—

“(5A) The Secretary of State must by regulations make provision for sections 3, 4 and 21 to come into force in full no later than two years after the day on which this Act is passed.”

This amendment would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring them to be fully implemented within 2 years.

New clause 11—Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention—

“(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983.

(2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made.

(3) The consultation must include input from relevant stakeholders, including—

(a) individuals with learning disabilities and autistic people;

(b) carers for people with learning disabilities and autistic people;

(c) healthcare professionals; and

(d) advocacy groups.”

This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Ms Furniss. I am grateful to my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and I am sure many in this room will remember his passionate speech about his constituent Declan Morrison, who has inspired many of these amendments. I am grateful to my hon. Friend for his help with my notes.

Amendment 20 would require integrated care boards to establish and maintain appropriate crisis accommodation specifically designed for people with autism and learning disability, as one its duties in relation to registers of people at risk of detention. Currently, just over 2,000 people with autism or learning disabilities are detained in mental health hospitals for an average of five years. Over half of delayed discharges are due to a lack of suitable housing or accommodation.

The crisis provision created in Cambridgeshire after my hon. Friend’s constituent Declan passed away was operating at 90% capacity before funding was withdrawn. When we hear Declan’s story, we realise the severe implications behind the amendment and why it is being put forward. We must also recognise that there has been a significant increase in section 136 use over the past 10 years. Many of the suites being used are outdated, unable to keep up with demand and unfit for purpose.

The amendment would therefore make appropriate crisis accommodation a statutory duty, and I hope all Members would agree that there is a desperate need for such accommodation, specifically for autistic people and those with learning disabilities. It would also require there to be specialist training for staff. We have already referenced today how important training is when it comes to protecting those who are in crisis and who need support. Finally, it would provide for safe, alternative detention under section 136, preventing situations such as that experienced by the hon. Friend’s constituent, where a vulnerable person is held in inappropriate emergency settings for extended periods.

Amendments 10 and 22 are both designed to ensure that there are sufficient resources for people with autism or learning disabilities. On amendment 10, it is crucial that community services are properly resourced to meet the needs of people with autism and learning disabilities. Too many of us will have seen how inadequate community services make detention and in-patient care much more likely, which is worse for the person detained, far more costly and unsustainable in the long term. Our amendments place duties on the integrated care board at the local level, and the Secretary of State at the national level, to be transparent about gaps in provision and to take steps to eliminate them.

Amendment 22 would require an integrated care board to conduct an assessment of the availability and adequacy of the relevant services within its area for people with autism or learning disabilities who have specified risk factors for detention, and to set out a plan to respond to those findings. There is currently an absence of suitable placements, with over 100 places that were contacted having no single bed available. We cannot continue with such a situation, given the significant implications when things go wrong.

Through those amendments, we are asking for an assessment, because there is currently no systematic assessment of whether services match demand, which is crucial to ensuring that the Bill is workable in the long term. It is also acknowledged that it may take 10 years to fully implement the Bill and to ensure that additional clinical and judicial staff are trained.

Amendment 21 was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would establish an accelerated implementation timeline for provisions related to autism and learning disabilities, requiring those provisions to be fully implemented within two years. Currently, just over 2,000 autistic people and people with learning disabilities are detained in mental health hospitals who are being let down by the system.

The Government have sadly already missed the targets, and we cannot afford to wait another decade—people’s lives are too important. In fact, the UN Human Rights Committee has called on the UK to end the detention of people with disabilities based solely on their disability. Every day that we wait means more people at risk of tragic outcomes. As I said, the amendment would establish a two-year deadline, and it recognises that these are some of the most urgent reforms in the Bill. I ask the Government to consider them as a priority.

Finally, amendment 24, which was also tabled by my hon. Friend the Member for St Neots and Mid Cambridgeshire, would establish an accelerated implementation timeline of services related to autism and learning disabilities, by again requiring them to be implemented within two years. I reiterate what we heard in the Chamber, which I am sure we will all hear in our inboxes and in conversations with our residents: it is crucial that we implement these changes at pace; otherwise, we risk failing individuals with autism and learning disabilities further.

