Mental Health Bill [ Lords ] (Eighth sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Dr Evans]

I am pleased that the Minister has clarified that the Government intend to take out clause 50, because that allows me to take out some of my speech. It would not be appropriate for me to retread the entirety of the argument—we have been through it, and I am aware of the numbers on the Committee—but I will address a few points, because the clause is important.

The clause would keep the role of authorised persons for the purposes of sections 135 and 136. Hon. Members will know that this is not a new issue, as we debated the removal of the definition of authorised person in relation to clause 5. On that occasion, I expressed my concerns about the risk of doing so, which were shared by Baroness May, who rightly argued that we must stop treating mental health as a policing issue and start enabling care to be delivered by the right person in the right way at the right time. This clause gives us a chance to make that principle real.

Clause 50 allows certain non-police professionals, defined as authorised persons, to use existing powers under section 135 to enter premises under a warrant and remove a person in a mental health crisis to a place of safety or assessment of care. It also allows those professionals to use powers under section 136, which is even more sensitive, permitting the removal and detention of a person from a public place without a warrant if they appear to be suffering from a mental health disorder.

The clause is not about weakening safeguards. It is about strengthening the frontline and moving away from a model where the police are the default responders to every mental health crisis, which is often not because they are best placed, but because no one else has the authority. As modelling has shown, 95% of mental health-related police calls do not require a criminal justice response. Officers are spending hours, even days, sitting in A&E with patients in distress, because no one else is trained and empowered to act.

Clause 50 helps to break that cycle. It creates a legal basis for trained health professionals—mental health nurses, paramedics and approved mental health practitioners —to intervene in crisis situations, rather than relying solely on the police.

The hon. Member for Ashford asked how we decide, but we already triage people when they ring 999 or 111. How do we decide who gets an ambulance for what sounds like a heart attack or stroke? That decision is made by clinicians. We have the ability to make those triaging decisions, and I think it is completely appropriate to try to empower the health services to find a better way of dealing with these people.

[Anna Dixon]

Does the hon. Gentleman recognise that health professionals do not wear stab vests or cameras? They are not equipped to go into dangerous situations. It is essential to protect healthcare workers and not put them at risk. We should maintain the current situation, whereby they work in tandem with the police, but the police are present for the detention.

[Dr Evans]

The hon. Lady is absolutely right. A paramedic never knows what they are going to when they are called out. It could be a terrorist incident; it could just be a person in distress who is hysterical. A paramedic never knows, but that is part of the point—when they get there, they would be able to make that assessment rather than having to call the police out. At the moment, they do not have those powers, so that is a reason to give them the option. I am not saying that that is always the right option, but it gives them the option. The clause allows us to think of new, innovative ways to deal with the complex, changing world of mental health in the modern age.

The Government have argued elsewhere that the definition of who detains could be too rigid or unnecessary, but I would say the opposite. Professionals on the ground need clarity—a lawful mandate to act in the best interests of a person in crisis, with clear boundaries of competence and training. The Lords were right to include a definition of “authorised person” that sets out the conditions of suitability. Clause 50 builds on that framework.

Having these powers in the Bill gives NHS trusts the chance and confidence to design alternative crisis responses. The clause is by no means a blanket approach—it actually drives innovation. Health professionals have the clarity to act and police forces have the breathing space to return to their core purpose: preventing and investigating crime.

Of course, the power must come with safeguards; it is not a blank cheque. The use of coercive powers by the police or anyone else must always be subject to training, regulation and oversight. Entering someone’s home or detaining them in public is a profound interference with their liberty and dignity, so the power must be exercised with care and caution.

We believe that clause 50 takes us in the right direction towards a health-led approach to mental health crisis, rather than a security-led one, as my hon. Friend the Member for Solihull West and Shirley said. It supports the police by lightening a burden from which they have long asked to be freed. It supports patients by increasing the chance that they will be met by someone who understands their needs. It supports the wider public by allowing police officers to return to doing what they are trained to do and passionate about doing: keeping communities safe. We should be building on this type of reform, not rowing back from it. I urge the Government to reconsider.

