Mental Health: Unregulated Treatment

Monday 2nd March 2020

(2 years, 2 months ago)

Lords Chamber
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Question for Short Debate
19:36
Asked by
Baroness Jolly Portrait Baroness Jolly
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To ask Her Majesty’s Government what assessment they have made of the impact of treatment by unregulated and unregistered persons offering psychotherapy or counselling services upon the mental health and wellbeing of their clients.

Baroness Jolly Portrait Baroness Jolly (LD)
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My Lords, I thank my noble friend Lord Marks for bringing this issue to my attention and for introducing me to someone whose family had been turned upside down as a result of the “treatment” of a member of it—I have used inverted commas, as it is was not treatment recognised as such by any professional body. I am also grateful to noble Lords who will speak in this debate, bringing both professional and personal experience. I hope that the Minister or one of his colleagues will be able to meet me and the family member to understand to some extent the harms that came from unregulated counselling.

I want to touch on what it takes to be a professional counsellor; the importance of registration, regulation and protected terms; online and face-to-face counselling, and the research about harms done to individuals by unregulated counsellors. Of course, I will expect the Minister to clarify the role of the NHS in the world of counselling.

The terms “counsellor” and “therapist” are not protected. All of us could call ourselves such. While the number of unregistered therapists is low, the expectation is that clients or patients working with unregistered counsellors and psychotherapists are more vulnerable to the possibility of harm. This is because they have no assurance of the level of training or competence of the practitioner nor a redress system to access should something go wrong. A register of qualified counsellors is held by the Health and Care Professions Council, and I would not wish there to be any confusion between these perfectly legitimate individuals and others who are not. The register protects the public from the harm that could be caused by people practising in a profession when they are not qualified.

Let me be clear: it takes many years to train to be a psychiatrist. One has to qualify as a doctor, undergo the extra qualification in psychiatry and then work under supervision until ready to practise. Training as a psychotherapist takes 400 hours over several years and, in most cases, this is paid for by the individual, as are their own therapy sessions which are a prerequisite for qualification. Counsellors have a shorter timescale but, typically, they would have a relevant degree and then several years in training before they qualify. They can work in both the NHS and the private sector.

If they are not on the register, they are not qualified. If they are using one of the terms on the register to describe what they do, without qualification, they are breaking the law. Article 39(1) of the Health Professions Order 2001 makes it a criminal offence for a person, with intent to deceive—whether clearly or by implication—to say that they are on the register of the Health and Care Professions Council, or use a designated title to which they are not entitled, or say falsely that they have qualifications in a profession regulated by the HCPC. In times past, they would just have been called quacks.

To demonstrate how easy this is, a BBC journalist, Jordan Dunbar, recently obtained a counsellor qualification certificate online for the price of £12.99—the cost of a session in a 24-hour gym or a wind-proof umbrella. At present, it is up to patients to make sure that counsellors are qualified and registered with an accredited body. The onus is on the patient, not the provider. A well mocked-up certificate, accompanied by a brass plaque, offers confidence to an anxious and vulnerable member of the public looking for someone to share their confidence with. However, practitioners interact with people at some of the most distressing times in their lives, leaving them vulnerable or worse. Research has shown that fewer than two-thirds of patients are aware of whether their therapist is a member of a professional body.

Many people who use private services do so because the NHS service is hard to access and there is a waiting time. A quick look at the NHS website does not mention waits and these may be quite short if access is via your GP. The NHS website also has an online assessment tool called “Mood self-assessment” which takes a very top-line look at depression and anxiety and makes sensible recommendations based on the results. I used it this morning; it was time not terribly well spent. The NHS Long Term Plan promises to

“deliver the fastest expansion in mental health services in the NHS’s history, with thousands more adults being able to access talking therapies for common disorders and better support being off ered to children and young people.”

When he sums up, will the Minister tell the House where the progress is with this ambitious claim since the publication of the NHS Long Term Plan?

