Mental Health Bill [Lords]
(1 day, 10 hours ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
17:59 - The House divided: - Ayes: 78 / Noes: 327 - Question accordingly negatived.
18:15 - The House divided: - Ayes: 163 / Noes: 339 - Question accordingly negatived.
18:28 - The House divided: - Ayes: 164 / Noes: 333 - Question accordingly negatived.
Zöe Franklin (Guildford) (LD)
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker (Judith Cummins)
With this it will be convenient to discuss the following:
New clause 3—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.
New clause 4—Adequacy of accommodation: review—
“(1) The Mental Health Bill 1983 is amended as follows.
(2) After Section 131A (Accommodation etc. for children) insert—
‘131B Adequacy of accommodation
(1) The Secretary of State must, within 12 months of the passage of the Mental Health Act 2025, publish a review of the quality of accommodation for any patient who is—
(a) liable to be detained in a hospital under this Act;
(b) admitted to, or remains in, a hospital in pursuance of such arrangements as are mentioned in section 131(1) above.
(2) The Secretary of State must, within six months of the publication of the review under subsection (1), publish a strategy to implement the recommendations of that review.’”
This new clause would require a review of the quality of accommodation for people detained or admitted to hospital under the Mental Health Act 1983 and require the Secretary of State to publish a strategy to implement the recommendations of this review.
New clause 5—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.”
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.
New clause 6—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.’”
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.
New clause 7—Children detained on adult wards—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 131A (Accommodation, etc. for children), insert—
‘131B Children detained on adult wards
(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of children detained on adult wards.
(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.’”
This new clause would require the number of children detained on adult wards to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.
New clause 8—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 9—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.”
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.
New clause 10—Report and Guidance: Transition to Adult Mental Health Treatment—
“(1) The Secretary of State must, within 18 months of passing of this Act, prepare and lay before Parliament a report on improving provision for patients transitioning from treatment in a hospital environment for children and young people to one for adults when they attain the age of 18.
(2) The report under subsection (1) must include an assessment of—
(a) the current pathways and outcomes for young people transitioning between hospital environments for children and for adults;
(b) any gaps in care or support experienced by patients during this transition;
(c) best practices for ensuring safe and effective transitions.
(3) Following the report under subsection (1), the Secretary of State must publish guidance for integrated care boards, local authorities, and providers of mental health treatment on improving outcomes and ensuring continuity of care for patients transitioning to a hospital environment for adults.
(4) The guidance under subsection (3) must include—
(a) specific steps to guarantee continuity of care for patients transitioning between treatment in a hospital environment for children and young people and one for adults;
(b) measures to identify young people requiring transition support at an appropriate stage;
(c) provisions for joint working and information sharing between providers of treatment for children and young people and for adults;
(d) requirements for the review and updating of care and treatment plans to reflect the needs of patients transitioning to a hospital environment for adults.
(5) Integrated care boards, local authorities, and providers of mental health treatment 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) young people with experience of transitioning between children and young people’s and adult mental health services, and their carers and guardians;
(b) relevant professional bodies;
(c) integrated care boards;
(d) local authorities;
(e) providers of mental health treatment;
(f) 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.”
This new clause would require the Secretary of State to review and report on the transition of patients from children's to adult mental health settings for treatment at age 18 and publish guidance for relevant bodies on improving provision and ensuring continuity of care during this transition.
New clause 11—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.”
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.
New clause 12—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.”
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.
New clause 13—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.
New clause 14—General duty to secure sufficient resources for services in the community—
“(1) It is the general duty of integrated care boards to ensure, insofar as is reasonably practical, that services in the community responsible for delivering care, treatment, or detention provisions under the Mental Health Act 1983 and this Act have the necessary resources, including financial support, to meet service demands.
(2) Additional forms of resource may be determined by integrated care boards in consultation with relevant local authorities or health care service providers and may include—
(a) sufficient numbers of trained medical professionals;
(b) purpose-built facilities for patient care;
(c) community services responsible for out-patient care.
(3) Each Integrated Care Board must conduct an assessment of its resources every two years to evaluate its ability to deliver services in the community effectively.
(4) Each Integrated Care Board must publish a report outlining its findings upon completing the assessment in subsection (3). The first reports must be published within one year of the passage of this Act.”
This new clause places a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand on services to ensure that the provisions of the Bill function as intended and to assess and report on this every 2 years.
New clause 15—Report: statutory competency test for under-16s—
“Within 12 months of day on which this Act is passed, the Secretary of State must undertake a review of whether a statutory competency test for under-16s in determining their ability to make a relevant decision would be expedient for the purposes of this Act or the Mental Health Act 1983.”
This new clause requires the Secretary of State to undertake a review of whether a statutory competency test for under-16s would be expedient for the purposes of this Bill and the Mental Health Act 1983.
New clause 16—Duty to promote mental health wellbeing—
“After section 142B of the Mental Health Act 1983, insert—
‘Duty to promote mental health wellbeing
(1) It is a general duty of local authorities and anybody in carrying out functions under this Act or the Mental Health Act 2025 to promote mental health wellbeing.
(2) In carrying out the duty under subsection (1), local authorities and commissioning bodies must have regard to—
(a) the prevention of mental illness,
(b) the promotion of positive mental health,
(c) the reduction of stigma and discrimination associated with mental health conditions, and
(d) the provision of accessible and appropriate support services to individuals experiencing mental health challenges.
(3) Local authorities and commissioning bodies must publish an annual report outlining the steps taken to discharge their duty under subsection (1), including an assessment of—
(a) progress in improving mental health wellbeing in their area for persons affected by the provisions of this Act, and
(b) any barriers to promoting mental health wellbeing for such persons and proposed actions to address them.
(4) The Secretary of State may issue guidance on the discharge of the duty under subsection (1), and local authorities and commissioning bodies must have regard to such guidance.’”
This new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing, with regard to any guidance published by the Secretary of State.
New clause 17—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.”
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.
New clause 18—Mental Health Commissioner—
“After section 142B of the Mental Health Act 1983, insert—
‘Mental Health Commissioner
142C Independent Mental Health Commissioner: establishment
(1) There is to be an office known as the Office of the Mental Health Commissioner.
(2) The Office in subsection (1) must be established by the Secretary of State three months after the day on which the Mental Health Act 2025 is passed.
(3) The Office of the Mental Health Commissioner will be led by an individual appointed by the Secretary of State titled the “Independent Mental Health Commissioner”.
(4) The role in subsection (3) is referred to as the “Mental Health Commissioner”.
(5) The Mental Health Commissioner may appoint staff to the Office of the Mental Health Commissioner they consider necessary for assisting in the exercise of their functions in section 142D.
142D Functions of the Commissioner
(1) The Mental Health Commissioner is responsible for overseeing the implementation and operability of functions discharged by relevant bodies and persons under the provisions of this Act, the Mental Health Act 1983, and the Mental Capacity Act 2025 particularly regarding the provision of treatment, care, and detention of people with a mental disorder.
(2) The Mental Health Commissioner must publish an annual report on the use of functions discharged under this Act, which must assess—
(a) the quality of mental health care treatment provided by relevant services;
(b) the accessibility of mental health care treatment services;
(c) the relationship between mental health and the criminal justice system;
(d) inequalities of mental health care provision regarding protected characteristics under the Equality Act 2010;
(e) the use and effectiveness of detention measures under this Act, including but not limited to Community Treatment Orders, for the purposes of therapeutic benefit outlined in section 1(2B);
(f) challenges surrounding stigma of mental health conditions;
(g) the accessibility of advice and support to mental health service users, their families and carers on their legal rights;
(h) other issues deemed appropriate by the Mental Health Commissioner.
(3) In fulfilling their duties under subsection (1), the Mental Health Commissioner may review, and monitor the operation of, arrangements falling within subsection (1), (2) and (3) for the purpose of ascertaining whether, and to what extent, the arrangements are effective in promoting the principles in section 118(2B) of this Act.
(4) Subject to any directions from the Secretary of State, the Commissioner may take action necessary or expedient in connection for the purposes of their functions.
(5) This may include—
(a) collaborating with health services, public authorities, charitable organisations, and other relevant entities, including NHS bodies, the Care Quality Commission, and the Parliamentary and Health Service Ombudsman;
(b) ensuring enforcement authorities and public bodies under the Mental Health Act 1983 have the necessary capacity and resources to adequately discharge duties under the Mental Health Act 1983 and this Act.
142E Appointment, Tenure, and Remuneration of the Mental Health Commissioner
(1) The Secretary of State may by regulation make provision for the appointment, tenure, removal, and general terms of appointment of the Mental Health Commissioner.
(2) The Secretary of State may also by regulation determine the Commissioner’s remuneration, allowances, and pension entitlements.
142F Examination of cases
(1) The Secretary of State may, by regulations, make provision for the examination by the Mental Health Commissioner of the cases of those who are detained under this Act receiving treatment by authorised mental health care providers.
(2) The Secretary of State may, by regulations, provide for the Office of the Mental Health Commissioner to access and examine relevant data on mental health treatment provision held by NHS England and any other authorities the Secretary of State considers appropriate.
142G Regulations
A statutory instrument containing regulations under sections 142E and 142F may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.’”
This new clause establishes the office of the Mental Health Commissioner and makes provisions for relevant duties and responsibilities.
New clause 19—Duty to provide advice and support to families and carers—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 117B insert—
‘117C After-care: provision of support and advice to families and carers
(1) The responsible integrated care board must ensure that, as part of the provision of after-care services under section 117 of this Act, advice and support is offered to the family or carers of the person discharged where the person consents.
(2) This support must include—
(a) information about the person’s condition and recovery;
(b) guidance on how to support their recovery at home and avoid relapse;
(c) access to financial, housing, and social care advice services relevant to the situation of the person’s family; and
(d) procedures for family members or nominated persons to notify the integrated care board of concerns that the person is at future risk of detention under Part 2 of this Act.
(3) Where a concern is raised under subsection (2)(d), the integrated care board must—
(a) consider whether the individual meets criteria to be included on the register of persons at risk under section 125D of this Act; and
(b) take reasonable steps to involve the family or nominated person in planning of subsequent support, subject to—
(i) the person’s consent; or
(ii) if they lack capacity, the person’s best interests.
(4) The Secretary of State must publish guidance under section 125B of this Act on the format and provision of support under subsection (3)(b).’”
This new clause would require the integrated care board, as part of the aftercare services offered under the Mental Health Act 1982, to offer support and advice to the family or carers of the person being discharged from treatment.
New clause 21—Assessment for admission: clinicians with outstanding complaints—
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part II (Compulsory Admission to Hospital and Guardianship), after section 6 insert—
‘6a Assessment for admission: clinicians under investigation
(1) For the purposes of the written recommendations required under sections 2(3) or and 3(3) of this Act, a recommendation may not be made by a medical practitioner who is, at the time of the assessment or written statement—
(a) under investigation by the General Medical Council or the hospital due to concerns relating to the medical practitioner’s care of the patient being assessed; or
(b) subject to a complaint to the General Medical Council or the hospital by the patient or the patient’s close associates.
(2) The Secretary of State may by regulations make further provision under this section.’”
This new clause would prevent a patient from being assessed to be detained by a doctor under investigation by the GMC or hospital trust, or subject to a complaint, in relation to their care of that patient.
New clause 22—Veterans’ Mental Health Oversight Officer—
“After section 142B of the Mental Health Act 1983 insert—
‘Veterans’ Mental Health Oversight Officer
142C Veterans’ Mental Health Oversight Officer: establishment
(1) The Secretary of State shall appoint a Veterans’ Mental Health Oversight Officer ("the Officer") to oversee the treatment and care of veterans under this Act.
(2) The Officer shall—
(a) oversee the cases of veterans who are—
(i) at risk of detention under this Act;
(ii) currently detained under this Act; or
(iii) following detention under this Act, subject to community or outpatient treatment or other post-discharge mental health provisions;
(b) advocate for mental health assessments and care tailored to veterans' service-related experiences;
(c) collaborate with mental health professionals, veterans' services, legal representatives, and third-sector organisations to safeguard veterans' rights and well-being within relevant treatment settings;
(d) promote diversion from detention where clinically appropriate, including the use of veteran-specific support services; and
(e) submit an annual report to Parliament detailing—
(i) detention rates of veterans under this Act;
(ii) outcomes and recidivism rates for veterans detained under this Act;
(iii) recommendations for service improvement.
(3) In this section—
“veteran” refers to a person who has served or currently serves in the armed forces of the United Kingdom or a Commonwealth nation;
“relevant health authority” includes NHS England, regional NHS boards, or their successors.’”
This new clause introduces a dedicated oversight role for veterans within the framework of the Mental Health Bill, recognising that service personnel have unique needs and experiences that need to be considered in mental health care and detention decisions.
New clause 23—Mental Health Act: interim support for a child or adolescent at risk of detention—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 33, insert—
‘33A Interim support for child and adolescent patients
(1) Where a child or young person (“P”) is referred to Child and Adolescent Mental Health Services and—
(a) P has not yet attended their first appointment, and
(b) P is at risk of detention under this Part, in the opinion of a family member or close associate,
the responsible authority must ensure that interim support is available.
(2) Interim support under this section must include at least one of—
(a) regular contact with a family support worker;
(b) access to GP appointments;
(c) regular contact with a school nurse or equivalent healthcare professional; or
(d) access to a peer support group, youth group, or youth club offering appropriate emotional support.’”
This new clause would ensure adequate interim support for children at risk of detention under Part II the Mental Health Act while awaiting an appointment with Child and Adolescent Mental Health Services (CAMHS).
New clause 24—Report: Mental health services for children and young people—
“(1) The Secretary of State must, within 18 months of passing this Act, prepare and lay before Parliament a report on the provision of specialist mental health services for patients aged under 18.
(2) The report under subsection (1) must include an assessment of—
(a) the number of patients aged under 18 receiving specialist mental health services;
(b) the availability of specialist mental health services based outside of hospital settings;
(c) any gaps in care and support experienced by patients aged under 18;
(d) the Secretary of State’s conclusions as to whether there are sufficient resources to deliver mental health services for patients aged under 18;
(e) the views of children, young people and families with experience of receiving specialist mental health services.