Mental Health Bill [ Lords ] (Seventh sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Anna Dixon (Shipley) (Lab)]

The hon. Gentleman makes some very good points about the importance of patients being offered advance choice documents and being supported to make them, as the Bill describes. The evidence submitted from the General Medical Council makes it clear that it supports the duties as set out in the Bill, and it says that they are in line with the current good medical practice guidelines for professionals. Does the hon. Gentleman agree that the Bill, as it stands, fits very well with current medical practice?

[Dr Evans]

I am grateful for the hon. Lady’s point. It would be interesting to know if that advice came when the Bill was debated in the Lords, because these clauses were not in place, but were introduced through the Government’s amendments. This is an extension to that. Our amendment to give a right to a patient would be a further strengthening. I entirely agree that the Bill is a good step forward, but if we are not going to address this again in the next 40 years, the Opposition would like that right to be enshrined. To be offered the opportunity is the key bit here—no mandation. It is good practice to let people know their rights, and we are affirming that. The worry is that while there is good intention to allow it based on the system, what happens if times are stretched? The amendment would give someone a statutory chance to say they have that right, and that it is upheld in law. That is what the Opposition are pushing for.

In essence, we are both trying to solve the same problem, but taking different approaches. The key distinction between the approach of the Government and that of the Opposition is that the Government’s creates a duty on the system, but no individual entitlement, while the Opposition’s proposes a patient right matched by a clear responsibility to inform and support the individual. The Government’s clause says that NHS England and ICBs must make arrangements as they consider “appropriate”. We say all eligible patients should have an informed right to create one. I anticipate that the Government might turn around and say, “Well, this is too rigid,” or that it imposes unfunded burdens on the ICB. I argue that it is targeted; we are not extending the right to everyone with a mental health condition but only to those at the most risk of future detention.

Mental Health Bill [ Lords ] (Sixth sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Tuesday 17th June 2025 Public Bill Committees

[Anna Dixon]

Does the hon. Gentleman agree that one of the challenges of that court ruling, which will stand unless the Bill amends the law, is that there will be people detained for longer than is appropriate because a conditional discharge is not possible under the law as it is currently interpreted? The whole Bill is about the principle of least restriction. Does he not agree that we need to make this change to fit with that principle?

[Dr Evans]

I agree on that, and we will support the clause. But, as the hon. Member rightly pointed out earlier, we need interoperability between the moving parts to make sure that they all align with the provision in the clause. She is absolutely right: this measure is in the Bill because the patient in the MM case had capacity and had agreed to being discharged with deprivation of liberty impositions, and that was found to be unlawful because of a parallel Act. What I am worried about, and the point that I am trying to make, is that there are so many moving parts in these Acts that we could be in danger of complicating the situation further.

Clause 36 seeks to address the uncertainty by legislating for a new power to impose deprivation conditions as part of a conditional discharge, as the hon. Member rightly pointed out. However, in doing so, the clause effectively runs parallel to, and perhaps even conflicts with, the as yet un-implemented LPS framework. The Government introduced the LPS framework through the Mental Capacity (Amendment) Act 2019. It was intended to be more flexible and responsive than DoLS. But given that the LPS framework has not been commenced, and that there is no clear timetable for implementation—the Minister seemed to suggest that he was unsure whether he will implement them, even though the 2019 Act was passed by Parliament—are we legislating for an entirely separate deprivation of liberty route under the Mental Health Act, and potentially bypassing or duplicating existing safeguards under the Mental Capacity Act?

It all comes back to the point made by my hon. Friend the Member for Solihull West and Shirley about good record keeping and legislative housekeeping. I ask the Minister how the new conditional discharge power will interact with either the DoLS or the liberty protection safeguards—if they are eventually implemented. Are they simply a subsection of the deprivation of liberty conditions, and therefore would not matter? Can the Minister foresee a time where a patient could be subject to both the new powers and the LPS, and if so, who is the decision maker and where do the appeals rightly lie? Should we not wait for the full implementation of the LPS before layering further deprivations in place? That is an open and rhetorical question, but one that vexes me when we are discussing this Bill in detail. There is a real risk here of fragmenting the legal landscape, leading to confusion for clinicians, patients and carers.

Clause 37, which is about conditions relating to the transfers of prisoners and others to hospital, addresses a barrier to timely transfers from prison to hospital. At present, under the case R (ASK) v. Secretary of State for the Home Department of 2019, a transfer from prison under section 47 or 48 of the Mental Health Act cannot be authorised unless a specific hospital bed has already been identified. While well intentioned, that threshold has arguably had a negative effect in deterring referrals and delaying access to treatment.