This issue is only becoming more urgent. Waiting lists for non-primary care NHS mental health services are long, and patients are turning to private healthcare solutions which are less likely to be affiliated to voluntary regulators. Also becoming more common are online treatments, where there is little accountability for any harms caused, making it easier than ever for patients to be exploited. Online counselling is a different matter altogether, as there are no boundaries. Mobile phone apps abound to increase well-being, gain confidence and sort personal problems. But there is not a lot of research on this. We know there is no regulation, no way of knowing where the site is based, or the qualifications of the counsellor, or a guarantee that you will be connected to the same person each time. The risk is real. Without protecting these terms, we leave the profession open to abuse by those who practise pseudoscientific therapies with the outcome of doing harm to their clients.

It is vital that the Government assess the impact of these harms. I have been contacted by individuals whose stories, although anecdotal, paint a picture of a real risk to their mental health and safety. The stories are extremely distressing. They tell the tale of vulnerable people putting their trust in therapists only to be exploited and isolated from their loved ones. It is no exaggeration to say that lives have been ruined. It is essential that these harms are documented so that we can find solutions. One possible solution, which I favour, is statutory regulation. This has been debated before in this House, largely driven by my noble friend Lord Alderdice. Unfortunately, the issue has been pushed off the agenda in recent years, but now is the time to revisit it. The Government have previously stated that statutory regulation may be introduced if harms to the public can be demonstrated and this risk cannot be addressed through other means. Will the Minister give some indication of what the department might do to help with the issue of assessment of harms?

Patients say that reporting harms through voluntary regulatory bodies can be an arduous process. This has been demonstrated in cases such as that of Patrick Strud. His therapist subjected him to so-called conversion therapy. Mr Strud had to wait two years for the BACP to withdraw her membership. The Government have indicated that they will outlaw conversion therapy. We all need to be comfortable with the way we are, and not feel that we are different. I hope that the Minister agrees that even one such case is too many and that our current system needs updating. When will the Government take action on those therapists who offer these services?

The most concerning issue is that, even if these regulatory bodies strike off a practitioner for misconduct, there is no legal requirement for that individual to stop practising. This includes those who are struck off for very serious allegations, including serious sexual misconduct. When I agreed to table this Question for Short Debate, I was surprised at the number of people who wrote to me with tales of family members who had been harmed through counselling, not helped or healed in the process. Although voluntary registers, such as the BACP and the UK Council for Psychotherapy, provide some safeguards, they are not enough, and they say that they would welcome regulation.

Given the experience and interest of all noble Lords, I am sure we are in for an excellent debate.

Lord Parkinson of Whitley Bay Portrait Lord Parkinson of Whitley Bay (Con)
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My Lords, as this is a time-limited debate with a dozen speakers, I remind the House of the three-minute speech limit.

19:46
Lord Giddens Portrait Lord Giddens (Lab)
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My Lords, I congratulate the noble Baroness, Lady Jolly, on introducing this debate so ably. We live in a world of dazzling change, in which the digital revolution and AI are among the major driving forces transforming our lives. This is new territory for all of us, but children and young adults are especially on the front line. The online world is almost wholly unregulated. Many traditional pathologies, such as addiction, appear in new forms. According to NHS estimates, 75% of people in England experiencing mental health problems get no treatment at all. It is not surprising, therefore, that the internet is awash with, in the words of the Question, “unregulated and unregistered persons” offering treatment for mental disorders, including in the shape of a swarm of apps offering counselling and therapy. Almost all of this is without any backup from registered healthcare professionals. Will the Minister update the House on the progress of the NHS’s Moodzone, which contains a directory of approved mental health apps? However, there is surely a need for a much more comprehensive strategy to deal with this new Wild West frontier.

The issues here for mental health are far-reaching indeed, since it is hard for any national Government to stamp their authority on the use of data that are in a large part global. Young people today spend a high proportion of their life online. Digital addiction is a huge issue in itself, with largely unknown consequences, since no previous generation has grown up in such a context. Have the Government set up any research projects on how to cope with its likely longer-term impact and its pathologies?

It is good to see that the Government are seeking at least to grapple with these issues, both in the context of the NHS and more widely. They have announced plans to upgrade the ways in which health apps and other digital technologies are reviewed and monitored by the NHS. To do so, it is said, Ministers are working with the digital corporations to try to establish proper standards of scrutiny and transparency—daunting though that is, given the speed with which the digital world Is evolving. A new digital health technology standard is being developed.