(3) For the purpose of this section—
(a) “specialist mental health services for patients aged under 18” means—
(i) inpatient mental health services specifically designed for individuals aged under 18 years, including specialist eating disorder services;
(ii) community-based mental health services specifically designed for individuals aged under 18 years as an alternative to inpatient care.
(b) “resources to deliver mental health services” include—
(i) finances;
(ii) appropriate trained medical professionals;
(iii) appropriate facilities for patient care.”
This new clause would require the Secretary of State to review and report on the availability of specialist mental health services for patients under 18.
New clause 25—Determination of competency for persons under 16—
“(1) For the purposes of this Act, a person aged under 16 (referred to in this section as a child) is able to make a relevant decision if they can—
(a) understand the information relevant to the decision;
(b) retain that information;
(c) use or weigh that information as part of the process of making a decision; and
(d) communicate their decisions (whether by talking, using sign language or any other means).
(2) Where a child is able to make a relevant decision in accordance with paragraph (1) above, that child will be competent for the purposes of this Act.
(3) A child is not to be regarded as unable to understand the information relevant to a decision if he is able to understand an explanation of it given to him in a way that is appropriate to his circumstances (using simple language, visual aids or any other means).
(4) A person determining a child’s ability to make a relevant decision under this section must—
(a) have due regard to Article 12 of the United Nations Convention on the Rights of the Child, and
(b) be able to show reasonable grounds for their belief that the child is or is not able to make a relevant decision.”
This new clause inserts a competency test for determining a child’s ability to make a relevant decision.
New clause 26—Duty to establish carer liaison service—
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part X (Miscellaneous and Supplementary), after section 133 insert—
‘133A Duty to establish carer liaison service
(1) The managers of every hospital providing services under this Act must establish and maintain a dedicated carer liaison service.
(2) A service established under this section must provide—
(a) support to unpaid carers when a patient for whom they provide care is—
(i) awaiting admission to hospital for treatment under the Act;
(ii) receiving treatment in hospital under the Act;
(iii) set to be discharged from a hospital where they had been receiving treatment under this Act;
(b) timely and accessible information regarding the discharge of the patient they care for, including details of—
(i) the patient's discharge plan; and
(ii) aftercare arrangements under section 117 of this Act;
(c) support for unpaid carers to identify their own needs and connect to relevant local services for post-discharge support, including local authority adult social care services, general practitioners, and local carers' centres;
(d) facilitation of effective communication and collaboration between unpaid carers and the patient's multi-disciplinary clinical team regarding the discharge process;
(e) assistance to unpaid carers in developing or updating a carer's support plan in the context of the patient's discharge, including guidance on—
(i) their rights to assessment and support as carers
(ii) their participation in education or employment;
(iii) available counselling services;
(iv) support in planning for emergencies in relation to the patient;
(v) benefits for the carer and patient; and
(vi) other forms of local support; and
(f) services to ensure that the perspective of the unpaid carer, as a key provider of support, is considered during discharge planning, where appropriate and with due regard to patient confidentiality and consent.’”
This new clause would require hospitals to establish a dedicated liaison service for the carers of patients detained under the Mental Health Act.
New clause 27—Duty to identify children of patients receiving treatment—
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part X (Miscellaneous and Supplementary), after section 133 insert—
‘133B Duty of managers of hospitals to identify children of patients
(1) Where a patient liable to be detained under this Act is in a hospital or registered establishment, the managers of the hospital or registered establishment shall take such steps as are practicable to identify children of the patient.
(2) The managers must ensure, where children of patients are identified, that—
(a) information is provided to the family about support available for the child;
(b) the appropriate practitioner consider whether the child might be a young carer and whether they might benefit from additional support including—
(i) a Young Carers’ Needs Assessment under section 17ZA of the Children Act 1989, or
(ii) additional support from their local authority or local young carers service.’”
This new clause would require hospitals to identify children of patients and provide support or provide guidance on available support to them, particularly if they are a young carer.
New clause 28—Duty to mitigate adverse effect of compulsory measures on parental relations—
“(1) The Mental Health Act 1983 is amended as follows.
(2) After section 131A, insert—
‘131B Duty to mitigate adverse effect of compulsory measures on parental relations
(1) Subsection (2) below applies—
(a) where—
(i) a child is subject to any measures authorised by virtue of this Act; and
(ii) the measures will or will be likely to impair the personal relations or diminish direct contact between the child and any person with parental responsibilities in relation to the child; or
(b) where—
(i) a person with parental responsibilities in relation to a child is subject to any measures authorised by virtue of this Act; and
(ii) the measures will or will be likely to impair the personal relations or diminish direct contact between that person and the child.
(2) Every person having functions by virtue of this Act shall take such steps as are practicable and appropriate to mitigate the impairment or diminution referred to in this section or, as the case may be, the likelihood of that impairment or diminution.
(3) In this section—
“child” has the meaning given by section 105 of the Children Act 1989; and
“parental responsibilities” has the meaning given by section 3 of the Children Act 1989.’”
This new clause would create a duty to mitigate the adverse effect of compulsory treatment under the Mental Health Act 1983 on relations between parents and their children, mirroring provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003.
New clause 29—Age-appropriate treatment for children—
“(1) Section 131A of the Mental Health Act 1983 is amended as follows.
(2) After subsection (1), insert—
‘(1A) A patient to whom this section applies must not be detained in, or admitted to, an adult ward unless the managers of the hospital consider that—
(a) there are exceptional circumstances which justify the patient’s detention in, or admission to, an adult ward; and
(b) the decision is in accordance with the best interests of the child.’
(3) After subsection (3), insert—
‘(3A) Where a patient to whom this section applies has been detained in, or admitted to, an adult ward, the managers of the hospital must record in writing the reasons for the admission, including—
(a) the reason, or reasons, why other options for accommodation were not available or suitable for the patient;
(b) details of the measures to be taken by the hospital to ensure that, while the patient is detained or otherwise accommodated in the adult ward, the patient is provided with care in a safe environment; and
(c) unless it has been determined that an adult ward is the most appropriate environment for the patient in accordance with subsection (1A), the steps being taken by the hospital to transfer the patient to more appropriate accommodation.
(3B) Where a patient to whom this section applies is—
(a) detained in, or admitted to, an adult ward or in a local authority other than the local authority in which the patient was ordinarily resident; and
(b) the detention or admission is of more than 24 consecutive hours' duration, the managers of the hospital must notify the regulatory authority immediately, setting out why they consider that the requirements under subsection (1A) above are met and providing the information set out in subsection (3A).
(3C) Subsection (3D) applies when—
(a) the managers of a hospital accommodate a patient to whom this section applies in an adult ward for a consecutive period of at least 28 days; or
(b) detain or admit a patient to whom this section applies who—
(i) was ordinarily resident immediately before being detained or admitted in the area of a local authority other than the local authority within whose area the hospital is situated, or
(ii) was not ordinarily resident within the area of any local authority.
(3D) Where this subsection applies, the managers of the hospital must immediately inform the appropriate officer of the responsible local authority—
(a) of the patient's detention or admission, and
(b) when the patient's detention or admission ceases.’
(4) Leave out subsection (4) and insert—
‘(4) In this section—
(a) “adult ward” means a ward in a hospital to which persons aged 18 or over are detained in or admitted to;
(b) “the appropriate officer” means—
(i) in relation to a local authority in England, their director of children's services, and
(ii) in relation to a local authority in Wales, their director of social services;
(c) “hospital” includes a registered establishment; and
(d) “the responsible authority” means—
(i) the local authority appearing to the managers of the hospital to be the authority within whose area the child was ordinarily resident immediately before being detained or admitted, or
(ii) where it appears to the managers of the hospital that the patient was not ordinarily resident within the area of any local authority, the local authority within whose area the hospital is situated.’”
This new clause seeks to ensure that children are only placed on adult wards where there are exceptional circumstances, and it is in their best interests. It includes procedural safeguards for determining the reasons behind (and suitability of) admitting a child to a hospital environment in which adults are simultaneously accommodated or in an out of area placement, along with notification requirements.
New clause 30—Application in respect of patient already on hospital grounds—
“(1) Section 5 of the Mental Health Act 1983 (Application in respect of patient already in hospital) is amended as follows.
(2) In subsection (1), after ‘or,’ insert ‘that the patient has attended a hospital or been brought to a hospital to seek help or admission as a patient or,’.
(3) After subsection (2), insert—
‘(2A) If, in the case of a patient who—
(a) is an outpatient in hospital; or
(b) has attended hospital to seek treatment as an outpatient; or
(c) has attended hospital to seek admission as an inpatient,
it appears to the registered medical practitioner assessing the patient that an application ought to be made under this Part of this Act for the admission of the patient to hospital, the registered medical practitioner may furnish to the managers a report in writing to that effect; and in any such case the patient may be detained in the hospital for a period of 72 hours from the time when the report is so furnished.’
(4) In subsection (3), after ‘(2)’ insert ‘or (2A)’.”
This new clause would allow people who have attended or been brought to a hospital to seek help or admission as a patient to be detained for assessment under the Mental Health Act.
New clause 31—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 would require 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.
New clause 32—Mandatory Independent Care (Education) and Treatment Reviews for patients detained in long-term segregation—
“In the Mental Health Act 1983, after section 142D (inserted by section 52 of this Act) insert—
‘142E Mandatory Independent Care (Education) and Treatment Reviews for patients detained in long-term segregation
(1) A notification of any use of long-term segregation for a patient detained under this Act must be issued to the Care Quality Commission, the hospital’s Board of Directors and the relevant NHS Commissioner within 72 hours of the person being placed in long-term segregation.
(2) Upon receipt of a notification under subsection (1), the Care Quality Commission must appoint a qualified professional to conduct an Independent Care (Education) and Treatment Review.
(3) The independent reviewer must—
(a) conduct a face-to-face assessment of the patient,
(b) consult with the patient’s family or carers, where appropriate,
(c) review the patient’s care and treatment plan, including the rationale for continued segregation, and
(d) assess whether alternatives, including ward or community-based alternatives, were considered prior to the implementation of long-term segregation.
(3) Where the assessment under subsection (3)(d) reveals that alternatives were not adequately considered, the independent reviewer may require the detaining organisation to—
(a) provide justification for this omission, and
(b) outline steps to ensure that alternative options are considered in future cases.
(4) The independent reviewer has authority equivalent to a second opinion appointed doctor to—
(a) confirm the appropriateness of the long-term segregation,
(b) recommend amendments to the treatment plan, and
(c) require alternative interventions if long-term segregation is deemed inappropriate.’”
This new clause requires independently chaired reviews for any person detained in long-term segregation, in line with the recommendations of Baroness Hollins’ report on solitary confinement for people with autism and learning disabilities.
New clause 33—Mandatory Independent Care (Education) and Treatment Reviews for patients with autism or learning disability detained for more than 5 years—
“In the Mental Health Act 1983, after section 142D (inserted by section 52 of this Act) insert—
‘142E Mandatory Independent Care (Education) and Treatment Reviews for patients with autism or learning disability detained for more than 5 years
(1) Where a person with autism or a learning disability has been subject to compulsory detention under this Act, including by virtue of a community treatment order, for a continuous period of 5 years or more, the Care Quality Commission must appoint a qualified professional to conduct an Independent Care (Education) and Treatment Review (ICETR) of that person’s care and treatment.
(2) The independent reviewer must—
(a) conduct a face-to-face assessment of the patient,
(b) consult with the patient’s family or carers, where appropriate,
(c) review the patient’s care, education (where applicable), and treatment plan, including the rationale for continued detention or the continuation of a community treatment order, and
(d) assess whether alternatives to continued compulsory detention, including community-based or less restrictive options, have been adequately considered.
(3) The Care Quality Commission must ensure that a further ICETR is conducted at intervals of not more than 12 months for so long as the person remains subject to compulsory detention under this Act or to a community treatment order.
(4) Where the assessment under subsection (2)(d) reveals that alternatives to continued detention or community treatment were not adequately considered, the independent reviewer may require the detaining organisation or responsible commissioner to—
(a) provide justification for this omission, and
(b) outline steps to ensure that alternative options are fully considered in future reviews.’”
This new clause provides for a new process with independently chaired reviews for any patient with autism or a learning disability subject to detention or community treatment orders for long periods of time.
New clause 34—Grounds for detention—
“(1) The Mental Health Act 1983 is amended as follows.
(2) In section 2 (admission for assessment), in subsection (2)—
(a) omit the ‘and’ at the end of paragraph (a);
(b) for paragraph (b) substitute—
‘(b) there is a risk of serious harm to the health or safety of the patient or of another person; and
(c) given the nature or degree of the harm, the patient ought to be so detained.’
(3) In section 3 (admission for treatment)—
(a) in subsection (2), for paragraphs (c) and (d) substitute—
‘(b) there is a risk of serious harm to the health or safety of the patient or of another person unless the patient is so detained,
(c) it is necessary, given the nature or degree of the harm, for the patient to receive medical treatment,
(d) the necessary treatment cannot be provided unless the patient is detained under this Act, and
(e) appropriate medical treatment is available for the patient.’
(b) in subsection (3)—
(i) in paragraph (a), for ‘(d)’ substitute ‘(e)’;
(ii) in paragraph (b), for ‘(c)’ substitute ‘(b) to (d)’
(4) In section 5(4) (detention for six hours pending application for admission), for paragraph (a) (but not the ‘and’ at the end) substitute—
‘(a) that there is a risk of serious harm to the health or safety of the patient or of another person unless the patient is immediately restrained from leaving the hospital;’
(5) In section 20 (renewal of authority for detention of patient detained in pursuance of application for admission for treatment etc), in subsection (4), for paragraphs (c) and (d) substitute—
‘(b) there is a risk of serious harm to the health or safety of the patient or of another person unless the patient receives medical treatment,
(c) it is necessary, given the nature or degree of the harm, for the patient to receive medical treatment,
(d) the necessary treatment cannot be provided unless the patient continues to be liable to be detained, and
(e) appropriate medical treatment is available for the patient.’
(6) The amendment made by subsection (5), so far as relating to persons who are liable to be detained by virtue of Part 3 of the Mental Health Act 1983, applies in relation to such a person whether the person became so liable before or after the coming into force of this section.”