Clause 37 rightly lowers that threshold. It amends section 47 and 48 of the Act so that a hospital place need not be available at the point of referral. Instead, the clinical decision about suitability for hospital can proceed earlier, allowing for better planning and quicker transfers. That seems a pragmatic response to a bureaucratic bottleneck, but how will this amendment be implemented in practice to ensure that it does not create the false expectation of imminent transfer? Will there be national guidance issued for uniform application of that new test across the entire prison estate?

Clause 38 deals with transfers from prisons to hospitals, and their timeline. It introduces a new statutory duty for transfers from prison or detention to hospital to be completed within 28 days of initial review for assessment via proposed new sections 47A and 48A. As we have heard, that reflects good existing practice. The NHS England guidance already recommends that transfers should be completed within 28 days. However, clause 38 now gives that statutory force subject to exceptional circumstances, which the Bill carefully defines. For instance, as we have heard, shortages of staff and hospital beds do not qualify unless they are caused by exceptional events such as fires or flooding.

This clause is welcomed as an important safeguard for therapeutic benefit, because delays in transfer can cause serious deterioration. It must, however, be supported by sufficient resources and capacity, on which I have a few questions. What assessment has been made of compliance with the 28 day target, and what proportion of cases currently fall outside of it? Will investment be made to ensure bed availability and staffing so that those statutory duties may be fulfilled? When this was debated in the other place, the Justice Minister said:

“I am pleased to share that this Government have recently established a health and justice strategic advisory group, which will bring together key partners with responsibility for the various parts of the transfer process. This group will be chaired by a national clinical director, who will report regularly to Ministers and be responsible for agreeing a joint work plan to support implementation of the statutory time limit, identifying solutions to common barriers to timely transfers and holding partners to account.”—[Official Report, House of Lords, 31 March 2025; Vol. 845, c. 102.]

That is laudable, so I tabled a written question to find out about the group that Lord Timpson talked about. Fortunately, the answer to my written question came back today. The group have not met and are not meeting until 1 July, so I ask for some clarification around that committee. It seems welcome, and this is a complex area. Given that the Justice Minister raised that issue, who will the group report to—the Ministry of Justice or the Department of Health?

Later in his remarks, Lord Timpson talks about the written ministerial statement coming to Parliament. We have heard the Government say that a couple of times about reporting timescales, but in his speech Lord Timpson talked about reporting to Ministers. What kind of time- scales and frequency can we expect if the group has not even met yet? What reporting will there be to Ministers, either in the Ministry of Justice or the Department of Health, to address some of the issues that we are debating today?

Clause 39 deals with transfer directions for persons detained in youth detention accommodation. It is rightly pointed out that this is a gap in the law. There is no power under section 48 to transfer to hospital a child who has been remanded to a youth detention accommodation by the Crown court, even if they urgently need in-patient care for mental disorders. That really does seem to be an anomaly. Such power exists for magistrates court remands, so clause 39 rightly corrects this, and I support it. Do we know how many children have been affected by that gap since 2012? I ask because if this is to come into law with immediate effect, it will have an immediate resource effect. We of course want to make sure that everyone—particularly young people—is in the right place. The fact that some of them legally are not may well cause another problem for us all.

Finally, I turn to clause 40, which appears to be a technical clarification of schedule 1 of the 1983 Act, confirming that the whole of section 66(2)(d) is disapplied for unrestricted part III patients. It clarifies the right of application to the tribunal, and to me it seems uncontroversial and helpful.

I acknowledge the thoughtful work being proposed in these clauses, and I understand what they are trying to do. They represent a clear attempt to modernise and humanise the way the Mental Health Act applies to some of the most vulnerable and high risk patients in our system, but we must ensure that any new powers, particularly those involving deprivation of liberty and retrospective legislation, are subject to clear safeguards, scrutiny and proper resourcing. I look forward to hearing the Minister’s response to my questions.

Mental Health Bill [ Lords ] (Third sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Dr Evans]

My hon. Friend is right: we agree that this is not a place for the police unless there is an absolute sign of criminal intent. The problem is that what happens is a member of the public sees something, reports it to the police and, naturally, it is the police, the fire service or the paramedics who come forward. If a person is unsure about someone behaving in an irrational manner, which by definition someone with a mental health issue could well be doing, the likelihood is that they will call the police and the police will be the first responders. We know that they tend to be the fastest to respond.