It is clear from ongoing research in this country, in the US and elsewhere that the selective use of Al could make a major contribution to diagnostics, which would mesh with the reforms that I believe are needed. As my final minute elapses, will the Minister say whether the Alan Turing Institute is at the forefront of such research?

19:50
Lord Astor of Hever Portrait Lord Astor of Hever (Con)
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My Lords, I have seen at first hand the devastating effect on a family whose lives have been turned upside down as they see a loved one being exploited and isolated from them by a bogus therapist, so I am delighted to support the noble Baroness, Lady Jolly. She has said everything that I would wish to have said and asked the questions that I would have asked.

I will make one further point: Section 76 of the Serious Crime Act covers domestic abuse. The Government accept that individuals can be coercively controlled, and they have rightly made it illegal for a spouse, partner or parent to coercively control somebody with whom they have a relationship—that is an imprisonable offence. However, in the case of coercive control, the law does not apply equally to everyone. A person coercively controlling their daughter would be breaking the law, but the same person coercively controlling someone else’s daughter is not covered by the law. There does appear to be a gap in the law, so will the Government look into this?

The noble Baroness, Lady Jolly, made the point that the terms “counsellor” and “therapist” are not protected—all of us could call ourselves such. I have been sent a list setting out some of the differences between healthy therapy with a trained professional and unhealthy therapy with an untrained person. A trained professional therapist is accountable and does not hide behind fronts, whereas an untrained person is not. Their qualifications are recognised by an outside body, whereas an untrained person is often self-appointed and usually hides behind fronts. Healthy therapy rehabilitates and is for the benefit of the client; unhealthy therapy debilitates and is often for the benefit of the therapist. A healthy therapist’s objectives are agreed with the client, as opposed to being the therapist’s own goals; they promote healthy relationships with others, as opposed to fostering alienation from others. A healthy therapist will aim for the independence of the client, as opposed to their dependence, and will psychologically enable the client and not disable him or her. In healthy therapy, questioning is encouraged, whereas a bogus therapist will discourage it.

The noble Baroness has raised a really important issue. 1 look forward to hearing the Minister’s ideas on how vulnerable people can be protected from unregistered and often very dangerous quack therapists.

19:53
Lord Macpherson of Earl's Court Portrait Lord Macpherson of Earl’s Court (CB)
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My Lords, I should first declare an interest; I am married to a chartered psychologist who works for the National Health Service. I too congratulate the noble Baroness, Lady Jolly, on securing this debate and on her very powerful speech.

The Government have rightly chosen to prioritise mental health in recent years, but, if we are going to take mental health seriously, we really must take seriously the question of who becomes a mental health practitioner. We do not allow unqualified people to carry out surgery, but we allow anybody to call themselves a therapist, a counsellor or even a psychologist. I recently did some research of my own. I came across a college offering a level 2 “Introduction to Counselling” course. The course has no specific entry requirements. It is online and to pass it requires just 80 hours of study. The advertising material states:

“The course is approved by the ACCPH”—


the Accredited Counsellors, Coaches, Psychotherapists and Hypnotherapists, and—

“at the end of this course students will be able to join and become a member of the ACCPH. The ACCPH is an independent self-regulated professional body for counsellors, psychotherapists and hypnotherapists.”

I went to that body’s website, which states that,

“joining as a professional member will prove to potential clients that you are fully qualified.”

Now, for all I know this course, which costs £379—rather more than the £12.99 course previously referred to—may be very good value for money, but I question whether 80 hours of tuition, without any practical face-to-face experience, is sufficient to become an accredited counsellor. Needless to say, the Professional Standards Authority does not recognise the ACCPH as an accredited register, but it is expecting a great deal of often vulnerable and anxious people to know that the PSA exists in the first place, to visit its website and to understand what it means when it lists a register as “in” or “out”.

The Five Year Forward View for Mental Health recommended, four years ago:

“The Department of Health should consider how to introduce the regulation of psychological therapy services.”