This new clause is intended to replace Clause 5 (see Amendment 43). It would remove from the criteria for detention any reference to ‘likelihood’ or ‘may be caused’, replacing those words with language related to an individual’s risk, in order to simplify a psychiatrist’s assessment of a patient’s levels of risk.
New clause 35—Community treatment order: conditions—
“(1) Section 17B of the Mental Health Act 1983 (Conditions) is amended as follows.
(2) After subsection (7) insert—
‘(8) The responsible clinician must ensure that a community treatment order complies with the code of practice as set out in section 118(2B) of this Act.
(9) A community treatment order has a maximum duration of 12 months, unless the conditions set out in subsection (10) apply.
(10) The responsible clinician may extend the duration of a community treatment order beyond 12 months only after the responsible clinician has—
(a) consulted the patient, the patient’s nominated persons, and any relevant mental healthcare professional involved in the patient’s treatment or care planning;
(b) undertaken a review to evaluate the ongoing necessity and therapeutic benefit of the community treatment order; and
(c) consulted a General Medical Council registered psychiatrist regarding the conditions of the community treatment order and obtaining their written agreement that an extension is necessary and in accordance with the principles set out in section118(2B).
(11) A tribunal may recommend that the responsible clinician consider whether to extend, vary, or terminate the duration and conditions of a community treatment order.
(12) A community treatment order with a duration of less than 12 months is not subject to the conditions set out in subsection (10).
(13) Where a community treatment order is extended beyond a period of 12 months, the order must be reviewed at intervals not exceeding six months from the date of the extension, in accordance with the requirements set out in subsection (10).
(14) At the conclusion of the initial 12 month period or of any extended period, the responsible clinician must undertake a review to assess the effectiveness of the community treatment order at complying with the code of practice set out in section 118(2B) of this Act.’”
This new clause would set out conditions for the extension of a community treatment order beyond 12 months, and would require such an order to comply with the Mental Health Act’s code of practice.
New clause 36—Age appropriate treatment for children—
“(1) Section 131A of the Mental Health Act 1983 is amended as follows.
(2) After subsection (1), insert—
‘(1A) A patient to whom this section applies must not be detained in, or admitted to, an adult ward unless the managers of the hospital consider that—
(a) there are exceptional circumstances which justify the patient’s detention in, or admission to, an adult ward, and
(b) the decision is in accordance with the best interests of the child.’
(3) For subsection (3), substitute—
‘(3) For the purpose of deciding how to fulfil the duty under subsection (2) above, the managers must consult—
(a) someone with parental responsibility for the child, unless it is not deemed in the best interests of the patient for someone with parental responsibility to be consulted; and
(b) a person who appears to them to have knowledge or experience of cases involving patients who have not attained the age of 18 years which makes the person suitable to be consulted.’
(4) After subsection (3), insert—
‘(3A) Where a patient to whom this section applies has been detained in, or admitted to, an adult ward, the managers of the hospital must record in writing the reasons for the admission, including—
(a) the reason, or reasons, why other options for accommodation were not available or suitable for the patient;
(b) details of the measures to be taken by the hospital to ensure that, while the patient is detained or otherwise accommodated in the adult ward, the patient is provided with care in a safe environment; and
(c) unless it has been determined that an adult ward is the most appropriate environment for the patient in accordance with subsection (1A), the steps being taken by the hospital to transfer the patient to more appropriate accommodation.
(3B) Where a patient to whom this section applies is detained in, or admitted to, an adult ward, and the detention or admission is of more than 24 consecutive hours’ duration, the managers of the hospital must notify the regulatory authority and the responsible authority within 48 hours of the patient’s admission, setting out why the managers of the hospital consider that the requirements under subsection (1A) above are met and providing the information set out in subsection (3A).
(3C) Subsection (3E) applies when the managers of a hospital accommodate a patient to whom this section applies on an adult ward for a consecutive period of at least 28 days.
(3D) Subsection (3E) also applies where the managers of a hospital detain or admit a patient to whom this section applies who—
(a) was ordinarily resident immediately before being detained or admitted in the area of a local authority other than the local authority within whose area the hospital is situated, unless the hospital is less than 20 kilometres from the patient’s ordinary residence; or
(b) was not ordinarily resident within the area of any local authority.
(3E) Where this subsection applies, the managers of the hospital must inform the appropriate officer of the responsible local authority without delay—
(a) of the patient's detention or admission, and
(b) when the patient's detention or admission ceases.’
(5) Leave out subsection (4) and insert—
‘(4) In this section—
“adult ward” means a ward in a hospital to which persons aged 18 or over are detained in or admitted to
“the appropriate officer” means—
(a) in relation to a local authority in England, their director of children’s services, and
(b) in relation to a local authority in Wales, their director of social services;
“hospital” includes a registered establishment; and
“the responsible authority” means—
(a) the local authority appearing to the managers of the hospital to be the authority within whose area the child was ordinarily resident immediately before being detained or admitted, or
(b) where it appears to the managers of the hospital that the patient was not ordinarily resident within the area of any local authority, the local authority within whose area the hospital is situated.’”
This amendment would restrict the circumstances in which a child can be admitted to or detained on an adult ward for treatment under the Mental Health Act 1983, require the hospital to notify the local authority when they have done so, or when they have placed a child in a ward outside their local authority, and require that the parents or legal guardians of the child have access to their child and are consulted about their admission to an adult ward.
New clause 37—Roadmap for the provision of sufficient services for autistic people and people with a learning disability—
“(1) Within six months of the passing of this Act, the Secretary of State must prepare and lay before Parliament a roadmap to outline the Government’s plans for ensuring sufficient community services for autistic people and people with a learning disability to facilitate the operability of section 3 of this Act.
(2) When developing the roadmap under subsection (1), the Secretary of State must engage with relevant stakeholders, including—
(a) autistic people and people with a learning disability;
(b) carers for autistic people and people with a learning disability;
(c) health and care professionals; and
(d) advocacy groups.
(3) Within twelve months of the publication of a roadmap under subsection (1) above and annually thereafter, the Secretary of State must publish a monitoring statement on progress made towards implementing the roadmap, including its targets and milestones.”
This new clause would require the Government to publish a roadmap outlining its plans for ensuring sufficient community services to enable the implementation of the Act’s provisions on ending the detention of autistic people and people with a learning disability.
Amendment 33, clause 1, page 1, line 19, at end insert—
“(2BA) The Secretary of State shall ensure that each of the following matters is addressed—
(a) the provision of access to advocacy services for patients who have not attained the age of 18, including patients admitted to, or who remain in, hospital in pursuance of such arrangements as are mentioned in section 131(1);
(b) the assessment of ‘competence’ in relation to patients who have not attained the age of 16;
(c) the preparation of care and treatment plans for patients who have not attained the age of 18, including patients admitted to, or who remain in, hospital in pursuance of such arrangements as are mentioned in section 131(1);
(d) matters to be taken into account by an approved mental health professional when deciding who to appoint as a nominated person in circumstances in which the patient has not attained the age of 18 and paragraph 7 of Schedule 2 of this Act applies;
(e) steps to be taken by managers of the hospital when section 131A of this Act applies including—
(i) matters to be taken into account when determining whether the patient’s environment in hospital is suitable having regard to the patient’s age (including article 3(1) of the UN Convention on the Rights of the Child (‘the best interests of the child’));
(ii) measures to be taken in cases where a patient who has not attained the age of 18 has been admitted to an environment that provides care and treatment to patients who have attained the age of 18, including—
(A) safeguards to ensure that the patient is provided with care in a safe environment; and
(B) action to be taken to ensure that the patient is transferred to a more age-appropriate environment as soon as reasonably practicable;
(f) matters to be taken into account when determining whether a patient who has not attained the age of 18 should be admitted to a hospital for the purpose of treatment (or assessment, or assessment followed by treatment) of mental disorder which is located in an area falling outside the local authority in which the patient was ordinarily resident, or otherwise living in, prior to such detention or admission and the safeguards to be followed if the patient is so admitted;
(g) an explanation of the arrangements for the commissioning and provision of community and inpatient mental health services for those who have not attained the age of 18.”
This amendment inserts commitments related to children and young people which the Government made in the House of Lords into the section on principles to inform decisions on the Code of Practice.
Amendment 2, clause 4, page 4, line 41, at end insert—
“(iv) accommodation and relocation, and”.
This amendment ensures the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities.
Amendment 6, page 5, line 23, at end insert—
“(v) the patient,
(vi) the patient’s nominated person, and
(vii) the patient’s independent mental health advocate.”
This amendment would ensure that nominated persons and independent mental health advocates receive copy of a care, education, and treatment review meeting report for children and young people with autism or a learning disability.
Amendment 7, page 5, line 31, for “12” substitute “six”.
This amendment would shorten the length between care and treatment reviews from 12 months to six months.
Amendment 8, page 7, line 6, at end insert—
“(iii) housing, and”.
This amendment ensures that housing needs are considered as part of care and treatment review meetings.
Amendment 9, page 7, line 32, at end insert—
“(v) the patient,
(vi) the patient’s nominated person, and
(vii) the patient’s independent mental health advocate.”
This amendment ensures that nominated persons and independent mental health advocates receive a copy of a care and treatment review meeting report.
Amendment 10, page 7, line 40, for “12” substitute “six”.
This amendment would shorten the length between care and treatment reviews from 12 months to six months.
Amendment 11, page 8, line 12, leave out “must have regard to” and insert
“have a duty to carry out”.
This amendment ensures that integrated care boards and local authorities responsible for a patient's treatment and care have a duty to implement recommendations arising from a care and treatment review.
Amendment 12, page 8, line 27, at end insert—
“(ba) the person is under 18 years old and satisfies the conditions in (b)(ii).”
This amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.
Amendment 3, page 9, line 20, at end insert—
“(6) The risk factors specified in regulations under subsection (5) must include—
(a) homelessness;
(b) addiction;
(c) domestic abuse;
(d) miscarriage and traumatic birth;
(e) experience of armed conflict; and
(f) bereavement.”
This amendment would specify risk factors for detention for people on the register of people at risk of detention under Clause 4.
Amendment 36, page 9, line 20, at end insert—
“125DA Registers: reviews
(1) Each integrated care board must make arrangements for ensuring that care and treatment review meetings take place in relation to a person included in that board’s register under section 125D if either—
(a) the person consents to meetings taking place and to the disclosure of information in accordance with the arrangements, and to the use of the information in accordance with this Act, or
(b) the person lacks capacity to give that consent but the board considers that it is nonetheless in the person’s best interests for the meetings to take place, and information to be disclosed and used, as mentioned in subsection (a).
(2) In this section ‘care and treatment review meeting’ means a meeting, convened by the integrated care board, for the purpose of reviewing a person’s case in order to—
(a) identify any needs of the person for—
(i) social care provision,
(ii) medical treatment, or
(iii) financial support, and
(b) make recommendations about—
(i) whether and how any such needs can be met,
(ii) how the person’s safety can be ensured while they are at risk of detention, and
(iii) how to reduce any risk of the person being detained in a hospital or registered establishment.
(3) The arrangements under subsection (1) must include arrangements for—
(a) the preparation of a report (whether by the board or another person) setting out the needs identified, and recommendations made, at each meeting, and
(b) the provision of a copy of the report, within the period of 14 days beginning with the day on which a meeting takes place, to each of the following persons (other than any who prepared the report)—
(i) the responsible commissioner,
(ii) the person’s responsible clinician,
(iii) the integrated care board, and
(iv) the local authority in whose area the person is ordinarily resident.
(The arrangements may also include provision authorising or requiring a copy of the report to be given to other persons.)
(4) The integrated care board shall arrange appropriate provision within 28 days of receipt of a report under subsection (3) to address any needs identified and recommendations made.
(5) The arrangements under subsection (1) must include arrangements for ensuring that—
(a) the first meeting in relation to the person takes place within the period of 28 days from their inclusion in the register under section 125D, and
(b) a further meeting takes place at least once in each successive period of 24 months for which the person remains on the register, beginning with the day on which the first meeting takes place.
(6) A person may withdraw consent to the taking place of meetings and to the disclosure of information in accordance with arrangements under subsection (1).
(7) The arrangements under subsection (1) must include provision about—
(a) how consent to the taking place of meetings or the disclosure of information may be withdrawn;
(b) what is to happen when consent is withdrawn (which may include provision about who is to be informed).”
This amendment replicates the provisions for care and treatment reviews for patients under sections 125A and 125B but for people with autism and learning disabilities who are at risk of detention, in order to identify needs and ensure that those needs can be met without detaining them.
Amendment 37, page 9, line 26, after “125D(3)(c)” insert “and 125DA(3)”.
Amendment 13, page 9, line 29, at end insert—
“(c) seek to ensure that the needs of children and young people can be met without detaining them under Part 2 of this Act.”
This amendment extends the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.
Amendment 38, page 9, line 32, after “125D(3)(d)” insert “and 125DA(3)”.
Amendments 37 and 38 are consequential on amendment 36 and would ensure that integrated care boards and local authorities have regard to reports from care and treatment review meetings with people on their registers when commissioning services.
Amendment 24, page 9, line 38, at end insert—
“125ZF Crisis accommodation: duty to assess and provide
(1) In exercising its functions under section 125E, an integrated care board must assess the need for appropriate crisis accommodation for autistic people and people with a learning disability within its area.
(2) Where such need is identified under subsection (1), the integrated care board must ensure appropriate crisis accommodation is available, either—
(a) within its area, or
(b) through arrangements with other integrated care boards for regional provision.
(3) For the purposes of this section, ‘appropriate crisis accommodation’ means accommodation which—
(a) is designed to meet the specific needs of autistic people and people with learning disability during periods of acute mental health crisis;
(b) is staffed by persons with specialist training in supporting autistic people and people with learning disability;
(c) provides a safe alternative to detention under section 136 of this Act;
(d) is developed through co-production with autistic people and people with learning disability.
(4) The Secretary of State must issue guidance about the assessment of need and provision of crisis accommodation under this section.”
This amendment requires ICBs to assess need and ensure provision of appropriate crisis accommodation, either locally or regionally, designed specifically for autistic people and people with learning disability in crisis.
Amendment 14, 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 25, page 10, line 5, at end insert—
“125FA Assessment: provision of services for autistic people and people with a 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 autistic people and people with 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 autistic people and people with 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) autistic people and people with 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 autistic people and people with learning disability at risk of detention and to prepare action plans to address any identified gaps.