Slightly widening and refining the definition of who can respond would allow us to build a framework and culture that might encourage a first responder—we often say that the AA is the fourth emergency service; it may well be that mental health services would be the fifth emergency service and could respond. That is what we need for service provision. The idea behind this is to try to crowbar the police out of that position, unless absolutely necessary, as my hon. Friend rightly says. Allowing a new framework would be good for safety and good for the police, because they would be freed up to do other stuff. More importantly, it would get the care as quickly as possible to the people who need it the most.

[Anna Dixon (Shipley) (Lab)]

I think there is some agreement between us, in the sense that obviously a police officer is not necessarily best placed to deal with those who are in mental distress. Having spoken to my local police team, I know that they would much rather there were frontline mental health professionals with the capability to take a person to a place of safety that is not a police station. We will come on to that in relation to later clauses, but does the hon. Gentleman agree that we already have some highly skilled professionals who are closely involved in these decisions in the form of approved mental health professionals? The vast majority of them—95%—are social workers. They play a very strong and excellent role, particularly to counterbalance the narrower clinical health perspective that there may sometimes be. Does he agree that, in a way, we already have in place some highly skilled individuals who are closely involved in making sure that these decisions are made in the best interests of the patient and the public, but also with clinical input?

[Dr Evans]

The hon. Lady makes an incredibly important point about the range of people who can and do respond in such cases. The Opposition are not saying that is a problem; we want to support them by giving them the legal backing and framework to step up to be the first port of call. Unfortunately, by default it is always the police, because they are the only ones whose ability to deal with such situations is covered. The amendment aims to create a culture so that the people she mentions have the confidence to deal with them, and the accountability so that we can say, “The police should not be there first; it should be the first responders that we have.” We are starting to see cross-fertilisation; we are simply providing a legal framework that says that this should be the way forward by default and design, not an exception where people are working around the system.

I think we are on the same page here. It is about the nuances of how we do this, and whether it requires primary legislation. The House of Lords voted that it requires primary legislation, and the Opposition share that belief. That is why I am asking Government Members to reconsider when the amendment comes to a vote whether the balance is right because we would give people the security, legal certainty and ability to do exactly what they want to do, which is to care for patients, not worry about whether there will be some criminal side to the situation, and what the police interaction could be.

[Anna Dixon]

Obviously, the Lords amendment puts the role of the police into law. I think we agree that we do not want to have the police’s role enshrined in legislation. Over the implementation period for this important Bill, the idea is that community health services will be in place, including urgent response for those who find themselves in crisis. We need to remove this provision to make sure that the default position remains for community support.

Mental Health Bill [ Lords ] (Second sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Evans]

I rise to speak to Liberal Democrat amendments 8, 47 and 9 to clause 4, which seek to expand the scope of the at-risk register, define risk factors and protect children and young people from unnecessary detention under the Mental Health Act.

Let me start by acknowledging the intent behind the proposals. There is genuine merit in ensuring that those who are at risk of detention, particularly children, are visible to the system before crisis point. That view is shared on both sides of the House. I also share the concern that we are too often intervening too late, after a child or young person has already reached breaking point; I would add families to that, because they also bear a lot of the brunt, especially when it comes to waiting. By extension, when there are waiting lists, as the hon. Member for Winchester mentioned, the clinicians themselves—often the GP—will struggle to deal with patients and families when they do not have the clinical expertise necessary for the most severe interventions.

Amendment 9, which would include all under-18s at risk of detention on the register, reflects that preventive ambition. Likewise, the proposed list of risk factors, including bereavement, homelessness and domestic abuse, rightly recognises the social determinants of mental ill health, which are all too often overlooked. However, I have some reservations about the proposals in their current form.

First, on the register for all under-18s, expanding the duty so broadly raises serious questions about safeguarding, data protection and deliverability. Children and young people are already subject to multiple overlapping systems, from social care to CAMHS and education, health and care plans. Before laying on a new national register, we should ask what safeguards will be in place, who will manage the data, and how it will integrate with existing responsibilities such as those under the Children Act 1989 and the special educational needs frameworks.