[Dr Evans]

I will direct my remarks at new clause 11 and the amendments spoken to by the hon. Member for Guildford. New clause 11 seeks a clear, costed and consultative plan to help ensure that integrated care boards and local authorities are properly equipped to deliver the community-based services that individuals with learning disabilities and autism need and, of course, deserve, so that they are not unnecessarily detained under part 2 of the Mental Health Act.

Let me begin by recognising the good intentions across the House when it comes to reducing inappropriate and prolonged detentions in mental health settings. There is broad consensus that detention should be the last resort. However, good intentions must be matched by a concrete, deliverable plan because, as the evidence has shown, too many people are being held in hospitals or other facilities, not because of clinical need, but because the right community support simply is not there.

--- Later in debate ---

Division 2

Ayes: 2

---

Liberal Democrat: 2

Noes: 9

---

Labour: 9

[Zöe Franklin]

I beg to move amendment 25, in clause 4, page 10, line 5, at end insert—

“125FA Training standards

(1) The Secretary of State must by regulations make provision about training standards for responsible bodies and individuals working with people with autism or a learning disability in—

(a) mental health hospitals;

(b) places of safety designated under sections 135 or 136 of this Act;

(c) crisis accommodation; and

(d) such other settings as the Secretary of State considers appropriate.

(2) Regulations under subsection (1) must—

(a) specify minimum training requirements;

(b) require training to be co-produced with people with autism or learning disability and their families or carers;

(c) require regular refresher training; and

(d) include training on de-escalation techniques and alternatives to restraint.

(3) The Secretary of State must publish guidance about the standards set out in regulations under subsection (1).

(4) A statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of either House of Parliament.”

This amendment would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings and require that training be co-produced with people with lived experience and their families.

Amendment 25 was, again, tabled by my esteemed colleague, my hon. Friend the Member for St Neots and Mid Cambridgeshire. It would require the Secretary of State to produce guidance on minimum training standards for staff working with people with autism or learning disabilities in mental health settings, and would require that the training be co-produced with people with lived experience and their families.

I suggest to all colleagues on the Committee, particularly those who heard my hon. Friend’s passionate speech on Second Reading, that we need to reflect and learn from the tragic story of his constituent Declan, in which insufficient training sadly contributed to Declan’s death. Autistic people in hospitals risk being subject to unnecessary restraint, over-medication and solitary confinement. That raises real concerns about whether there is sufficient training available to staff working with them. I acknowledge that enormous numbers of incredible professionals work with individuals who are in crisis, but when such tragedies happen, we need to reflect on whether training is sufficient.

Across mental health hospitals, places of safety and crisis accommodation, training is crucial to ensuring good outcomes for those in crisis. Some 92% of people with learning disabilities or autism in hospitals are detained under the Mental Health Act, yet many staff lack specialist understanding. Research shows that training is most effective when it is developed with people with lived experience.

The amendment would ensure that all staff working with autistic people and people with learning disabilities receive specialist training. It would require co-production with families and people with lived experience, with which Conservative colleagues have already said that they agree. That would include mandatory training in de-escalation techniques and alternatives to restraint; create consistent national standards, rather than the unfortunate postcode lottery; and address fundamental staff knowledge gaps that contribute to inappropriate treatment. I ask the Minister to accept the amendment, which would enable us to ensure that those providing crucial mental health support to those in crisis have the appropriate training to prevent tragedies like the loss of Declan.

--- Later in debate ---

[Stephen Kinnock]

The Health and Social Care Act 2008, as amended by the Health and Care Act 2022, already requires that all CQC-registered health and adult social care providers ensure that their staff receive specific training, appropriate to their role, on learning disability and autism. The associated code of practice has been consulted on and is expected to be published and laid before Parliament soon.

The code sets out four standards that outline minimum training requirements, including expectations of training content at different levels; that training is co-produced and co-delivered alongside people with a learning disability and autistic people—that addresses the point made by my hon. Friend the Member for Thurrock about co-production and things not being done in an ivory tower; and that staff complete training at least every three years. To set out separate standards in secondary legislation, as the amendment asks, would cut across that existing legal requirement and the forthcoming code. Inadvertently, that could lead to confusion. I hope that that satisfies the hon. Member for Guildford enough to persuade her to withdraw the amendment.