I was optimistic that things would change, but the department dragged its feet. The recent statement by the noble Baroness, Lady Blackwood of North Oxford, that

“The Government has no plans to extend professional regulation to psychotherapists or counsellors”


is, for me, at least, deeply disappointing. Her statement that

“We urge anyone seeking the services of a psychotherapist or counsellor to take the time to find a reputable, insured and appropriately qualified practitioner”,


sounds a little complacent. I hope the Minister, for whom I have the highest regard, will tell me that I have misunderstood that statement.

19:56
Lord Alderdice Portrait Lord Alderdice (LD)
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My Lords, like other noble Lords I am grateful to my noble friend Lady Jolly for securing this debate. As a psychiatrist in psychotherapy for the whole of my professional life, I found that the question of unregulated psychotherapy came to me as a problem quite early on. It is now 20 years since I introduced a Private Member’s Bill. I did not do that simply off my own bat; I spent many months consulting all the major psychotherapy and counselling bodies in this country—and almost all, even at that time, were entirely in agreement about the need for regulation of psychotherapy.

However, it is not an easy business. Indeed, the practice of psychotherapy is difficult to regulate, so we focused on a Bill that would require the registration of psychotherapists—in other words, the protection of title, so that people would at least know the person with who they were engaging and whether that person was professionally accountable and trained. The Government, however, did not accept it. They said that they still had to be persuaded about matters of effectiveness—though, frankly, that has nothing to do with regulation and registration. They have now had a further 20 years to address that question.

During that 20 years, professions such as medicine—my own core profession—social work, clinical psychology, nursing and, indeed, the functions of the NHS itself have all had to undergo increasing amounts of regulation and supervision, and absolutely properly so. Are the Government still convinced that, while doctors, nurses, clinical psychologists and social workers all need to be regulated, psychotherapists, almost alone among all these professions, can be left to simply regulate themselves?

Let us consider that the vast majority of such therapists are operating on their own, outside the NHS, and not as part of a core profession. Those who are part of a core profession are, in that sense, already regulated. Working within the NHS, they are almost all working not on their own but as part of multi- disciplinary teams, and they are operating within a health service structure which is itself highly regulated. So it is not just a question of psychotherapists; the context in which they are working is so much more open and flexible and therefore has the potential for abuse. My three minutes are virtually up, but, 20 years after my Private Member’s Bill, I think that the Government’s time ought to be up in terms of doing something serious about the registration and regulation of psychotherapy and counselling.

19:59
Baroness Bryan of Partick Portrait Baroness Bryan of Partick (Lab)
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My Lords, I join the thanks to the noble Baroness, Lady Jolly, for securing this debate. I absolutely support the aim of properly regulating psychotherapy and counselling. I will make two quick points. First, there should be routes into counselling for people from all walks of life. Secondly, supervision for counsellors should include casework supervision.

I had the privilege to work for over 20 years as a director of the charity Employee Counselling Service. During that time, I must have worked with 60 or 70 counsellors, all accredited and registered. I came to appreciate the importance of different routes into counselling. The clients we worked with included refuse workers, school caterers, hospital orderlies, care home workers, train drivers and office workers. Half the clients were men; they were people who probably never dreamed in a million years that they would be talking to a counsellor. It was important that the counsellors they worked with understood something of their lives and the day-to-day pressures that made it hard to step back and take time to reflect. They often needed to prioritise changes to help secure their jobs, homes and health before they could give space to other issues.

The world of counselling can sometimes seem designed for middle-class therapists working with middle-class clients. Counsellor supervision is generally focused on supporting the counsellor, which is of course essential. A common factor in the reports of BACP disciplinary hearings is that counsellors work alone and without accountability until a client makes a complaint. It should not be left to the client to have to identify problems.

In the voluntary sector, it was usual for counsellors to receive casework supervision. This, more than anything else, safeguards the client from counsellors who may lose focus or get out of their depth in their work. Casework supervision, which involves a supervisor regularly discussing the direction and progress of each case, safeguards both the client and the counsellor. I hope the Minister will take up these two issues to ensure the well-being of clients and counsellors.