Secondly, although I agree that we must understand the drivers of detention, the list of mandatory risk factors, including miscarriage, bereavement and even armed conflict—all of which are profoundly serious—could widen the scope of the register so far that it loses operational focus, as we have heard. That is why the Opposition have tabled a later amendment to define it as childhood trauma instead, which is a more encompassing way of dealing with it. Also, we risk casting the net too wide without necessarily improving outcomes for targeting the right support or, conversely, missing something. For example, looking at that list, I would argue that gang violence or gang involvement is a key factor that Members on both sides of the House would agree is very pertinent, and yet it is not mentioned. Therein lies a problem.

Thirdly, amendment 9 seeks to prevent the detention of children and young people unless it is absolutely necessary, which is a principle that I wholeheartedly support, but how do the Lib Dems propose that it be enforced? What levers are in place if a service fails to deliver that community-based service? Without resourcing CAMHS, investing in crisis alternatives and reforming commissioning models, the duty risks being symbolic rather than systemic. In essence, the hon. Member for Winchester is trying to make the point that we should have these discussions.

Although I support the goals of the amendments—visibility, prevention and early support—I am not sure that the specific mechanisms in them are the best way to safeguard achieving them. Instead, I wonder whether consideration has been given to piloting regional early intervention panels for under-18s at risk of admission, building on existing safeguards in educational frameworks, rather than creating separate registers. Alternatively, we could include risk indicators in statutory guidance, rather than setting them rigidly in legislation, which I think was the point made by the Government. That would allow some clinical judgment and flexibility. Above all, we must ensure that ICBs are not just given duties, but held to account. How are they are going to deliver them? That means having the right metrics and oversight and a strong role for advocacy and families.

[Anna Dixon (Shipley) (Lab)]

The shadow Minister is making some useful observations about best practice. One of the real injustices that we are seeing with detention at the moment is the racial disparities in detention rates. One could argue that such a disparity is a potential risk factor, but behind it is something that we should be addressing through dealing with inequalities in the mental health system, particularly the unwarranted variation in practice from clinicians perhaps making discriminatory judgments in these cases. Does the shadow Minister agree that that is another reason why we should not be over-specifying some of these points where we see associations between risk factors and detention rates under the Mental Health Act, and that therefore we should not be including them in the Bill?

[Dr Evans]

I entirely agree with the hon. Lady’s end point and with the thrust of what she says. Causality is not causation, and we need to be very careful. When we get to the later clauses of the Bill, that will be at the forefront of our discussion.

We cannot deny the reason we are having this legislative debate in the first place: the observation that black men in particular are subject to community treatment orders far more than any other group in the country. However, we must not make a lazy causal analysis and say, “Well, just because that is the case.” For example, black men have a higher risk of prostate cancer, and white people a higher chance of coeliac disease, because of the genetic basis. Is there something in that? Is there systemic bias by clinicians, as she hinted? That all needs to be explored.

The hon. Member for Shipley beat me to the punch when it comes to my closing statement. We owe it to our children and young people not to legislate in haste, so I welcome the spirit of the amendments, and I welcome the debate, but we must be careful to ensure that we are truly legislating for and defining exactly what we know. Otherwise, we risk creating other inequalities and unintended consequences or, worse still, a system that becomes even more flabby and difficult to manoeuvre through. That is the last thing we want for our patients, clinicians and the public.

--- Later in debate ---

[Dr Evans]

Far be it from me to tell the Minister what to do, but if I were a wise Minister, I might look at where my predecessors had benefitted from further information and where they may have stumbled. The Bill has been looked at for a number of years by many people from outside and inside the House. Many have been involved throughout its progress, including a former Prime Minister, who tabled amendments in the other place. There is definitely the ability to learn from what the last Government found and to use that information in the kinds of plans that we need.

[Anna Dixon]

The hon. Gentleman elaborates on the great history of the previous Conservative Government. From where I am sitting, the record is less rose-tinted—but perhaps I am wearing different spectacles. Might he return to the substance of new clause 11, which, it seems to me, is about community provision? I return to the points that I raised earlier about proposed new section 125E. I do not see what new clause 11 adds to the Bill in regard to duties relating to the commissioning of services. I encourage him to address the specifics of the amendment.