Amendment 26, page 10, line 5, at end insert—
“125FA Report: services for autistic people and people with a 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 autistic people and people with a 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 autistic people and people with a learning disability; and
(d) progress made towards meeting the needs of autistic people and people with a learning disability without detaining them under Part 2 of this Act.
(2) In preparing the report, the Secretary of State must consult—
(a) autistic people and people with 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 autistic people and people with learning disability and on progress implementing the relevant provisions of the Act.
Amendment 28, 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 autistic people and people with 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 autistic people and people with 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 autistic people and people with learning disability in mental health settings and require that training be co-produced with people with lived experience and their families.
Amendment 43, page 11, line 15, leave out clause 5.
Amendment 44, clause 6, page 12, leave out lines 26 to 29 and insert—
“(b) there is a risk of serious harm to the health or safety of the patient or of another person unless the patient receives medical treatment,”.
This amendment is linked to NC34
Amendment 45, page 12, line 29, for “degree and likelihood” substitute “or degree”.
This amendment is linked to NC34
Amendment 15, page 12, line 40, 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.
Amendment 16, clause 8, page 14, line 13, after “treatment” insert
“including the setting in which treatment takes place,”.
This amendment ensures that the definition of appropriate medical treatment includes the setting in which treatment takes place.
Amendment 17, clause 18, page 26, line 22, at end insert—
“(1A) Regulations under subsection (1) may only be made to provide for circumstances where—
(a) the treatment is immediately necessary to save the patient’s life,
(b) obtaining a second opinion would cause a delay that places the patient at a significant and imminent risk of death or serious physical harm, and
(c) the treatment is reversible.”
The amendment limits the power to dispense with a second medical opinion for urgent electro-convulsive therapy to exceptional, life-threatening cases, introduces periodic reviews of its use, and ensures transparency by prohibiting retrospective application.
Amendment 4, clause 21, page 29, line 28, at end insert—
“(ab) containing steps to alleviate social and financial stressors contributing to the patient’s risk of requiring detention in future; and”.
This amendment would require social and financial stressors be addressed in care and treatment plans.
Amendment 40, page 29, line 30, at end insert—
“(c) containing an assessment of the levels of risk to public safety posed by the patient in the community.”
This amendment would require consideration to be given to public safety in care and treatment plans.
Amendment 18, page 29, line 39, at end insert—
“(iii) the discussion of the person’s finances and financial situation.”
This amendment ensures that the care and treatment plan includes matters relating to the patient’s financial circumstances.
Amendment 1, page 29, line 41, at end insert—
“(4A) For the purposes of preparing a plan under this section, a discharge planning meeting must be held.
(4B) A meeting under subsection (4A) must include—
(a) the patient;
(b) the patient’s nominated person;
(c) any independent mental health advocate acting for the patient;
(d) a representative of the integrated care board;
(e) a local housing officer;
(f) a local authority social worker;
(g) a representative from the Department for Work and Pensions; and
(h) any other person or agency involved in the patient’s care or likely to support recovery in the community.
(4C) A care and treatment plan under this section must include—
(a) actions agreed by relevant agencies to support the patient’s recovery;
(b) provisions to address clinical, financial, housing, and social needs;
(c) steps to reduce the likelihood of readmission or further detention under this Act; and
(d) a record of any points of disagreement and how they are to be resolved.
(4D) Where an agency listed under subsection (4B) fails to attend a discharge planning meeting, the responsible clinician must take reasonable steps to obtain their input in writing and record it in the plan.
(4E) For the purposes of subsections (4A) to (4D), the Secretary of State must issue guidance on best practice for discharge planning meetings and multi-agency collaboration.”
This amendment would require the clinician preparing a care and treatment plan to hold a multi-agency planning meeting to inform it, and specifies what must be included within the plan.
Amendment 19, page 29, line 41, at end insert—
“(4A) The information authorised or required to be included in, or attached to, a care and treatment plan by virtue of regulations under subsection (3) must include provision to protect the patient's housing and accommodation during and immediately after they are subject to a care and treatment plan.”
This amendment ensures that protection of housing and accommodation are considered as part of care and treatment plans.
Amendment 20, page 30, line 26, at end insert—
“(g) following the patient turning 18 years of age during the course of a care and treatment plan.”
This amendment ensures that individuals turning 18 during a care and treatment plan have their plans reviewed to maintain continuity of care while transitioning from child to adult services.
Amendment 39, page 30, line 26, at end insert—
“(vii) for a relevant patient who has not yet reached the age of 18, the parents or legal guardians of the relevant patient, unless that is not deemed in the best interests of the patient.
(5A) Any care plan prepared under this section, if prepared for a relevant patient who has not yet reached the age of 18, must include provision for the parents or legal guardians of the patient to be directly involved in the care and treatment of the relevant patient, unless such involvement is not in the best interests of the patient.
(5B) For the purposes of subsection (5A), the parents or legal guardians must be given regular access to the relevant patient through attendance on the hospital ward.”
This amendment would require a practitioner to consult the parents or legal guardians of a child patient when preparing the patient’s care and treatment plan, require parental involvement in patient care through the plan, and enable those parents (or guardians) regular access to the patient on the hospital ward.
Amendment 27, page 29, line 41, at end insert—
“(4A) Where a patient has autism or a learning disability, the care and treatment plan must—
(a) identify specific crisis prevention strategies appropriate to the patient's individual needs;
(b) identify suitable crisis accommodation options in the event that the patient's current placement becomes unable to meet their needs;
(c) specify how the patient's sensory needs will be met;
(d) specify communication approaches appropriate to the patient's needs; and
(e) record the views of the patient’s family members or carers, where appropriate and with the patient's consent.”
This amendment would ensure that care and treatment plans for patients with autism or learning disabilities include specific components addressing their particular needs, including crisis prevention strategies and identification of suitable crisis accommodation options.
Amendment 22, clause 45, page 56, line 37, at end insert—
“(5A) An ‘advance choice document’ under subsection (5) should include consideration of the person’s financial circumstances.”
This amendment ensures that the advance choice document includes matters relating to the patient’s financial circumstances.
Amendment 32, page 58, line 2, at end insert—
“(2A) After subsection (3), insert—
‘(3ZA) After-care provision under subsection (3) above may include, for patients who have not yet reached the age of 16, appropriate Early Help services in the community.’”
This amendment would ensure that, when a tribunal is discharging a child who has experienced a mental health crisis, the tribunal may recommend that they are referred to appropriate Early Help services as part of their after-care planning.
Amendment 29, clause 46, page 59, line 10, at end insert—
“(4) After subsection (6), insert—
‘(6A) After-care services under this section may include provision for authorised community pharmacies to dispense emergency and ongoing medication in line with after-care plans.
(6B) Community pharmacies providing services under subsection (6A) must be—
(a) given access to suitable training and resources;
(b) integrated into the local primary care team, with appropriate access to prescribing professionals and multidisciplinary support; and
(c) given appropriate remuneration and reimbursement for providing after-care services.
(6C) Responsible bodies must carry out due diligence of any pharmacy operator before authorising them to provide after-care services under this section.
(6D) Due diligence checks under subsection (6C) must include ensuring that—
(a) the operator is not in significant arrears in respect of staff wages, supplier payments or other financial obligations;
(b) the operator can demonstrate the financial capacity to sustain additional locations without compromising existing services; and
(c) the operator has an established record of compliance with relevant regulatory and contractual requirements.
(6E) Where due diligence checks under subsections (6C) and (6D) determine that a pharmacy operator is failing in its existing financial obligations, the pharmacy operator must not be authorised to take on new after-care service locations.’”
This amendment would allow community pharmacies to be reimbursed for dispensing medication under the aftercare provisions of the Mental Health Act 1983, and would ensure that they have access to relevant training, that they are integrated into the primary care team, and that the responsible body carries out due diligence checks on their financial health.
Amendment 30, page 59, line 10, at end insert—
“(4) After subsection (6), insert—
‘(6A) After-care services provided under this section must include the availability of family support workers.’”
This amendment would require the provision of family support workers as part of the after-care provisions under the Mental Health Act 1983.
Amendment 31, page 59, line 10, at end insert—
“(4) After subsection (6), insert—
‘(6A) When determining the adequacy of after-care services for a specific patient, responsible bodies must take into account—
(a) whether the patient lives in a rural or urban area;
(b) associated travel times between the patient’s residence and after-care services;
(c) the patient’s levels of contact with others in their community; and
(d) the views of local transport authorities and operators and relevant community transport or volunteer groups on levels of accessibility to after-care services.
(6B) The responsible body must ensure the provision of outreach or visiting services to isolated individuals eligible for after-care under this section, including to those in remote or agricultural areas.’”
This amendment would ensure that the needs of individuals living in rural areas are accounted for when providing after-care services under the Mental Health Act 1983, and that local transport operators are consulted on how easy it is to access these services.
Government amendments 34 and 35.
Amendment 41, schedule 2, page 77, line 21, at end insert—
“(3) Where the patient has not yet reached the age of 16 (the ‘child patient’), the nominated person must be a person with parental responsibility for the child patient, unless the factors set out in sub-paragraph (4) below apply.
(4) A person who has parental responsibility for a patient under the age of 16 (‘the parent’) must not be the nominated person if—
(a) the parent is subject to a prohibited steps order under section 8 of the Children Act 1989;
(b) a local authority is taking action under section 47(8) of the Children Act 1989 to safeguard the child patient or otherwise protect the child patient’s welfare due to concerns about the parent; or
(c) the local authority has made enquiries under section 47(1) of the Children Act 1989 and concluded that the child patient is suffering, or is likely to suffer, harm at the hands of the parent (within the meaning of section 31(9) and (10) of that Act).”
This amendment would stipulate that the nominated person for a patient under the age of 16 must have parental responsibility for the patient, unless there are safeguarding concerns.
Amendment 42, page 80, line 13, after “2(2))” insert
“, has parental responsibility for the patient, subject to conditions (see paragraphs 2(3) and 2(4)),”.
This amendment is connected to Amendment 41; it would stipulate that the nominated person for a patient under 16 must have parental responsibility for the patient, unless there are safeguarding concerns about that parent.
Amendment 5, page 86, line 38, at end insert—
“18A In section 130B (arrangements in relation to independent mental advocates: England), after subsection (3)(d), insert—
‘(e) support the patient’s carer and family members to prepare for the patient’s discharge from hospital treatment, and
(f) support the patient to access help with social and financial stressors that might otherwise increase their likelihood of future detention.’”
This amendment extends the support offered by Mental Health advocates to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.
Amendment 23, schedule 3, page 90, line 32, after “patient” insert
“or English qualifying informal patient under 18”.
This amendment extends the provision of opt-out advocacy services in England to informal in-patients under 18.
Zöe Franklin
I am honoured to open today’s debate on Report and to have served in Committee, where it was clear that Members on both sides of the House shared a commitment to high-quality mental health care for those in crisis. I thank my colleagues who also served in Committee; it was an informative and moving discussion. It is that commitment to high-quality mental health care that underpins new clause 2. It addresses a critical issue: the inconsistency and inadequacy of care in mental health units across England.
I am sure we have all heard distressing accounts of vulnerable individuals being placed in units that are understaffed, unsafe and ill equipped for recovery. Families entrust the system with their loved ones during moments of crisis, only to find that trust undermined—not by a lack of compassion, but by a lack of national direction. New clause 2 seeks to change that by establishing a national strategy and annual reporting to ensure that every mental health unit is safe, well-staffed and fit for purpose.
In my Guildford constituency, a family recently shared with me their experience of a loved one’s stay in a mental health facility. The unit was understaffed from the outset and wards were mixed in age and illness, with little therapeutic structure. There was no clear advocate or caseworker, and the family did not know whom to contact. They described a system that, in their words,
“dishes out drugs without improving mental health or wellbeing.”
The setting was so short-staffed that their loved one was able to self-harm—an unacceptable failure in any care setting. New clause 2 aims to prevent such failures from recurring.
The Care Quality Commission has repeatedly raised concerns about the safety of mental health wards, citing staff shortages, poor infrastructure and environments that are unfit for therapeutic care. In 2023, the King’s Fund reported that 40% of NHS mental health providers were rated “requires improvement” or “inadequate” on safety—figures that would be intolerable elsewhere in the health system. The Health Services Safety Investigations Body has identified systematic risks in in-patient mental health care, including delayed responses to distress, inappropriate use of restraint and a lack of therapeutic staffing models. Perhaps most starkly, the British Medical Journal reported over 17,000 serious incidents in mental health services between April 2022 and March 2023. Each one was a moment when care went seriously wrong. These are not just statistics; they represent real people who deserve better.
New clause 2 would require the Secretary of State to publish a national strategy within 12 months to ensure that all mental health units meet or exceed “good” safety standards under the CQC framework, and to report annually to Parliament. It focuses on three key areas: recruitment, retention and training of staff; safe staffing levels and patient-to-staff ratios, especially during nights and peak times; and ongoing accountability through public reporting. The new clause would make patient safety a national obligation, not a postcode lottery. It is about responsibility and transparency.
Although the Bill modernises detention criteria and patients’ rights, it does not explicitly require the Secretary of State to guarantee basic safety and staffing standards, and new clause 2 would fill that gap. Some may worry that it would be too prescriptive or add bureaucracy, but it would not replace local management; it would support it. It would build on the CQC’s role by ensuring that action is taken when failings persist, and it would turn inspection findings into a driver of national improvement.
On cost, unsafe care is already expensive. It leads to readmissions, litigation, staff burnout and the loss of public trust. A national strategy would allow for smarter investment, preventing failures rather than paying for them later. We have had decades of guidance and reviews, but what we have not had is statutory accountability. My new clause would deliver that.
New clause 2 is focused, deliverable and urgently needed. It complements the Bill by ensuring that the rights it enshrines are backed by safe, well-staffed and properly regulated environments. Without it, we risk legislating for rights in theory while leaving patients unsafe in practice. By supporting it, we affirm that mental health care deserves the same national standards as any other branch of healthcare. I urge Members to support new clause 2 and make safety, dignity and accountability a permanent part of our mental health law, and I look forward to the debate in this House today.