20:02
Lord Garnier Portrait Lord Garnier (Con)
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My Lords, I join other noble Lords in thanking the noble Baroness, Lady Jolly, for introducing this debate. At its heart, this debate is about preventing the exploitation of the vulnerable—not of the mentally ill, the elderly or children, who are protected quite widely by the law already, but of those whose vulnerability, be it emotional or psychological, permits them to be preyed on by charlatan counsellors. These charlatans suborn them through their cynical promises of peace of mind and future happiness; through lies about their families and bogus therapy they suborn them into breaking off contact with them. Frequently, since they target people with money, they charge exorbitant fees for doing so. They are purveyors of deceit, misery and distress. They need to be stopped.

I first came across this form of quackery in the late 1970s, when I was acting for the Daily Mail against a cult called the “Moonies”, who broke up families wholesale and brainwashed children. Most of them were adult children in a vulnerable and emotional state, lonely and far away from home. I was reminded of them in about 2013 or 2014 when I came across the case of a young woman who had been suborned into leaving her family, cutting herself off and paying this extraordinary woman vast sums of money for her quackery. Supported by David Cameron, the then Prime Minister, Sir Oliver Letwin, then the Government’s policy chief, and Mr Tom Sackville, a former Home Office Minister, I attempted to amend the law to prevent these quacks operating and exploiting their victims. Although we tried, we could not find an opportunity to amend the law and achieve our aim.

However, it can and has been done. It has been done in France, Luxembourg and Belgium. They have passed laws to amend the criminal law which have withstood challenges in the Strasbourg court under the European Convention on Human Rights. With care, provision can be made to protect freedom of religion, assembly and association so that, for example, adult children can if they want to, even if their parents object, join closed religious orders, give their money away or just cut themselves off from their families. But quacks should not be permitted any longer to exploit emotionally vulnerable adults.

This cruel practice must stop. We should ensure that it does. I suspect that we give more protection to cats and dogs against quack vets than to emotionally and psychologically vulnerable adults against quack counsellors. It is time we did better.

20:05
Baroness Murphy Portrait Baroness Murphy (CB)
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My Lords, I have been a psychiatrist for 40 years, and it will not surprise your Lordships that I agree with every word that has been said in this welcome short debate of the noble Baroness, Lady Jolly.

I have long been astonished that we have such regulation for practically every healthcare profession under the sun except psychotherapy. Art therapists, for example, are registered and regulated; so are osteopaths and chiropractors, who both have their own regulatory councils. Yet we left the Professional Standards Authority struggling to think through how it would approach this problem. It could not regulate this massive amount of mental health care without doing something about it, and so it developed its accreditation scheme— and all credit to it for doing so—but the time really has come.

Efficacy is clearly not the issue at stake because, after all, there are many qualified physicians and psychiatrists who are not very efficacious. Nevertheless, we try to ensure that they do not cause positive harm by making sure they have appropriate training. The issue is whether a person is setting themselves up to provide care and support to somebody else. That is healthcare, and somebody doing that needs to be regulated.

I have heard it said that some of these therapists do not want to be regulated. I am sure they do not, but if you were here in 1856 and listened to the antipathy in the debates towards the notion that you might regulate doctors, you would hear the same arguments. The time has come.

There are now over a million new people coming into the health service to ask for psychotherapy every year, and we provide that to them, admittedly through accredited organisations. Nevertheless, there are a huge number of people getting it, and it is clear that the time has come to offer proper regulation and reassure the people coming to ask for help that individuals have got at least some accreditation and that we can protect the public from harms.

20:08
Baroness Barker Portrait Baroness Barker (LD)
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My Lords, I thank my noble friend Lady Jolly for the opportunity to talk a bit about conversion therapy, or the use of non-accredited counsellors offering psychotherapy or counselling to those seeking help for their unwanted same-sex attraction, which is prevalent in some churches. It is defended by some religious groups as a legitimate part of their faith, but the majority of churches, alongside the professional bodies, see it as a very harmful practice.

In December 2018, there was a small study of people who had been subjected to conversion therapy. Of those, two-thirds said that they wanted to see the practice made criminal. The remaining third did not want to see it criminalised, but they did want to see it stopped, because it had profound and harmful effects upon the people who were subjected to it.