--- Later in debate ---

[Dr Evans]

Let me address these points, then I will be happy to give way. When we come to clause stand part, I will address the other amendments, but I specifically said that my comments would be on new clause 11. When scrutinising the Bill, it is important that we talk about how we will deliver, as the hon. Member for Shipley rightly pointed out. It is entirely right to try to put together a plan to ensure that the Government are held accountable. We are not saying how the plan should be formulated; we simply stipulate that a plan should be formulated and introduced. That is a very different argument.

My concern about previous Lib Dem amendments was that they were too specific. We have to get the balance right. New clause 11 simply provides that the Government have 18 months to introduce a fully costed plan, so that we can again have a debate in this House. Especially as a spending review will, I believe, be announced tomorrow, we need to consider how we will match budgets in the future. We accept that it is a 10-year project.

[Anna Dixon]

Will the hon. Gentleman give way?

[Dr Evans]

I am still addressing the hon. Lady’s first point. The Conservatives understand that it will take a long time to put in place, but a credible plan is needed. There was a credible plan in place, as I have said, in the 2011 and 2016 strategies, with the funding to match. I use that as an illustration because it is provides an apt evidence base for the new clause. Otherwise, I might well be challenged by someone saying, “What is your evidence base of a delivery network and a delivery ability from a Government?” I hope that by talking through these points, I am giving the Government the chance to learn from the mistakes we made and from the way we took forward mental health. Regardless of political party, I hope hon. Members that the debate has moved on a long way from when we started in 2010 with the work done partly under the coalition Government. I will now take the intervention.

[Dr Evans]

There is quite a lot to unpack in the hon. Lady’s intervention. As I pointed out, reflecting on what the previous Government learned is also important—for example, when considering Wales. Objectively, the data shows that Wales is struggling more than England, and the same is true of Scotland. Wales and Scotland have been run by different parties from England for a long time, so my natural inclination is to attack back and say, “Well, actually, the Conservatives did better,” but my fundamental point is that we all need to do better because we have seen the problems rising. As I mentioned, over the last 10 years the number of people turning up in mental health facilities has increased by a quarter.

On the hon. Lady’s point about people with autism and learning disabilities, I sat on the Health and Social Care Committee that looked specifically at that issue. We looked at some of the best models in the world, including that of Trieste, where community care is in place. When we took evidence, we found that most people were supportive of that model, but fearful people did come forward to say that the community was not the best place for their daughter, son, husband or wife. Managing the nuance is really important. It takes time to get this right. In 2018, when the last Government looked to legislate on this issue, there was pre-legislative scrutiny, which does not always happen in this place. It was done because there was fundamental agreement that we must get the legislation right, because it applies to the most vulnerable people.

The hon. Lady is right that Lord Darzi identified three shifts that will be really important, but when he looked at this issue, he missed a fundamental point. His report starts from 2010, but when I was a junior doctor— I qualified in 2007—we had issues that affect the culture now: for example, how we managed MRSA and C. diff. That was not a brilliant time to be a patient. The medical training application service fiasco affected doctors applying for jobs so much that in 2004 the Government had to apologise and change the system, because so many people who wanted to get into specialist training could not go through that service.

We are still paying for IT infrastructure that the last Labour Government tried to introduce. The last report, in 2018, said that that cost the taxpayer almost £14 billion. We wonder why, when we try to make a shift to introduce more tech, as recommended by Darzi, people in the NHS are reticent, but they have been burnt by IT projects before. They have seen what happened under a Conservative Government, a coalition Government, and a Labour Government. All that has an immediate and impregnable effect on the legislation and the practicalities that we are dealing with today.

I am not trying to talk facetiously about the legislation; the point is to give some pragmatic direction and to actually say something tangible. On that basis, I look forward to the Minister hopefully supporting proposed new clause 11, which would give the Government the flexibility to have a plan that they choose, as is their democratic right, but also the safeguards to know that it will be delivered and we will not have more delay. There is a balance between making legislation in haste and making sure that we avoid inaction. Would the hon. Member for Shipley like to intervene?