Lewis Atkinson (Sunderland Central) (Lab)
Many Sunderland families, including mine, share stories of Cherry Knowle, the Sunderland borough asylum in my constituency, which opened in 1895. Severe mental illness has always been a feature of society. Thankfully, the legislative framework and services have developed somewhat since 1895, but arguably they have not developed fast enough, particularly over the 42 years since the Mental Health Act 1983 was passed. At the start of my NHS career, I spent time shadowing staff on the wards of the then Cherry Knowle, which in 2014 was replaced by a much better facility in Hopewood Park in Ryhope in my constituency. To this day, 2,825 adults are detained under the Mental Health Act in Sunderland Central as a result of that facility.
Sojan Joseph (Ashford) (Lab)
Similarly, a community service called Mental Health Together has been introduced in my area. Does my hon. Friend agree that the whole mental health system is so complex, with different practices in different parts of the country, and that not having continuity and a standard across the country is a big issue for mental health?
Lewis Atkinson
My hon. Friend is absolutely right and I thank him for his intervention. Part of the issue around poorly reported waiting times is that it is less easy to see that differential access than it would perhaps be in physical health services. Indeed, over the years when specialist teams have been set up—for example the early intervention and psychosis teams and assertive outreach teams, which I know my hon. Friend knows well given his professional background—they have been introduced with very good intentions and to target specific needs, but they sometimes make it more difficult for patients to get overall care rather than very specialist care for individual conditions.
I will not take any more time, Madam Deputy Speaker, but I will just say that the mantra of investment and reform applies to mental health services, as it should apply to all our health services. For us to make further progress in pursuing parity of esteem between mental health and physical health, we not only need to consider these amendments today and pass the Bill to modernise the legislation, but ensure the Government have sufficient political priority on producing and improving mental health services.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Members will have noticed that many people are standing to speak and there is not a significant amount of time for the debate, so with the exception of Front-Bench contributions, there will be an immediate four-minute time limit. I call the shadow Minister.
Dr Luke Evans (Hinckley and Bosworth) (Con)
When we last debated the Bill on Second Reading, I said that protecting someone’s freedom for their own safety is not a licence to own their life, but a duty to help them find it again. That principle still guides us today, because good intentions alone do not mend a troubled system. Compassion without competence is not care; it is sentiment without substance.
On Second Reading, I spoke of bridges and rough roads, and of how resilience and recovery depend on the strength of the structures that carry people through their hardest times. Tonight, we return to that bridge. The question before us is not whether we believe in reform—after all, there is cross-party agreement on that—but whether the Government have built the foundations to make it stand. Warm words are plentiful, but the reality is that too many people are still falling through the gaps: detentions are still present, community services are stretched, and families are left navigating a maze of bureaucracy while waiting for help that may never come.
We all know that reform cannot be delivered on aspiration alone. It requires a delivery plan, a workforce and a system capable of learning from its own mistakes. We know the chapter on delivery is missing from the 10-year NHS plan and there is further risk tonight that we miss another opportunity. After all, the principles in the Bill are the right ones. They are even on the face of the Bill—choice and autonomy, least restriction, therapeutic benefit, and treating the person as an individual—but those principles need power behind them and that power lies in delivery.
This Report stage is our chance to turn those words into commitments. New clause 31 requires the Government to publish a fully costed delivery plan within 18 months of the Act passing into law, setting out how integrated care boards and local authorities will deliver adequate community services. Crucially, the plan must be developed through consultation with those who know best. That is vital, because although we support the many aims of the Bill, the Government already have a pretty dismal record of announcing reforms without any credible plan to deliver them.
Let us take the ongoing NHS reorganisation. In March, Ministers made a surprise announcement of the abolition of NHS England and its absorption into the Department of Health and Social Care, yet six months on they cannot say what it will cost, how many staff will be lost or how it will be paid for. The Health Service Journal reports growing confusion inside the system and warnings from NHS leaders that the lack of clarity risks paralysing decision making. Written questions to the Government simply receive the answer
“some upfront cost in the millions”
yet independent estimates say the cost is over £1 billion. Even the chief executive, Sir Jim Mackey, points out that the Treasury must agree funding for integrated care board redundancies within weeks or the NHS will have to turn to a plan B.
The same chaos is playing out across integrated care boards, with local leaders warning that there is already destabilisation due to the 50% reductions. If Ministers cannot manage their own top-down reorganisation, why should anyone believe they can deliver a more ambitious overhaul of mental health services without a clear costed plan, especially when waiting lists have risen in the last three consecutive months?
This Labour Government have already cut the proportion of spending on mental health. As Dr Lade Smith CBE, the president of the Royal College of Psychiatrists, said at the time:
“It is illogical that the share of NHS funding for mental health services is being reduced at a time of soaring need and significant staff shortages.”
Going on, she said that:
“The proportion of NHS funding allocated to mental health services will decrease”,
which will
“equate to these vital services missing out on an estimated £300 million or more that they would have received if their share…had been maintained.”
Layla Moran (Oxford West and Abingdon) (LD)
It is a decrease in the proportion of the mental health investment standard for the first time in, I believe, nine years. It is incredibly concerning. It was hard-won, cross-party support that made that proportion go up over time. It was incremental, but it was starting to make a difference to the system. Does the hon. Gentleman agree that it would be helpful if the Government clarified whether that will continue in 2025-26? When Baroness Merron came to our Committee, she could not confirm that. If there is not going to be a continuation, the system needs to know by now, frankly, so that it can prepare adequately for it.
Dr Evans
The Chair of the Health and Social Care Committee is absolutely right. A simple answer from the Minister today, on Report, would go a long way to alleviating those fears from the mental health sector. I look forward to his response on that.
Amendment 40 would add a simple but important requirement that each care and treatment plan must include an assessment of the levels of risk to public safety posed by the patient in the community. The purpose of the Bill is right; the Government want to make the system more compassionate, therapeutic, patient-centred and modernised, and we strongly agree with that ambition. However, modernisation must go hand in hand with public confidence, and the public and patients themselves must know that every plan for treatment and discharge is rooted not only in care, but in safety.
In Committee, I argued that the framework still omits one dimension, which is public safety. As far as I can see, there is still no explicit requirement in the Bill for clinicians to assess and record the level of risk posed to the public.
Joy Morrissey (Beaconsfield) (Con)
My hon. Friend is making an excellent point. Constituents have come to me about patients with schizophrenia, for example, who had been released before their psychosis had fully passed, with one such instance tragically ending in the death of another resident. All of these situations could have been prevented if the patient had been kept safely in a bed until they were at a proper level of medication and the psychosis had passed. Does the shadow Minister agree that that is something we need to take forward in this Bill? It is a win-win for all parties.
Dr Evans
I thank my hon. Friend for raising that tragic case. Those are the kind of cases that this amendment seeks to deal with. We have only to look at the tragic cases of Nicola Edgington and Valdo Calocane to see how escalating risk happens, with huge consequences for the families, patients and victims.
When I raised this matter in Committee, the Minister gave a very thoughtful answer. He said that:
“if any risk at all to public safety is perceived, that must be documented… It is a basic expectation of the professional management of a particular patient that any risk identified to public safety and protection must be in there.”
I welcome that.
With amendment 40, I am simply asking, if that is indeed the Government’s position, why not make it clear in the Bill? The Minister conceded in Committee that
“I take the hon. Gentleman’s point on whether or not it should be in the Bill. I will come back to him on that, because I would be rather surprised if it were not made very clear somewhere that that is a basic expectation; if it were not, that would obviously need to be looked at, but I am reasonably confident that it is.” ––[Official Report, Mental Health Public Bill Committee, 12 June 2025; c. 171.]
Unfortunately, expected in practice is not the same as required in law. We know from past reviews that there is a gap in the risk assessment and that communication can be too inconsistent. Putting such a requirement in statute would not be bureaucracy; it would simply clarify that. The Minister may argue that it already exists in professional codes, in the Mental Health Act code of practice or even in risk management frameworks, but the statutory duty does not. Our amendment would put that duty squarely in the Bill.
Talking of safety, I will turn to new clause 29, which would ensure that no child is placed on an adult mental health ward except in truly exceptional circumstances, and only when it is demonstrably in their best interests. The Government argue that guidance already covers that, but this guidance has no teeth; it can be ignored or inconsistently applied. Again, guidance without legal backing is too easily ignored. That was why the Joint Committee on Human Rights argued in its letter that this part of the Bill needs strengthening. The Minister also said that placing these safeguards in legislation would remove flexibility for clinicians in emergencies, but new clause 29 does allow for exceptional circumstances; it simply requires that they are justified, recorded and subject to oversight.
Research from University College London found that there has been a 65% increase in the number of children and young people admitted to adult wards for mental health disorders, and this increase is sharpest among teenage girls with eating disorders. They are the most vulnerable, and they are the ones who bear the brunt of this.
Joy Morrissey
That is another reason why I am shocked that the mental health budget is decreasing. I am seeing an increase across my constituency—and I am sure it is the same in many others—of girls in secondary school presenting with severe mental health issues, suicidal tendencies and eating disorders, and they are desperately crying out for additional mental health support.
Dr Evans
My hon. Friend is absolutely right that that support needs to be there. Fortunately, it is not the budget that is reducing but the proportion of funding, and it shows the priorities of this Government when it comes to mental health.
I am concerned that without new clause 29, a child may be harmed or traumatised and placed in an adult ward without proper justification—and it will be little comfort for the family to hear that guidance was breached.
Amendment 41 stands up for the simple but vital principle that when a child is detained under the Mental Health Act, the person legally recognised to act for them—their nominated person—should hold parental responsibility. Only where there are legitimate safeguarding concerns should that be set aside. At first glance, this may seem technical, but it speaks to something profound about how the law views childhood, family and the balance between protection and autonomy.
The Government are right to use the Bill to modernise the old “nearest relative” system, which was too rigid, too bound by bloodline and at times blind to the complexities of family life. Under the Bill, however, a child under 16 deemed competent could nominate any adult—that could be a 19-year-old boyfriend or peer or someone exercising control—and once nominated, that person gets full control. It is a legal authority. We need to ensure that protection is there for the person if there is a breakdown on the family side. [Interruption.] I see that Madam Deputy Speaker is encouraging me to wind up, so I will solidify my comments into a more erudite approach.
The point is that in law this principle is already clear in the Children Act 1989, which defined it as the foundation stone of what families should look like. With this amendment, I believe we have solved the concerns the Minister had at Committee stage about the state of a family in the modern era. In any other walk of life the legal framework exists, so why would we weaken it when it comes to mental health?
We discussed the issues with A&E and the grey area there in Committee, and I was grateful to the Minister for meeting beforehand to discuss them. I know that he took on my comments about solving the practicalities, and I hope he will look at them seriously.
For this House, there is no greater moral burden than deciding for someone who cannot decide for themselves—where care ends and where control begins. That is exactly what the House is addressing with this Bill: how to protect without diminishing, how to act with compassion without surrendering precision, and how to empower without imposing. Involuntary care must never be the reflex of a system, be it under pressure or out of principle. The House agrees on this position; the challenge is delivery. Compassion demands more than good intentions. It demands delivery, discipline and detail. With this Bill, the Opposition lays the challenge of delivery. It must be not just a pledge but a plan. The public will judge us all not just on how kindly this House speaks, but on how faithfully it serves those who depend on us most.
Mr Richard Quigley (Isle of Wight West) (Lab)
I will speak to new clauses 28 and 36 and amendment 39, which I tabled not just as an MP but as a father. After what my family have been through, I believe that any parent would do the same.
Yesterday, alongside the right hon. Member for Salisbury (John Glen), I had the privilege of hearing Dr Kate Szymankiewicz speak about her daughter Ruth. She shared not only the tragic circumstances of Ruth’s death but the type of person Ruth was: her dream of becoming a vet, her kindness, and how friends described her as a character straight out of an Enid Blyton novel. That is the Ruth her family remember and cherish. As parents, we became part of a world we never wanted to know. I am privileged to have met Kate, but we agreed that we wished our paths had never crossed because of what that meant.
Ruth was admitted to an in-patient facility for treatment of an eating disorder, but instead of receiving the care she needed, her family were shut out and allowed only two two-hour visits per week. They spent more time travelling than they did with their daughter. Ruth was just 14 years old when she fatally self-harmed, just five months into her stay.
Three months from that date, my family were faced with the same hospital, Huntercombe, as the only choice of a bed for our daughter. At that same hospital, when a child asked if they could have an extra type of jam for breakfast in the morning, they were told it did not have the budget, and when asked why Minstrels were no longer part of snack time, they were told that they were eating too many. That is the problem with NHS-funded private provision: even at £900 a night, the operators plead poverty.
My wife and I have two vivid memories of our youngest being prised from us without any warning. We thought that was normal. Six months of nasogastric tube feeding—we thought that was normal. Illegal restraint so bad that it caused post-traumatic stress disorder—we thought that was normal. Forgetting to feed our daughter 11 times—we started to realise that that was normal, but not acceptable. Instead of wishing to improve its practice, the hospital has accused me of making this up.
If a child is facing any other physical illness such as cancer, or even something more short-term that requires a hospital stay, parental visits and involvement are quite rightly seen as a means of enhancing care. I genuinely struggle to understand why our clinical consensus around mental health continues to support a model where already vulnerable children are isolated from their parents—the very people who know and love them most. Children on these wards are treated as wilful—they are not; they are children—and without empathy or sympathy. Many consultants we encountered opted not to apply the National Institute for Health and Care Excellence guidelines. Staff were poorly trained and in fear of psychiatrists, who ruled the roost and prevented people from speaking up. The private equity firms are focused not on long-term treatment but just on turning mental health into money.
My amendments do not seek to undermine the Bill’s strengths, nor the important work undertaken by the Department. In fact, the cross-party support I have received, including from the right hon. Member for Salisbury, reflects how uncontroversial they are.
The Minister and I have had robust and constructive discussions on the matter, but I ask him to confirm that he will do everything in his power to ensure the following. Parents must not be shut out of their child’s care, as evidence shows that regular parental contact enhances care outcomes. The placement of children on adult mental health wards under the Mental Health Act must be limited strictly to exceptional circumstances, and practitioners must be actively compelled where appropriate to involve themselves in the development and delivery of a child’s care and treatment plan.