That is the point I want to make, following that from the noble and learned Lord, Lord Garnier. We go to religious organisations in the extremes of happiness and of despair. They are rarely neutral places in which to transact matters such as counselling. Therefore, it is only right for us to ask the Government, when they bring in some form of regulation—and they will inevitably have to—not to allow, as they do in other cases, any form of exemption for religious organisations. There should be ethical standards to which all practitioners, no matter the context in which they practise, conform.

The Government’s LGBT Action Plan recognised this as a very important issue for our community. There are some particularly vulnerable young people who are perhaps locked into religious communities, from which it is difficult to find a way out or alternative point of view. It is of the utmost importance that we make sure that, when those young people live their faith, they do so in safety. Therefore, I ask the Minister to update us on what is admittedly a technically difficult area of law but one that is of the highest importance to a number of people and one that, I would suggest, is urgent.

20:11
Lord Marks of Henley-on-Thames Portrait Lord Marks of Henley-on-Thames (LD)
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My Lords, I am also grateful to my noble friend Lady Jolly for securing this debate and her clarity in opening it. We have had an excellent and, so far, unanimous debate.

In a humane society, unqualified practitioners may not set themselves up as doctors and dentists to practise medicine or dentistry without training, supervision or regulation, as the noble Baroness, Lady Murphy, and others have eloquently argued. We now promise, and are promised, parity of esteem between mental and physical health, which the Mental Health Foundation defines as

“valuing mental health equally with physical health”,

with commitments for

“equal access to the most effective and safest care and treatment … equal efforts to improve the quality of care … equal status within healthcare education and practice”.

If those commitments are to be more than glib platitudes, we must end the scandal of untrained and unregulated self-styled therapists, counsellors, healers or life coaches peddling untested and dubious treatment to the psychologically and emotionally vulnerable and suffering.

We have heard harrowing accounts of victims, often young, brainwashed by unscrupulous and controlling individuals. These charlatans play on their clients’ suffering, deluding them into a false belief in their treatment, often conjuring up in them fake memories about their early years and inducing unhealthy long-term dependence on the therapist and rejection of families and friends. For this, they often take significant fees and frequently inflict devastating and long-term damage. This debate has pointed the way to what is needed.

First, we must insist on licensing and regulation for therapists, for which my noble friend Lord Alderdice and the noble and learned Lord, Lord Garnier, have long argued. We need an approved body that maintains a register of practitioner members, who must secure qualifications, comply with a clear statement of ethical standards and submit to supervision.

Secondly, I support the call by the noble Lord, Lord Astor, the charity Family Survival Trust chaired by Tom Sackville—a former Home Office Minister, who is here tonight—and leading academics in seeking amendment to the Serious Crime Act 2015, which outlaws controlling or coercive behaviour, but in a domestic context only, where perpetrator and victim are in an intimate personal relationship or live together as family members. The Act needs to go wider to cover so-called therapists causing psychological damage and distress to their clients and their clients’ families and friends. Such legislation would be simple and effective. Will the Government bring forward such an amendment to the Act now?

20:14
Baroness Thornton Portrait Baroness Thornton (Lab)
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I thank the noble Baroness, Lady Jolly, for securing this debate and I assure the noble Lord, Lord Marks, that we will be unanimous in this discussion. What the noble Baroness, Lady Jolly, has done is to illustrate the problems and dangers of a sector that is not properly regulated, and it goes from one extreme to another.

One extreme was outlined in the letter that we all received about unregulated abuse, coercive control and cultic abuse. It makes the point outlined by the noble Lord, Lord Marks, about recognition of coercive control covering domestic matters only and failing to recognise the harm that can be done by the sorts of organisations that were graphically described to us by the noble and learned Lord, Lord Garnier. Therefore, the law is inadequate in this regard and needs to be addressed. The Minister must realise that the whole House is unanimous in thinking that that needs to happen. He needs to know that, when the first Bill comes along in which we can bring forward that amendment, we probably will. The Government would be wise to do it themselves, because they will lose otherwise, because the House is united in this.