[Zöe Franklin]

Having had a conversation with my hon. Friend the Member for Winchester, I can say that we will withdraw the amendment. However, we hope that the Minister will ensure that the provisions addressing the need for training in such situations will come soon, and with a timeline, so that all members of the Committee understand when we will see the statutory guidance. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Dr Evans]

It is a shame that the hon. Member for Shipley is not in her place to hear me speak to the rest of the clause 4, having considered the amendments to it first—[Interruption.] Oh, she is here just in time. I am grateful to the Government and the Chair, as the clause stand part debate allows things to be more structured.

I want to discuss proposed new part 8A of the Mental Health Act 1983, which will introduce welcome changes to provisions specific to people in England with autism or learning disabilities who are subject to detention under the Act. At the outset, let me say that the Opposition welcome the Government’s recognition that people with autism or learning disabilities require a tailored and rights-based approach within our health system. We know—the evidence points clearly to the fact—that such individuals have been inappropriately detained in institutional settings, often for years, without the care and support that they truly need. The creation of a statutory care, education and treatment review in legislation was a step in the right direction. It therefore makes sense in this part of our proceedings to discuss such reviews.

The background is really important to understanding what the measure will do. Care, education and treatment reviews were introduced in 2015 as part of the Transforming Care programme, a joint initiative between NHS England and the Department of Health and Social Care under the last Government. The TCP was launched in response to the Winterbourne View scandal, which we have heard mentioned a few times, where serious abuses of people with learning disabilities and autism in private hospitals were exposed.

The purpose of CETRs in the Transforming Care programme was to ensure multi-agency oversight of care plans for people with learning disabilities and/or autism, particularly those with complex needs detained in in-patient or secure settings. They were there to promote person-centred care by involving patients, families and a broad range of professionals; to identify barriers to discharge and support safe, timely moves to community or less restrictive settings; and to improve care quality and reduce inappropriate long-term in-patient stays.

The implementation timetable started in 2015 with CETRs introduced as a mandatory part of the TCP, initially focusing on children and adults with learning disabilities and/or autism in in-patient settings. In 2017 to 2019, CETRs were expanded and refined, with NHS England producing guidance and a framework for conducting reviews consistently. Ongoing, CETRs are now embedded across the health and social care systems, extending beyond learning disabilities to other groups with complex mental health needs, including secure mental health services.

CETRs are multidisciplinary independent reviews designed to improve the care and treatment of people with complex mental health needs, particularly those detained in secure hospitals or secure settings, such as children and young people with learning disabilities, autism or complex mental health needs, or in other in-patient settings where there are concerns about the appropriateness of their care, treatment or placement. The purpose is to ensure that the care, education and treatment plans are appropriate, person-centred and holistic; to identify and address any barriers to overcoming recovery and discharge; to promote co-ordinated working between health, social care, education and other relevant services; and to support the least restrictive care principle, one that we have now enshrined in the Bill—helping people to move to less restrictive settings where possible.

There are, however, some complications. The number of CETRs has increased over recent years, especially with the growing recognition of the need for better oversight of complex needs. Several hundred CETRs take place annually across England and Wales, primarily within secure and specialist mental health services. Exact numbers are quite difficult to pin down and vary by service user populations, health trusts, NHS England monitoring and the reporting of the activity.

What is a CETR made up of? That is really important. A typical CETR involves a multidisciplinary panel including independent clinical reviewers such as a senior psychiatrist or clinician not involved in direct care; representatives from social care services; educational specialists, especially for children and young people; advocates or independent mental health advocates; the patient or service users themselves, where possible, to ensure their voice is central; family members or carers where appropriate and with consent; and commissioners and other relevant professionals involved in the person’s care pathway.

Under the review process, the panel examines the individual care, the treatment, the education and progress. It assesses whether the current placement and treatment plan are meeting the person’s needs and whether there is scope to support transition to less restrictive or more appropriate settings. Recommendations may be made on changes to care, treatment plans, discharge or support arrangements.