We have a duty to ensure that the tragic circumstances surrounding Ruth’s death are never repeated. The Government were elected with a phenomenal majority, winning places we never thought possible—including my own constituency of Isle of Wight West—on a platform of meaningful change. If we do not use this moment to do the right thing and acknowledge that children in mental health services need their parents more often than not, I fear that we may never get another chance.
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Dr Danny Chambers (Winchester) (LD)
I begin by thanking colleagues across the House who have worked so constructively on this long-awaited Bill. There has been a shared recognition that the current mental health system is failing too many people and that reform is urgently needed. I thank the Minister for engaging with us so constructively throughout the process, including as recently as yesterday; it is much appreciated.
When I speak to people in Winchester—I know that hon. Members have very similar stories—mental health is one of the issues that comes up the most. We have families waiting months or even years for treatment, we have parents watching their children deteriorate, and we have people languishing on waiting lists when they would rather be working or studying.
The Bill represents the biggest reform of mental health care in over 40 years. It strengthens patient autonomy, modernises detention procedures and rightly removes police stations from the definition of places of safety. These are vital and much needed steps forward and I know that Members on all sides welcome them.
I will speak briefly to several new clauses tabled in my name, each aimed at strengthening the Bill’s impact for some of the most vulnerable people it seeks to protect. New clause 26 would ensure that every hospital has a dedicated liaison service for the carers of patients detained under the Mental Health Act. This is a vital step to support carers during what can be an unimaginably difficult time and to close blind spots that too often exist when someone is caring for a loved one with serious mental illness.
We know that parental mental health concerns are now the most common factor in children’s social care assessments, and that those children are at much higher risk of developing mental ill health themselves. Yet only about a third of mental health professionals in in-patient settings ask whether a patient is a parent. These children and the carers who support them are too often invisible. By identifying and supporting carers properly, new clause 26 would help close those gaps and ensure that no family has to struggle in silence.
Dr Luke Evans
We did not discuss this specifically in Committee, but I would be interested to know about the interaction between the independent mental health advocates, which are being expanded and which we all agreed with in Committee, and a new liaison service. I worry about the duplication. Will the hon. Member explain how that crossover would work in practice?
Dr Chambers
That is a prescient point. At the moment, there is no responsibility to ensure that children in particular, and other carers too, are identified. Even if they are put in advance choice documents, if the person making those decisions does not identify them, that will not come about. We would have to be careful that there is not unnecessary duplication; however, the initiative the hon. Gentleman puts forward is not a belt-and-braces approach to identifying young carers and other carers who are struggling.
New clause 7 seeks to end the detention of children on adult wards, requiring the number to be reduced to zero within five years—other Members have discussed that today—and the Secretary of State to set out how that will be achieved. It simply cannot be right that children are still being treated on adult wards. It is unacceptable and can seriously hinder recovery and effective care.
Although the Bill rightly focuses on hospital-based treatment, the process has also laid bare how fragile our wider mental health services have become, with the lack of early support in primary and community care and the shortage of initiatives that help people long before they reach crisis point. That is why new clause 14 would place a duty on integrated care boards to ensure that community services have the resources they need to meet the demand and report on that regularly. Keeping people well in their communities must be at the heart of any modern mental health strategy, because if we get the community care right, we prevent crises, reduce pressure on hospitals and help people live healthier, more independent lives.
Finally, new clause 22 would establish a veterans’ mental health oversight officer. That dedicated role would ensure that those who have served our country receive the understanding and tailored care they deserve when they come into contact with mental health services. Too often, veterans experience mental ill health, sometimes linked to their service, and they find themselves in systems that do not fully recognise their unique experiences. The proposal would help change that by providing proper oversight; encouraging joined-up working across the NHS, veterans’ services and the third sector; and ensuring that compassion and accountability sit at the heart of how the Mental Health Act is applied to veterans.
Taken together, the proposals are about making our mental health system even more humane, more joined up, and more focused on prevention and recovery. I hope the Government will take them in the spirit in which they are intended, which is to strengthen this important Bill, which we very much support, and deliver a system that truly supports those who need it most.
Abtisam Mohamed (Sheffield Central) (Lab)
I will speak on new clause 35, which sets out the conditions under which community treatment orders can be extended beyond 12 months. Like many across my constituency of Sheffield Central, I know personally how overstretched our mental health services are. My brother lives with complex mental health needs and our family has seen at first hand the impact of a churning workforce, long waiting lists and a lack of community support services, brought about by an unrelenting crisis in funding.
Our system has not been properly expanded or adapted to meet the challenges. Instead, far too many people are detained and restricted, rather than supported to recover. We see this nowhere more acutely than in the overuse of community treatment orders, which were supposed to be a bridge from hospital to home for those who are constantly readmitted to hospital. People have described them as
“a tag that nobody can see, but you know it’s around your mind.”
The evidence shows that they have not met their intended purposes, with three major studies having found no reduction in readmissions or hospital time through their use. Yet despite the previous Government having promised reform, community treatment orders have continued. Reform has been too slow and too narrow in scope.
John Glen (Salisbury) (Con)
I rise to support new clauses 29, 28 and 39. First, I pay tribute to the hon. Member for Isle of Wight West (Mr Quigley), who mentioned my constituents and the tragic case of the loss of their daughter, Ruth. My experience of listening to her story has made me support the new clauses.
I want to finish my remarks with what Kate asked me to say in this House. Kate Szymankiewicz is a GP in Salisbury and her husband is a surgeon. Their daughter, Ruth, took her own life aged 14. She was unlawfully killed while in a child mental health facility—that is what actually happened. That is what was exposed in the court case this summer. What happened to Ruth was a tragedy. The system did not work as it was supposed to work. I am anxious today that the Minister should not rely on the advice and understandings of officials, or on the guidance that is in place. I ask that he is really assured in his own mind that the legislation he is going to take forward will mean that this will not happen again.
I will not go into the whole story but, essentially, Ruth was placed in a facility that was a two-hour drive from her home. She was not technically placed out of area, but the family would spend more time driving to see her than they would be allowed to actually spend with her. These are wonderful, loving parents who did everything they could—everything in their power—to support their daughter through a condition that she could and should have recovered from. But because she was sectioned under the Mental Health Act to allow her to be force fed, her parents technically lost many of their rights to involvement in their daughter’s care. They had a wonderful, loving relationship with their daughter. She was a happy child who was determined to get better, and her family were keen to see that that happened. She was sectioned only to allow her to be fed, but the knock-on consequence was that the dynamic between the parents and their daughter, who was a patient, changed as adult protocols were put in place.
When Kate visited Parliament yesterday, I asked her, “What would you like me to say on your behalf?” And she said this:
“If your child is unwell and must go into hospital, whether that is because of a physical illness such as cancer, or a mental health illness like an eating disorder, they need to know that their mum, or dad, or caregiver, can be there with them, whenever they need, to help them through a scary and vulnerable time.
Children cannot be treated in isolation. They need the support of those who love and know them best—their family. Families need to be at the heart of our health system in order for children to heal and for their families to heal with them.
When the next child is in crisis, which is right now, I ask you all not to turn away, but to grasp this opportunity to make the Mental Health Act a champion for their wellbeing. Please include all these…amendments to safeguard this generation of young people”.
Richard Baker (Glenrothes and Mid Fife) (Lab)
The Bill addresses fundamental flaws in our current mental health legislation in relation to the rights of people with learning disabilities and autistic people. I will focus my comments on new clauses 32 and 33, which I have tabled. They are also about vital rights within our mental health legislation and relate closely to the powerful comments made by the right hon. Member for Salisbury (John Glen) and by my hon. Friend the Member for Isle of Wight West (Mr Quigley).
New clause 32 would provide for mandatory independent care, education and treatment reviews for patients detained in long-term segregation. In her report, “My heart breaks”, Baroness Hollins highlighted the harms and sufferings that are so often associated with long-term segregation, and assessed how introducing care, education and treatment reviews can reduce the incidence and use of segregation. I very much welcome the provisions on reviews of care and treatment that Ministers have already included in the Bill, but it has now been demonstrated that independently-chaired reviews are making a real difference and lead to inappropriate long-term segregation being challenged and addressed. The human impacts are substantial. New clause 32 would make such reviews a requirement when someone has been placed in segregation for 72 hours.
New clause 33 seeks to introduce a new level of scrutiny in cases where patients with autism or learning disability have been detained for more than five years. I believe there is a very strong case for an additional check and balance when people have been under detention and compulsory measures for so many years. I understand that the latest data for England shows that 350 people with a learning disability or autism who are currently in in-patient units have been detained there for more than 10 years.
In a previous role, I provided advocacy for the family of a young man, Kyle, who has a learning disability. He is a patient in the State hospital in Carstairs in Scotland, but his family live in the north-east of Scotland. His mother and grandmother have to make a round trip of nearly seven hours to see Kyle for visits which have in the past been restricted to a single hour. Kyle was convicted of no crime when he was admitted to Carstairs in 2009. He has been there for 16 years. The toll that this has taken on his family has been horrendous. The situation is devastating for them, and there is no end in sight. Although it is a case for the Scottish mental health system, it has provided me with an insight into what many people with learning disabilities and their families will be experiencing in England today, and the limitations of mental health tribunals in dealing with these issues.
People with learning disabilities have been losing their liberty for years because of their disability; this is a human rights emergency. It is clear that we have to do far more to prevent these situations from happening. The Bill will help to do that with its welcome measures on prevention, but where these cases are happening now, I believe there should be an additional level of scrutiny—an extra check and balance so that after so long, someone with the right level of authority and expertise can challenge providers to do better and to ask the question, “How can it be that someone has lost their liberty and their right to a family life, because we cannot make their care and treatment work in a community setting?” Although I very much welcome the introduction of the care, education and treatment reviews, I believe we should go further in these circumstances. That is why new clause 33 would make provision for notification to the Care Quality Commission when someone has been detained for more than five years.
This is an excellent Bill. It will do so much for the rights of people with learning disabilities and autism, but there are several areas where I hope the Minister can outline what further ambitions the Government have to ensure that our mental health system is fit for purpose and based on human rights.
Madam Deputy Speaker (Ms Nusrat Ghani)
To squeeze in a few more Back Benchers, the speaking limit is now three minutes.
Layla Moran
This is a long-overdue and very welcome Bill, but frankly it will not even touch the sides of what most of our constituents and communities need when it comes to the wider mental health landscape. I support many of the amendments to improve it, not least those laid by my hon. Friends on the Liberal Democrat Benches. I need to make a couple of quick points, because we want the Bill to succeed.
The Minister will know that since December the Health and Social Care Committee has been conducting an inquiry into community mental health services, because we recognise that unless we start tackling these matters upstream, we will not achieve the Bill’s aims. For so many, it feels like they are walking through an NHS desert: they simply cannot get the appointments they need; they do not feel supported; and no one can navigate this complex system.
Just a few weeks ago, while still on maternity leave, I decided to have a keeping-in-touch day and the Committee decided to visit an oasis in this desert—the incredible Barnsley Street neighbourhood mental health centre in Tower Hamlets. Unfortunately, the centre is one of only six pilots set up to this level across the country, but we heard some amazing stories of how people had been diverted away from in-patient mental health units by an approach that truly puts the patient at its centre. It was inspiring. However, we heard from the centre that its funding will not continue beyond April. It is only just starting to gather the data it needs; system change is desperately needed in this space, but the concern is that the system will change without robust data behind it. My question to the Minister is, will the centres be funded beyond April? If not, how can the Department make decisions about the system based on data that does not represent a full calendar year?
I also want to speak in support of amendment 9. I pay tribute to Cyril and Dianne whose son Leon suffered from schizophrenia for many years and sadly completed suicide in January 2019. He was let down by community mental health services. Leon’s mother, Dianne, saw the illness get worse and worse, and when she tried to re-refer him into the system after he had been detained, she was told, “Computer says no.” This Bill will improve the lives of families like Dianne and Leon’s, because Dianne’s pleas would have been heard under the new nominated persons provisions. Amendment 9 would be an extra step, ensuring that the plan is shared with parents and carers—with the nominated person. I pay tribute to those who have campaigned so doggedly for the inclusion of nominated persons in the Bill.
Anna Dixon (Shipley) (Lab)
I am no expert on mental health law, but I do have decades of experience in the health and care sector, and my sister is a psychiatrist. I know that the decision to detain someone with severe mental illness is never taken lightly, and that psychiatrists must weigh up a range of factors and information to come to a final decision. I tabled amendments 43, 44 and 45 and new clause 34 after a number of conversations with the Royal College of Psychiatrists, which has expressed concern about the wording used in the detention criteria.
Taken together, the purpose of my amendments is to ensure that the detention criteria are aligned with good clinical practice. It is important that they are reflected in the primary legislation, rather than simply relying on a code of practice. They would remove from the detention criteria mention of the terms “likelihood” or “may be caused” to allow psychiatrists to make a straightforward, holistic assessment of individual risk in the context of significant mental disorder. The risk is that “likelihood” suggests that it is possible for clinicians to predict serious harms such as violence or suicide when it is not possible to do so, while the idea of causation neglects the fact that complex background conditions can be the genesis of a harm. There is a risk, too, that the language may lead to preventive detention—more detention, not less. It is always easier with hindsight, when unexpected harms have happened, to oversimplify causation and ask, “Why was this person not detained?
Gregory Stafford (Farnham and Bordon) (Con)
As a member of the Bill Committee, I had the opportunity to closely examine the development and scrutiny of this Bill alongside my Opposition colleagues. We sought to strengthen the legislation, particularly in relation to safeguarding children and ensuring robust protections for those admitted under the Mental Health Act framework.
Given the shortness of time, I will speak only about amendments 41 and 42. They make the vital clarification that the nominated person for any patient under the age of 16 must have parental or guardian responsibility unless there are clear and established safeguarding concerns. In essence, that would ensure that the parents remain the lawful decision-makers and the first and most natural safeguards for their child’s welfare.
Let us consider, for a moment, what is at stake. Imagine a vulnerable 14-year-old girl, frightened and confused during a psychiatric admission. In that moment of distress, a well-meaning adult—or, worse, someone with a hidden agenda—could persuade the child to nominate them as their representative. That individual would then gain legal powers to object to treatment or discharge decisions, while the parents—the very people who know the child best and have both a moral and legal duty to protect them—could be sidelined.