The other extreme is the regulatory framework, with which all noble Lords are familiar. It is significant that the Professional Standards Authority felt it needed to draw attention to the inadequacies in this direction, in the letter that we received from Christine Braithwaite, the director of standards. She says:

“for a number of years we have requested changes to the Rehabilitation of Offenders Act 1974 and the Safeguarding Vulnerable Groups Act 2006 to include Accredited Registers to better strengthen the protection they are able to provide. To date, no amendments have been made.”

If the body that registers the different counselling and psychoanalytic organisations is saying that this is inadequate, as well as saying that the regulatory framework is inadequate, the Government really need to sit up and listen to what is being said right across the piece.

It is a matter for the Government to regulate this profession. Statutory regulation will offer great protection to the public. The Government also need to look at the titles of counsellors and psychotherapists to make sure that they are recognised as such and are being protected under statutory regulation. I look forward to what the Minister has to say.

20:17
Lord Bethell Portrait Lord Bethell (Con)
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My Lords, I join others in thanking the noble Baroness, Lady Jolly, for raising this important issue. Before I make my formal comments, I should like to recognise the clear and strong feelings expressed on this issue in the House today, which one cannot help but feel moved by. On a personal note, perhaps I may share that I have myself lost a friend to manipulative individuals. It was a friendship that I valued very much, so I can feel some of the hurt that Members have expressed about that sensation of losing loved ones in such difficult circumstances.

I shall move on to the more formal comments about the Government’s approach to mental health services. I want to reassure the House that this Government absolutely put the modernisation of mental health services at the heart of our commitment to the health of the British people. The message on mental health has come up again and again in the Chamber and I have stood at this Dispatch Box many times to hear it. I want to reassure noble Lords that that message is 100% understood.

I need hardly remind some of those here that spending on NHS mental health services has already risen under this Government from £10.9 billion in 2015-16 to £12.5 billion in 2018, and that under the mental health investment standard, for the first time clinical commissioning groups are increasing the amount spent on mental health services by at least the amount of their overall budgets. The noble Baroness, Lady Jolly, asked for clarification of the role of the NHS. Let me reassure her that the NHS Long Term Plan also explains that there will be a comprehensive expansion of mental health services, giving 380,000 more adults access to psychological therapies, which represents a huge expansion in the Government’s investment in mental health.

However, I recognise that as well as expanding the size of mental health services provision, the Government need to understand the importance of ensuring the quality of the services that are delivered. We agree absolutely that service users should be able to expect high-quality psychological therapies that bring about positive impacts on mental health and recovery. The noble Baroness, Lady Jolly, asked specifically what progress has been made on mental health goals in the NHS Long Term Plan. I reassure her that 12 pilot sites have already received £70 million of funding for new specialist services and that that is the first step in a £975 million investment as part of the long-term plan to transform community mental health services.

The Government are committed to improving access to psychological therapies through the Improving Access to Psychological Therapies programme. Each year, more than 1 million people access IAPT services and the Government are committed to expanding them massively so that by 2023, 1.9 million people will be able to access those services. I can reassure the noble Baroness, Lady Jolly, that waiting times, which she asked about, for access to IAPT services have also improved to the point that 98% of patients seeking a first referral get that referral within 16 weeks, against a target of 95%.

The IAPT service provides a gold standard, highly professional service, routinely monitored on outcomes achieved, and the professionals providing these services undergo regular outcomes-focused supervision. These principles ensure that therapies are delivered by fully trained and accredited practitioners with appropriate skills in providing individualised support to people with mental health problems. The intensity and duration of each IAPT therapy is designed to optimise patient outcomes and, as the noble Lord, Lord Alderdice, alluded to, all IAPT clinicians should have completed an IAPT-accredited training programme with nationally agreed curricula aligned to NICE guidelines. High-intensity therapists in IAPT services should be accredited by the relevant professional bodies and all IAPT clinicians should be supervised weekly by appropriately trained supervisors in the manner rightly described by the noble Baroness, Lady Bryan.