CETRs are a very valuable safeguard. They bring together the independent clinicians, the social care professionals, the educators, the advocates and, crucially, the patients and their families to review the care and treatment being provided. The aim is to ensure that the treatment is person-centred, appropriate and geared towards recovery, while also exploring opportunities to move people to less restrictive environments when safe to do so. That said, while CETRs are increasingly used, questions remain about their consistency, effectiveness and impacts on outcomes. On page 12 of the explanatory notes, paragraph 46 states that

“recommendations are not always being acted upon”,

which is contributing to

“the perpetuated detention of people with a learning disability and autistic people, often without therapeutic benefit.”

That is really significant. To that end, how many CETRs are conducted annually and what are the mechanics in place to ensure that the reviews lead to meaningful change in care, rather than becoming a procedural exercise? I must admit that I struggled to find that information. If I, as someone looking into it, am struggling, there is a concern about how wide that information and data is.

Mental Health Bill [Lords]

Zöe Franklin Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Zöe Franklin (Guildford) (LD)]

I welcome the direction of the Mental Health Bill. It marks a long-overdue shift in how we treat some of the most vulnerable in our society, recognising that people deserve more than crisis care—they deserve dignity, choice and autonomy. It has been a real privilege to be in the Chamber for this important debate, and to hear the very moving speech by my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and by so many others across the Chamber who shared their constituents’ stories, and their own.

The Bill rightly puts patients at its centre. It gives them more say in their treatment, improves the complaints process and introduces personalised care plans. Replacing the outdated “nearest relative” with a nominated person reflects a broader move toward a more respectful, person-centred system that listens, empowers and supports recovery. But here is the uncomfortable truth: however well-intentioned, the Bill will achieve little unless we confront the funding crisis already engulfing our mental health services. The Bill asks overstretched and underpaid staff to deliver changes that demand time and care when many are already at breaking point. My constituents across Guildford see that every single day. Jennifer came to me in despair over the care that her daughter Leah is receiving at a local mental health unit. Chronic understaffing and a lack of support mean that concerns go unanswered. Underfunding has created a cycle of inadequate care—treatment refused, early discharges to free up beds, and inevitable readmissions when Leah’s needs are left unmet. I have heard from Samantha, whose son suffered a psychotic episode that ended in tragedy—a stark reminder of what happens when crises go unsupported. I also want to mention the story of a young woman whom I will not name, but who made a series of attempts on her life until she tragically succeeded, after gaining access to a poison from overseas. I know this is not a unique story, and that multiple coroners have written to the Secretary of State for Health and his predecessors on this issue. Will the Minister agree to meet me to discuss the case and whether it may be possible to use the Mental Health Bill to prevent further similar deaths?

There is also the fact that across the country people are waiting months and sometimes years for mental health care. Children and young people are falling through the cracks, as CAMHS is overwhelmed and referrals are delayed; patients are sent miles from home due to local bed shortages; and police are left to respond to mental health emergencies because there is no one else to call. Our system is not just stretched; it is at breaking point. Yet the proportion of NHS funding going to mental health care is falling—despite soaring demand, despite mental illness making up a fifth of the NHS’s burden, and despite the Government’s promises. These are not just gaps in the system; they are failures of political will.

[Iqbal Mohamed]

As well as NHS funding for direct mental health services, does the hon. Lady agree that we should invest in preventive steps to help children to avoid the mental health anguish that they are suffering today?

[Zöe Franklin]

Absolutely. I know from my own caseload of too many stories of where if young people had received preventive care and support, they would not be facing the tragic situations they and their families are now living through.

This Government have scrapped key mental health targets, including goals for early intervention, therapy access and physical health checks for people with mental illnesses. I am sorry, but this signals a retreat at the very moment we need to advance.

I support the vision outlined in the Bill, but its success depends entirely on the foundation on which it stands. Without adequate investment, even the very best intentions will struggle to take root. Ensuring that people can exercise their rights and that staff can support them demands more than legislation; it demands real resources and sustained commitment from this Government.

We need a national effort to rebuild mental health care from the ground up, with early intervention for young people, trained professionals in schools and communities, continuity of care and a culture shift that treats mental health with the same urgency and seriousness as physical health. Failure is not an option—not for the thousands still waiting, not for the staff stretched to their limits, and not for the communities left to pick up the pieces. We can and must do better.