[Anna Dixon]

Yes, briefly. I was trying to get the hon. Gentleman back to the point, which is people with autism and learning disabilities, rather than mental health policy in general. The point of reference I used earlier was the failure to deal with Winterbourne View in 2012. My hon. Friend the Member for Thurrock made the point very well: if we get down to it, we are talking about community provision for people with learning disabilities and autism. Too many people remain institutionalised, too far from their family, friends and community. I was pointing at that failing. I encourage the hon. Member to get back to that point. Would you like to give clarity on what is within scope of the group of amendments that we are currently debating, Ms Furniss?

[Dr Evans]

You may want to set me straight, Ms Furniss, but as we have agreed, I will directly address those points in the clause 4 stand part discussion. The hon. Member for Shipley rightly talks about community settings, but where does she think primary care staff come from? They come through medical training. When we talk about the Darzi impact, it is important that we fully understand why people choose not to go into mental health or primary care and become a GP. Without establishing that, which is a problem that this Government have to deal with, we will run into real problems when it comes to delivery.

Mental Health Bill [ Lords ] (First sitting)

Debate between Anna Dixon and Luke Evans

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the Minister for his collaborative tone on some of the difficult amendments that we have discussed.

I will open where the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), left us on Second Reading. As he rightly emphasised, the importance of updating the Mental Health Act cannot be overstated. I fully share his view that it was right to take the necessary time to get this legislation right. The cross-party commitment to reform in this area, spanning both previous and current Governments, reflects a shared recognition of the urgent need to modernise our approach to mental health, particularly for those who are most vulnerable.

I welcome the Bill’s focus on enhancing patients’ voice and autonomy, including through the expansion of independent advocacy and the shift away from using police and prison cells as a place of safety. Those are positive and overdue steps. At the same time, as my right hon. Friend outlined, the Opposition’s role is to engage rigorously and constructively with the details of the Bill. Over the next few weeks, I look forward to working with colleagues on the Committee to ensure that, for example, the principle of patient choice is embedded not only in policy but in practice, such as through the use of advance choice documents.

We will continue to scrutinise the Bill in good faith, proposing improvements where needed, with the aim of delivering the strongest possible protections and outcomes for patients, their families and the community. How we begin a conversation often determines whether it becomes dialogue or dispute, so I hope that the Committee can take a constructive and productive look at what lies ahead of us.

I support clause 1, which will rightly update section 118(2B) of the Mental Health Act 1983 and embed a refreshed code of practice at the very heart of the mental health framework. This is not merely a procedural amendment; it is a statement of values, placing humanity, dignity and recovery at the centre of how we treat some of the most vulnerable people in our society, who are profoundly affected by mental health legislation. It is vital that the framework guiding professionals be clear, principled and rooted in respect for individuals.

Why do we need these changes? For too long, the Mental Health Act has been criticised as outdated and insufficiently centred on patient autonomy and dignity. Concerns raised by successive independent reviews, clinicians and, crucially, by people with lived experience have pointed to inconsistencies in how decisions are made, which can often result in over-restriction, lack of patient involvement and insufficient therapeutic focus.

The independent review of the Mental Health Act, which was published in 2018, made a landmark contribution by recommending the adoption of the four core principles in front of us today: choice and autonomy, least restriction, therapeutic benefit and recognition of the person as an individual. These principles are designed to shift the culture and practice towards one that respects autonomy while safeguarding wellbeing and public safety.

The historical context is that the Mental Health Act has undergone several amendments since its introduction—notably, in 2007, updates were made to some of the detention criteria and safeguards—but it was clear that the Act remained predominantly paternalistic. The 2018 independent review was a comprehensive, evidence-based re-examination of the entire Act, informed by extensive consultation, including with patients, families and clinicians. It concluded that embedding the principles formally into the law and code of practice was essential to modernise and humanise mental health law.

The four key principles—choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be treated with dignity—are not abstract ideals. They are the foundations of compassionate, lawful and effective care. They echo the spirit of the UN convention on the rights of persons with disabilities and signal a move away from paternalism and towards genuine co-production of care plans. Involvement ensures that decisions are not made about patients without them. The principle of choice and autonomy reminds us that the mental illness must not be a justification for blanket restrictions. The principle of least restriction challenges us to find community-based alternatives before defaulting to detention. Therapeutic benefit ensures that care is not custodial, but meaningful healing. These principles are what most of us would hope to see for our own family.