Once such a nomination is witnessed, it carries legal force. The rights and responsibilities of parents could, in effect, be overridden. Although that may sound hypothetical, it is not. Family courts have seen precisely how manipulative individuals exploit vulnerable young people. Groomers, traffickers and abusers thrive in the legal grey zones. If we are not crystal clear that only a court may displace parental responsibility, we risk leaving the door ajar for such exploitation. I ask the Minister to assure the House in winding up that no child under 16 will be permitted to override parental authority simply by nominating someone else, without a full and proper judicial process.
The Bill does have fallback provisions, which are of course welcome, but they are not watertight unless the law explicitly confirms that only a court can transfer or restrict parental rights.
Dr Luke Evans
My hon. Friend makes an excellent point. The only protections that I can see in schedule 2 are an age requirement, a stipulation not to be disqualified by a previous court order, and the presence of a witness. There is therefore no pre-emptive way of protecting people, which is why amendment 41 is so important.
Gregory Stafford
My hon. Friend is absolutely right. Both he and I made those points in Committee. I am surprised that the Minister does not see the risks here. The safeguard that my hon. Friend talks about must be beyond any doubt. The amendment in his name provides exactly that clarity. It would prevent unrelated or loosely connected individuals from stepping into a role that rightfully belongs to those with both a legal duty and an emotional bond—the parents or guardians—and it would preserve the fundamental principle that parents should not find their role diminished by accident or administrative oversight.
As I was saying, this is not an abstract risk; it is a very real and foreseeable consequence of the unclear drafting. These amendments do not weaken the rights of patients. They strengthen the protections around them. They ensure that in modernising this law, quite rightly, we do not inadvertently undermine the oldest and most important protection of all: a parent’s duty to safeguard their child. We must ensure that the state can only curtail that right under the strictest judicial scrutiny, with evidence tested and the child’s welfare paramount. In doing so, we will make this legislation not only legally sound but, in my view, morally right.
New clause 31, tabled by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), would require local authorities and ICBs to supply a fully costed plan to ensure they are able to provide adequate community services for people with learning disabilities and autistic people. I support that entirely. As vice-chairman of the all-party parliamentary group for special educational needs and disabilities, and from speaking to groups in my constituency such as Last Wednesday and Growing Hope, I know that the process around SEND is complicated and not fit for purpose. Fortunately, we have a chance to help it slightly with this Bill, so I ask the Minister to support new clause 31.
Sojan Joseph
I would like to speak in support of new clause 37, tabled by my hon. Friend the Member for Thurrock (Jen Craft). On Second Reading, I warmly welcomed the changes that this legislation will introduce regarding autistic people or those who have a learning disability. As a result, it will no longer be possible for someone to be detained in a mental health hospital indefinitely simply because they have autism or a learning disability. In the current system, autistic people and those with a learning disability have experienced inappropriate care, over-medication and extended periods of detention because of a lack of facilities in the NHS and social care, so this change is welcome and long overdue.
The Government have confirmed that the changes will be implemented once the necessary community provision is in place. Establishing strong support in the community is essential for not only enabling safe discharge from hospital settings but preventing unnecessary admissions in the first place. I recognise that the Government are working on setting out what strong community services look like and what resources they require to implement them. From serving with the Minister in Committee, I have no doubt about his commitment to ensuring that this community provision is introduced in a timely manner, but I support the proposal of my hon. Friend the Member for Thurrock that there should be a road map in the legislation that will provide a clear framework outlining how those services will be introduced. After all, ending inappropriate detention requires robust community-based alternatives to ensure that people with autism or a learning disability who would have previously been detained do not fall through gaps in the system.
Having a road map developed in conjunction with autistic people, people with learning disabilities, their carers and healthcare professionals will help to identify and address any gaps in service provision and workforce capacity. I also believe that it will help to reduce the risk of people with autism or a learning disability needing police intervention or emergency hospital care because the support is inadequate. By putting in place a road map, new clause 37 would help to ensure that we end all the sooner the injustice of people with autism or a learning disability being detained.
Ian Sollom (St Neots and Mid Cambridgeshire) (LD)
I will speak to amendments 24 to 28 and 36 to 38 in my name, which address gaps in crisis provision and accountability for autistic people and people with learning disabilities.
On Second Reading, I told this House about Declan Morrison, my constituent who died aged just 26 after spending 10 days in a section 136 suite that was wholly inappropriate for his complex needs. I remind the House that section 136 suites are designed for 24-hour stays, or a maximum of 36 hours in extreme cases. The coroner who investigated Declan’s death found that
“there is a risk that future deaths could occur unless action is taken.”
The timeline of what happened in the run-up to Declan’s death shows a cascade of systemic failures. Declan’s family, Graeme, Sam and Kaitlyn, have asked me to ensure that Parliament learns from what happened. These amendments in my name reflect those lessons and the coroner’s recommendations.
In Committee, the Minister made several points about earlier versions of these amendments, which I have tried to address in these revised versions. In particular, on crisis accommodation, the Minister argued that existing duties on ICBs already cover crisis provision and that the amendment was too prescriptive, potentially restricting ICBs in designing provision, emphasising the importance of flexibility for ICBs to meet local needs. I understand the desire not to be overly prescriptive, but in Declan’s case, over 100 places were contacted and no suitable accommodation could be found anywhere in the country. Flexibility failed Declan.
The revised version of the amendment allows for regional solutions beyond the ICB, but I suspect that the Minister will still find it too prescriptive. However, the fundamental question remains: should there not be a duty to ensure that provision exists somewhere? The Cambridgeshire and Peterborough ICB established a crisis service after Declan’s death that operated at 98% capacity, demonstrating both need and viability, but it closed when funding was withdrawn, highlighting the challenge with voluntary provision.
Steve Darling (Torbay) (LD)
On funding, the Devon partnership NHS trust looks after people with mental health challenges in the Torbay community, where levels of depths of despair are particularly high. The trust is facing a £21 million cut, so does my hon. Friend agree that changes will be irrelevant if we do not have adequate funding?
Ian Sollom
I agree that resources need to be put in place to support the many good measures in the Bill and in many of the proposed amendments. In Declan’s case, services were created in the wake of tragedy and funding was found, but too often such services disappear when attention moves elsewhere.
I recognise that the implementation challenges are real, and I appreciate that the Minister has committed to providing annual written statements on progress, but I believe the principles in the amendments around crisis provision, proactive intervention, accountability and co-production with autistic people merit consideration. As much as I would like him to, I do not expect that the Minister will have a late change of heart on the amendments today. However, I hope he will be willing to meet me after the Bill receives Royal Assent to discuss how we can work together to ensure the systemic failures that led to Declan’s death are properly addressed during implementation of the measures in the Bill. In stopping those systemic failures, we would honour the memory of Declan.
Josh Dean (Hertford and Stortford) (Lab)
In the interest of time, I will turn straight to new clause 25, tabled in my name.
The Bill sets out a range of situations where the competence of a patient aged under 16 will be relevant, but it does not set out a framework for how it should be determined. That puts patients under 16 years old at a huge disadvantage. Unlike those aged 16 and over, there is no clear mechanism for determining whether a child under 16 can make decisions and the law assumes that under-16s cannot make decisions for themselves, unless they demonstrate they are able to do so. That means that under-16s may not benefit fully from the rights and safeguards set out in the Bill because they are assumed to lack competence to make the relevant decision. For example, they may not be able to exercise their right to choose a nominated person or to access enhanced safeguards around treatment.
There is currently no statutory test for determining a child’s ability to make decisions. While some may refer to Gillick competence, the Joint Committee on the draft Mental Health Bill noted that Gillick competence is “broad”, “ambiguous” and that there were significant inconsistencies in its application. A similar observation was made by the Court of Appeal in a decision earlier this year, which also indicated the Court’s approval of a functional test to determine a child’s competence.
New clause 25 addresses this disparity by introducing a “functional test” to determine an under-16’s ability to decide. This reflects the suggested approach in the current code of practice, adopted by some judges. The Law Commission has recommended a similar test as part of its proposed legal reform concerning disabled children’s social care. This test fills a significant gap in the Bill, providing important clarity for professionals when a child’s competence needs to be determined. Crucially, the test set out in new clause 25 is explicitly limited to decisions made under the reformed Mental Health Act. It does not cover decisions falling outside of the Act, so does not affect the existing decision-making powers of the courts or those with parental responsibility. A clear and consistent approach to assessing a child’s competence can only be achieved by including a test on the face of the Bill, as the code of practice can only reflect the law—it cannot prescribe a test for competence. I would be grateful if the Minister addressed that point at the end of this debate, and if he would consider meeting me to discuss my amendment in more detail. This Bill has many strengths that will deliver for people and modernise mental health care, and it is crucial that we ensure children and young people can benefit from those strengths in the same way adults can benefit.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
This Bill gives us a real opportunity to modernise mental health care and make sure that patient choice and fairness are at the heart of mental health services, but to achieve that, we must first confront the deep inequalities that still shape people’s experience of mental health care, particularly among ethnic minority communities, those facing economic hardship and young people. Like so many issues, the intersectionality between those factors means that some groups face particular challenges in navigating and accessing the help they need.
In Dewsbury and Batley, we see the human reality of that inequality. Rates of depression stand at 15.4%, higher than the national average, and schizophrenia is also more common locally, compared with other constituencies in the UK. Across Yorkshire and the north, mental ill health is consistently higher than elsewhere in England. NHS data and mental health organisations are clear that both ethnic background and wealth disparity play a major role in that gap. People in my constituency are more likely to experience a mental health condition, yet the funding for research and specialised services in the north remains lower. That means less support, fewer beds, and fewer opportunities to provide specialist care.
That is why I strongly support new clause 13, which requires every hospital to have a named person responsible for overseeing race equality in how the Mental Health Act is applied. Black people are still four times more likely to be detained under the Act and eight times more likely to be placed on a community treatment order. Without accountability, those injustices will continue. I also support new clause 35, tabled by the hon. Member for Sheffield Central (Abtisam Mohamed), which seeks to put limits on CTOs.
We must also do far more for young people. The new clause proposed by the hon. Member for Hertford and Stortford (Josh Dean) powerfully argues for giving under-16s a clearer say in their own treatment decisions. A mother told me how both of her daughters needed mental health support, yet she had to seek private care because local services were overstretched and not up to standard. She pointed me to the Good Childhood Report, which shows that the wellbeing of children in the UK is among the lowest in Europe. I also support new clause 28, which aims urgently to address the need to stop children being placed in adult wards or sent miles away from home for treatment. I welcome the work that West Yorkshire ICB has done recently to expand mental health services for older people, but we must match that ambition for children and young people. If those commitments cannot all be secured through this Bill, they must be delivered in the forthcoming Children’s Wellbeing and Schools Bill.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call Jen Craft to make the final contribution. All those who have contributed to the debate should make their way back to the Chamber.
Jen Craft (Thurrock) (Lab)
Thank you very much, Madam Deputy Speaker—I will be as brief as possible. I will speak to new clause 37, which stands in my name and which seeks to support the Government in ending the scandal of the inappropriate detention of people with a learning disability and/or autism. I declare an interest as the chair of the all-party parliamentary group on learning disability.
Currently, a learning disability or autism, in and of itself, can be grounds for detention under the Mental Health Act. As we all know, this is an absolute scandal—something from a previous age that should be a source of moral shame to everyone in our community. The Bill seeks to address this by removing autism or a learning disability, in and of themselves, as criteria for detention under the Mental Health Act. That offers a lifeline—a light in the tunnel of darkness that a number of people who are detained under the current Act face.
However, the impact assessment for the Bill states that the proposed changes to the detention criteria in clauses 3 and 4
“will only be switched on when systems are able to demonstrate sufficient level of community support”.
The families and carers of those have a learning disability or autism and who are detained under the Mental Health Act, and the organisations that support them and people who advocate for them, know that too often this vulnerable group of people are pushed to the bottom of a list of competing priorities, and very often slide off it.
We know that this Government and the Department of Health and Social Care have a number of competing priorities to deliver on, and the concern for people who fall into this bracket under the legislation is that their concerns just will not be addressed and that this absolute scandal will continue in perpetuity. People who have a learning disability or autism will be detained because our community services just are not up to snuff; we have so categorically failed them that the only thing we can think to do is to lock them away from society.
Jen Craft
I will not, because I am aware that I am almost out of time.
My new clause would ensure that the Government have to set out, within six months of this Bill receiving Royal Assent, a road map that engages in a co-productive way with people with learning disabilities or autism, their advocates and organisations that champion their rights. The road map will design what they need to support them to lead independent dignified lives in the community, and there will be a report every year to say how we are getting community services to a sufficient place so that these much-needed clauses in the Bill can be switched on.
This Bill updates mental health legislation and brings it into the 21st century. It is only right that it does so for everyone in our society, including the most vulnerable.
The Minister for Care (Stephen Kinnock)
I thank everyone in the Chamber for their contributions to today’s debate. I will start by talking about the deeply moving contributions regarding the tragic death of Ruth Szymankiewicz. I extend my heartfelt condolences to Ruth’s family, and I pay tribute to my hon. Friend the Member for Isle of Wight West (Mr Quigley) and the right hon. Member for Salisbury (John Glen) for so powerfully advocating on behalf of Ruth and her family. The circumstances around Ruth’s death were unacceptable and should never have happened. We acknowledge multiple failings in her care.
Turning to the amendments, while we are not accepting any changes to the Bill, I hope that I can assure the House, in the short time remaining, that we are taking action to address the concerns that have rightly been raised. In relation to new clauses 6, 7, 29 and 36, we absolutely do not want young people placed in adult wards, and we are clear that patients should get treatment close to home. However, further legislative restrictions on placements risks leaving clinicians without options in emergencies or preventing treatment that is in the patient’s best interests. NHS England has worked with hundreds of children and families to develop a new service specification for children and young people’s mental health services. The specification is for commissioners and providers to follow, defining the care expected from organisations funded by NHS England to provide specialised care.
Mr Bayo Alaba (Southend East and Rochford) (Lab)
Will the Minister give way?