NHS Backlog

Zöe Franklin Excerpts

Monday 6th January 2025 Commons Chamber

[Zöe Franklin (Guildford) (LD)]

Before Christmas, I shared in this Chamber the issues impacting my Guildford constituents who are struggling to access support for special educational needs and disabilities. Today, I want to highlight an aspect of the NHS that is directly linked to the SEND issues that I raised: child and adolescent mental health services, better known to most of us in the Chamber as CAMHS.

Unlike many SEND-related issues, CAMHS sits not within the remit of education but in health, as it requires significant input from NHS specialists. The first step to getting help from CAMHS is usually a referral for an assessment. However, the waiting list for some people is up to three years. That is why I am raising the matter today. A long wait for an assessment leaves young people without support or a diagnosis and has wide implications. A young person’s mental health can deteriorate during that wait, which can lead to self-harm, lashing out and harming family members, and even suicide. Imagine going through that as a parent—watching, often helpless to support your child, while the system designed to help does not. Even if they eventually get a CAMHS assessment, there are well-documented shortages in medication and problems accessing therapies.

The son of one of my constituents was diagnosed with attention deficit hyperactivity disorder and autism spectrum disorder in April 2020, but received no follow-up appointments. While his family said it was manageable initially, his school performance began to decline towards the end of 2021-22, leading his family to seek a review with CAMHS in February 2023. Twenty months on, the review has not taken place. His parents sought support to prepare him for his GCSEs, even if the medication had to be delayed, but they were met with a system unable to provide even basic support. They now face an indefinite wait with no resolution in sight.

Another constituent has been fighting for support for her 13-year-old daughter, who has been waiting more than two years for an ADHD and pathological demand avoidance assessment, despite the mother pleading for help for seven years. This single-parent family has endured systemic failure, leaving them suffering to an extent that I will not detail today. The prolonged wait for an assessment has taken a devastating toll on both their lives.

It is clear that action is desperately needed to ensure that the resources are there to support young people and their families through the CAMHS system and to ensure that medication shortages are addressed. How will this Labour Government work to recruit and train more professionals to clear the CAMHS backlog and ensure that the service can respond in good time—not years—to requests for assessments and support? Too many young people and their families are being failed by the current system, and it is time that that came to an end.

Children’s Hospices: Funding

Zöe Franklin Excerpts

Wednesday 30th October 2024 Westminster Hall

[Zöe Franklin (Guildford) (LD)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I start by thanking the hon. Member for Liverpool West Derby (Ian Byrne) for organising this very important debate on the funding of children’s hospices. I have had the sobering privilege of visiting Christopher’s children’s hospice, which is run by Shooting Star Children’s Hospice Association of the South East, just beyond the border of my constituency of Guildford, on two occasions in the past year. Each of those visits has left me with a lasting impression, as I witnessed the incredible work that the dedicated staff team do to support not only the children with life-threatening conditions in my constituency, and well beyond, but their families.

My reason for speaking today, just as so many others have done, is to highlight how challenging the financial situation that hospices are experiencing has become. We have heard that only a third of the funding required by hospices comes from the NHS and central Government, and the rest is sourced from charitable donations. We are really fortunate to live in a society where fundraising for children’s hospitals can keep them funded, but is that really how we should be providing the majority of the funding for crucial services for children with life-limiting and life-threatening conditions? The £25 million allocated by NHS England is intended to support children’s hospices, but the distribution through ICBs has led to significant delays in accessing that funding for the upcoming 2024-25 financial year, and there is a really troubling uncertainty whether it will continue into 2025-26 and beyond. That only exacerbates the already daunting task of financial planning for hospices.

Given those circumstances, it is perhaps not surprising that, in a recent survey of children’s hospices, Together for Short Lives found that hospices would prefer NHS England funding to be distributed centrally, according to an overwhelming 83% of respondents. That would provide the certainty and stability that is crucial to them. I am sure that everyone here can agree that children’s hospices play a vital role in our communities, and I want to put on the record today a really big, heartfelt thanks for the care that hospices and their honestly incredible staff provide to children and their families. I particularly thank Christopher’s in Shalford for the care it provides for my own local residents, as well as those across Surrey and beyond. Those families and their children are going through some of the toughest challenges imaginable. However, our gratitude is not enough. I really urge the Minister today to commit to a fair, long-term deal on funding for children’s hospices and to ensure that the NHS funding returns to being a centrally managed grant.