None the less, we are aware of concerns regarding the treatments that some people receive from some services outside the provision of government services. My noble friend Lord Astor spoke very movingly about healthy and unhealthy therapies, and in this matter he is entirely right. The anecdotes recounted by noble Lords, including the story from the noble Lord, Lord Macpherson, about the ACCPH, are clearly disturbing. We acknowledge that some private individuals are delivering therapies that may be putting patients’ safety at risk. I have read the Unsafe Spaces blog and the contributors’ concerns. I watched the BBC documentary that noble Lords referred to. Who can read these stories without feeling a sense of sadness? I think of my own lost friend.

Let us be clear. The Government are committed to a proportionate system of safeguards for the professionals who work in the health and care system. I join the noble Baroness, Lady Thornton, in paying tribute to the Professional Standards Authority and its important letter that was circulated among noble Lords, and describing its recommendations as interesting.

Where practitioners pose a direct risk of harm to the health and well-being of patients, legal avenues will and must be explored. The noble Baroness, Lady Jolly, described many of the legal remedies. I assure the noble Lord, Lord Astor of Hever, that coercive or controlling behaviour has been an offence since 2015. The Government remain committed to supporting the police to bring offenders to justice and to ensuring that victims have the support they need to rebuild their lives.

However, more rules are not always the answer to every problem. While statutory regulation is sometimes necessary where significant risks to users of services cannot be mitigated in other ways, it is not always the most proportionate or effective means of assuring the safe and effective care of service users.

We do not take this position without careful thought. We have previously considered the introduction of statutory regulation of counsellors and psychotherapists. We have considered various Private Members’ Bills, including from the noble Lord, Lord Alderdice. None the less—in reply to the noble Lord, Lord Macpherson, and others who have asked the question straight—I will give a straight answer: we currently have no plans to do this. This may come as disappointing news but, as I am sure the noble Baroness will appreciate, there is a wide range of mental and physical therapies on offer in modern Britain and an important focus on personalised approaches to mental health care and treatment. What might suit one person today might be snake oil to another.

The noble Lord, Lord Giddens, asked about health apps. The NHS app library contains a number of mental health apps, which undergo a number of quality checks before they are allowed on the website. Some apps, such as Chill Panda and Cove, are currently being tested in the NHS.

The regulation of these services is complex. Issues that must be considered carefully include the impact of any regulation on delivery, quality, ensuring that we do not stifle innovation, ensuring that we do not discourage individuals from working in mental health and the principle of consumer choice. However, I assure the noble Baroness and other noble Lords who have spoken in this debate that the Government remain committed to addressing the important recommendations of the—

Lord Marks of Henley-on-Thames Portrait Lord Marks of Henley-on-Thames
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My Lords, I am sorry to interrupt, but I know the Minister has a few minutes left. There was mention of the Serious Crime Act. Does the Minister recognise that Act’s limitation—which the noble Lord, Lord Astor, and I mentioned—to the domestic context? Will he do something about it? Will he also confirm agreement to a meeting to discuss the future of regulation?

Lord Bethell Portrait Lord Bethell
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My Lords, I was just reaching the key segment of my speech. With kind permission, I will finish the speech, since time is of the essence.

I assure the noble Baroness and other noble Lords who have spoken in this debate that the Government remain committed to addressing the recommendation in the Five Year Forward View for Mental Health to consider the regulation of psychological therapy services, including their inspection. The department is currently considering issues around regulation of this area. I assure the Chamber that we will carefully consider the potential impact on services and the people who use them. I will endeavour to update the House on progress as it happens.

I assure in particular the noble Baronesses, Lady Barker and Lady Jolly, that the Government are committed to ending the practice of conversion therapy. The 2018 LGBT Action Plan clearly outlined that commitment. The Government Equalities Office is currently working on this.

In the meantime, I extend my thanks to the noble Baroness for securing this debate and to all noble Peers here today. It is an important debate. The noble Lord, Lord Alderdice, said there had been no progress in the last 20 years. We now have more than 50,000 talking service professionals on the registers, accredited by the Professional Standards Authority. The department is currently considering the regulation of psychological therapy services, as per the recommendations in the Five Year Forward View for Mental Health. This is progress. The department will set out further details of its considerations on these matters later in the year and Ministers will be happy to update the House as this work develops.

20:29
Sitting suspended.