Stephen Kinnock
I will, but I have got little time and a lot of amendments to address, so I will not take any further interventions.
Mr Alaba
I had the privilege of meeting Helena and Christina, who shared with me the challenges they faced when their mother was sectioned when they were young girls. For two weeks, the responsibility for care was left entirely in their hands while local services struggled to find a suitable bed. Can the Minister confirm that through the Mental Health Bill, in conjunction with the Children’s Wellbeing and Schools Bill, young carers will be properly identified and that the additional boost in Government investment directly into mental health services will ensure that young carers receive the support they need?
Stephen Kinnock
I can give my hon. Friend that assurance. One of the core purposes of this Bill is to ensure that we catch such issues, particularly around the identification of children in cases where parents are required to be detained. We will reaffirm that children should be treated in the least restrictive, most age-appropriate environment and close to home and family, and that all services would work towards alternatives to admission, such as day care and intensive home treatment, with better support for visits, including with dedicated family areas and overnight stays. We have committed £75 million for systems to invest in reducing out-of-area placements, and I am pleased to report that the number of children placed on adult wards is now decreasing, and that trend must continue.
We have also committed in the Bill to reviewing the existing CQC notification requirements, including whether notification should be extended to other incidents and whether the time period remains appropriate. We will work with families, clinicians and MPs as part of that review. Indeed, following recent conversations with my hon. Friends the Member for Isle of Wight West and for Lowestoft (Jess Asato), I have asked officials to host a roundtable next month with Members and experts on how we can provide greater clarity in the code. The focus will also be on NHS England’s service specifications and regulations on the placement of children and young people in adult wards, including determining if a placement is suitable.
The revised code, on which we will engage extensively with—among others—children and their families and carers, will provide further opportunities to address concerns raised in amendments 33 and 39 and new clause 28. The code will also address the issue of competency. We believe that that is more appropriate than a test for competency in the Act, as proposed in new clauses 15 and 25.
Stephen Kinnock
I will, but can the right hon. Gentleman please make his intervention very short?
John Glen
I am grateful to the Minister, and I am also grateful to him for what he said about my constituent. There are so many codes of best practice, and so many guidelines. Can he say a little more about what force the code would have, so that we can have some reassurance that the risks that were so tragic in the case of my constituent will be eliminated?
Stephen Kinnock
The code of practice will be statutory. It is better to have these provisions in the code, because clinical practice evolves, and it is much easier to revise a code of practice than to go through primary legislation.
We understand the concerns expressed about young carers in new clauses 26 and 27, and recognise that despite existing duties, the right questions are not always being asked to identify children when someone is detained. While we do not agree that additional legal duties are needed, especially as multi-agency working is already being strengthened through the Children’s Wellbeing and Schools Bill, we do agree that we need to make the requirements more explicit. The revised code of practice will therefore specify that when someone is detained, steps must be taken to identify the children of the patient. Information about support that is available must be shared, and if a young carer’s needs assessment is required, the appropriate referral must be made.
Stephen Kinnock
I am really struggling for time. I am sorry, but I cannot take any more interventions, because it is not fair to Members who have tabled amendments.
Amendments 41 and 42 would prevent children with competence from choosing a step-parent or kinship carer as their nominated person if that is the most appropriate person for them. A nominated person can be overruled or displaced if acting against the child’s best interests. Parents will always maintain their rights under the parental responsibility.
Many amendments concern statutory care and treatment reviews designed to help to ensure that people with a learning disability and autistic people receive the right care and treatment while detained and barriers to discharge are overcome. Reviews will happen within 28 days of detention, and at least once a year during detention. This can be more frequent, depending on needs. Patients’ families and advocates can request a review meeting at any point. In respect of new clause 32, we have consulted on making some restrictive practices, including long-term segregation, notifiable to the Care Quality Commission within 72 hours.
Let me now deal with amendments 14 and 26 and new clauses 31 and 37. I acknowledge the importance of having a clear plan to resource community provision for people with a learning disability and autistic people to implement these reforms. We have committed ourselves to an annual written ministerial statement on implementation of the Bill post Royal Assent. Following conversations with my hon. Friend the Member for Thurrock (Jen Craft), we will work with stakeholders, including people with lived experience, to shape our road map for commencing changes to clause 3. The written ministerial statements will give updates on progress, as well as setting out future plans. It is not possible at this stage for us to commit ourselves to the specifics of implementation and community support, which depend on the final legislation passed, future spending reviews, and engagement with stakeholders to get implementation planning right.
As for the concerns raised by my hon. Friend the Member for Shipley (Anna Dixon) about the detention criteria in the Bill, it is vital that the work “likelihood” is included in those criteria to set clear expectations of what clinicians need to consider. However, we are clear about the fact that our intention is not to set a threshold for detention. Under the new criteria, a harm does not have to be likely to justify detention. The criteria require likelihood to be considered holistically, alongside the change, nature and degree of the harm.
I know that the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans) is keen for me to deal with the question of public safety. The key point is that there are detention criteria in clause 5, which makes a clear reference to harm either to the patient or to other persons. That is clearly a consideration of public safety, and we therefore believe that amendment 40 is surplus to requirements.
I trust that, on the basis of the assurances I have given, Members will be content not to press their amendments and new clauses.
Madam Deputy Speaker (Ms Nusrat Ghani)
Zöe Franklin, is it your pleasure that new clause 2 be withdrawn?
Zöe Franklin
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 26
Duty to establish carer liaison service
“(1) The Mental Health Act 1983 is amended as follows.
(2) In Part X (Miscellaneous and Supplementary), after section 133 insert—
“133A Duty to establish carer liaison service
(1) The managers of every hospital providing services under this Act must establish and maintain a dedicated carer liaison service.
(2) A service established under this section must provide—
(a) support to unpaid carers when a patient for whom they provide care is—
(i) awaiting admission to hospital for treatment under the Act;
(ii) receiving treatment in hospital under the Act;
(iii) set to be discharged from a hospital where they had been receiving treatment under this Act;
(b) timely and accessible information regarding the discharge of the patient they care for, including details of—
(i) the patient's discharge plan; and
(ii) aftercare arrangements under section 117 of this Act;
(c) support for unpaid carers to identify their own needs and connect to relevant local services for post-discharge support, including local authority adult social care services, general practitioners, and local carers' centres;
(d) facilitation of effective communication and collaboration between unpaid carers and the patient's multidisciplinary clinical team regarding the discharge process;
(e) assistance to unpaid carers in developing or updating a carer's support plan in the context of the patient's discharge, including guidance on—
(i) their rights to assessment and support as carers
(ii) their participation in education or employment;
(iii) available counselling services;
(iv) support in planning for emergencies in relation to the patient;
(v) benefits for the carer and patient; and
(vi) other forms of local support; and
(f) services to ensure that the perspective of the unpaid carer, as a key provider of support, is considered during discharge planning, where appropriate and with due regard to patient confidentiality and consent.””—(Dr Chambers.)
This new clause would require hospitals to establish a dedicated liaison service for the carers of patients detained under the Mental Health Act.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Before I ask for the next decision, I remind colleagues in the Chamber that once the doors are locked, Members should not be forcing themselves through the doors to either Lobby.
Stephen Kinnock
I beg to move, That the Bill be now read the Third time.
Since the Mental Health Act 1983 was passed, and since it was updated in 2007, attitudes towards mental health have shifted dramatically, and our understanding has grown, but the law has been neglected. That is why this Government were proud to announce this Bill in our first King’s Speech, fulfilling our manifesto commitment and taking the first steps towards ensuring patients are consistently treated with dignity and respect—promise made, and promise delivered.
It is clear that adults and young people with mental health issues have been let down for years, which is why we are transforming the current mental health system through our 10-year health plan, including through recruiting more than 8,500 additional mental health workers, delivering more NHS talking therapy appointments than ever before, increasing the number of mental health crisis centres, and providing access to a specialist mental health professional for every school in England.
Today, we are another step closer to delivering the reforms to dealing with people with severe and acute mental health disorders, a step closer to strengthening and clarifying the criteria for detention, and a step closer to better supporting clinicians to make the right decisions around appropriate care and treatment, including community treatment orders. We want to make sure that patient choice and patient needs are at the heart of decision making. That is why we are introducing these reforms to enshrine in law measures such as the clinical checklist, the use of advance choice documents, the role of nominated persons and the expansion of advocacy services.
We are increasing the scrutiny and oversight of compulsory detention. We are making sure that those patients who are detained have a clear path to recovery and to discharge. We are introducing statutory care and treatment plans for all patients, so that their needs are met both during and after their hospital stay. To reduce reliance on in-patient care and ensure that people with a learning disability and autistic people get the right support, we are limiting the scope for detention. We are also introducing a package of measures to improve community support, including statutory care, education and treatment reviews and dynamic support registers. We are introducing stronger safeguards for people who lack capacity or competence to consent to treatment—a potentially highly vulnerable group. Those patients will receive a second opinion-appointed doctor at an earlier stage in their treatment.
This Bill has been the product of years of work predating this Government, and it is right that we thank hon. Members and peers for their scrutiny and support over many years. We should particularly note the work of the former Prime Minister Baroness May for launching the independent review that paved the way for this legislation, along with the review chair, Sir Simon Wessely, and his vice-chairs, Steven Gilbert, Sir Mark Hedley and Baroness Neuberger.
I thank Members who served on our Public Bill Committee, including the Chairs, and the clerks and all the parliamentary staff who have worked hard to ensure that the Bill was subject to the proper scrutiny while ensuring smooth and quick passage. I also thank the Joint Committee on Human Rights and particularly Lord Alton for its report and recommendations. I am grateful to the devolved Governments for their support during the Bill’s passage and to the Welsh Senedd and Northern Ireland Assembly for granting legislative consent. I thank the Bill team, my private office and all the officials and stakeholders over numerous years who have worked hard to get this legislation to where it is today.
Above all, thanks go to those with lived experience who have bravely shared their personal experiences with us through the independent review, through our consultation with stakeholder groups and through Members across both Houses. The Bill is the product of sustained effort over a number of years. That work will continue following the Bill’s Royal Assent, but none the less it is an important moment to acknowledge and pay tribute to those who have got the Bill to where it is now.
The work continues as we look to implement the legislation. The first priority once the Bill gets Royal Assent will be to draft and consult on the code of practice. We will engage closely with people with lived experience and their families and carers and with commissioners, providers, clinicians and others to do that. Much has been done, but there is much more to do. This Government are delivering on our commitment to modernise the Mental Health Act, and the work begins now to deliver that change on the ground. The Bill will of course now go to the other place, and I thank peers for their previous extensive consideration. I hope the noble Lords will be able to agree to the changes made in this House, so that the Bill can make swift progress to Royal Assent. I commend this Bill to the House.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call the shadow Secretary of State.
Stuart Andrew (Daventry) (Con)
I want first to recognise and thank everyone for the constructive debates we have heard here and in the other place throughout the Bill’s passage. In particular, I thank the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), for everything he has done on the Bill, especially in Committee. I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his expertise, whose involvement with the Bill began before he was elected to this place. I also pay tribute to my right hon. Friend the Member for Salisbury (John Glen) and my hon. Friend the Member for Farnham and Bordon (Gregory Stafford) for their thoughtful contributions.
This is clearly an important and emotive issue, and the respect and sensitivity that have been shown by all sides is a testament to this House. Since the election, we have said that we would not oppose for the sake of opposition. While we have rightly asked tough questions of the Government, we have done so with the best interests of patients at heart, because everybody here wants to help and support vulnerable people better—those patients with the most severe and complex mental health needs. This Bill, which started under the previous Government—I pay tribute to former Prime Minister Baroness May for that—and continued under this Government, will achieve that. We welcome efforts to improve the patient’s voice and involvement in their own care, to ensure that patients receive effective and appropriate treatments, to minimise restrictions on liberty so far as is consistent with patient and public safety, and to treat patients with dignity and respect.
Although we are disappointed that opportunities to strengthen the Bill further have been missed, especially in public safety and the protection of vulnerable children, we listened closely to what the Minister said and to his assurances on action, for which we thank him. We will of course continue to push on these matters, not on party political grounds, but because doing so is the right thing for patients.
We are very disappointed that the proportion of health spending on mental health has been reduced. We welcome the Government’s continuation of our work looking again at how we treat and protect people with the most severe mental health illnesses, so that we can improve the safety, treatment and dignity of patients and the wider public, and ensure that our laws remain relevant and proportionate in the modern world. The Government must now turn their words into action and deliver on the commitments that they have made.
I thank everybody again for the constructive way in which they have dealt with the Bill. We are pleased to support its Third Reading. We hope that it will bring improvements for those we all care about: the patients.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call the Liberal Democrat spokesperson.
Dr Chambers
The Liberal Democrats support the Bill, which makes mental health law much fairer and more compassionate. However, reforming detention law is only half the job, because without investment in prevention and community care, the Bill risks becoming an improved way of managing failure rather than preventing it. Without proper early intervention, people deteriorate until crisis is the only door open to them.
Melbury Lodge in my Winchester constituency shows what a good partnership can look like: NHS teams working with citizens advice to help patients sort out debts, bills and benefits before discharge—recovery is impossible if patients return home to a pile of threatening letters and bills. Yet schemes like that are the exception, not the rule. Debt, insecure housing, domestic abuse and bereavement are not side issues—they are often root causes—and care plans that ignore them are not truly caring.
Before I bring my remarks to a close, I pay tribute to the extraordinary people working at the frontline of mental health care—nurses, doctors, counsellors, therapists, support workers, carers and charities—who hold up a system that too often feels as if it is collapsing around them. Their compassion and professionalism are the reason so many people make it through their darkest moments. They deserve much more than just thanks; they deserve a system that supports them as much as they support others.
In my years of campaigning for better mental health, including as a trustee of a mental charity and, in the past year, as the Liberal Democrat mental health spokesperson, I have become more convinced that mental health cannot be seen as the responsibility of NHS services alone. It must be embedded across society, in education, healthcare, housing, farming and even in the way we support small businesses.
I thank the Minister and his team for all their work on the Bill and their cross-party engagement, as well as everyone who served on the Bill Committee and the Members who have turned up repeatedly to these debates. One thing that does unite the House is improving mental health care.
Question put and agreed to.
Bill accordingly read the Third time and passed, with amendments.