[Anna Dixon (Shipley) (Lab)]

I thank the hon. Gentleman for his comments. Does he agree that the Wessely independent review setting out these four principles gets right the balance that even though people may need to be detained, they should not lose their personhood and control, and that embedding these principles in this updated Bill will ensure that those rights are enshrined in law?

[Dr Evans]

The hon. Member is absolutely right. The key part is about trying to change not only the legislative framework, but the culture around clinicians and society as a whole. We saw that impact in 1983, we saw it in 2005 with the update on capacity, and we saw it in 2007. Now is the right time to look again at this, and it is well overdue.

I am glad that it has taken a while to ensure that the Bill has been thoroughly thought out. As we heard in the House of Lords debate, this is exactly the kind of framework that we need to make sure that society moves forward in a collaborative way that puts the patient at the centre, but also protects the wider community. Given some of the high-profile incidents that we have seen, we must also make sure that relatives, the community and the wider public at large are all protected.

As the Minister has rightly highlighted, the core principles must be the default for everyone. Clause 1 therefore represents an important step forward: by requiring the Secretary of State and the Welsh Ministers to include the four principles explicitly in the code of practice and by making it a legal duty for decision makers to have regard to them, the clause will strengthen the ethical foundation of mental health law. However, we must be honest about the challenges. The success of the principles depends on the culture, not just the codification. Training, supervision and leadership across clinical settings will be essential to bringing the values off the page and into practice.

These principles will also require resource backing. We cannot call for the least restrictive or most therapeutic interventions while community mental health services remain as they are. A plan for investment and a timeline for delivery will be imperative, or else we risk embedding principles we cannot fulfil. Members on both sides of the House understand that. I know that the Minister will have to think carefully about setting out a timetable, but it is key.

We must also guard against tokenism. We must guard against lofty principles being left unenforced and becoming rhetorical wallpaper. If we are to legislate for these values, we must look for accountability, with regular auditing, patient feedback mechanisms and a duty on the provider to report on how the principles are being upheld. Those are all areas that His Majesty’s Opposition will scrutinise.

To that end, I wish to raise several important questions for the Government and the Committee to consider. The first is about enforcement and accountability. How will the Government ensure that decision makers truly have regard to the principles in practice, and is there a robust mechanism for monitoring compliance and addressing breaches?

The second question is about balancing conflicts. In some cases, principles may conflict: for example, the imperative to respect patient autonomy may clash with the need to impose restrictions for safety. How does the code intend to guide practitioners to navigate these difficult trade-offs?

The third question is about care and interested parties. Although the clause highlights patient involvement, what explicit protections and roles will be afforded to carers and other interested parties, and how will their sometimes divergent perspectives be balanced?

The fourth question is about training and resources. Embedding the principles requires more than words on paper. What investments are planned to equip practitioners with the skills and understanding necessary to apply these principles sensitively and consistently?

The fifth question is about the timeline and consultation. The explanatory notes mention that the code must be consulted on and presented for scrutiny. What is the proposed timeline for that process, and how will people with lived experience continue to be involved?

--- Later in debate ---

[Dr Evans]

I rise to speak to amendment 56, tabled by my hon. Friend the Member for Runnymede and Weybridge. The amendment proposes to grant the Secretary of State the power to update the definitions of “mental disorder”, “autism”, “learning disability” and “psychiatric disorder” by secondary legislation, subject to affirmative resolution by both Houses of Parliament. Currently, the Bill sets out fixed definitions of those terms in the primary legislation—the Mental Health Act, as amended. Those definitions can be changed only through further primary legislation. That means that any further change, reflecting new scientific knowledge or evolving clinical consensus, would require a full legislative process. Given that the Act was passed in 1983, and we are here more than 40 years later, I think that the problem is clear.

[Anna Dixon]

Does the hon. Gentleman recognise the work of the World Health Organisation in producing the international classification of diseases and ICD-11, which provides a scientific, evidence-based update, including on psychiatric disorders, autism and other neurodevelopmental disorders? Has he considered whether that is an appropriate reference point for the Bill?

[Dr Evans]

The hon. Member makes a good point. We have had ICD-10 and DSM-5, which aim to codify those disorders. Part of the problem is that someone with Korsakoff syndrome, which is brain damage from alcohol, or with Rett’s disease would potentially come under the scope of these definitions. That makes it very difficult. What about acquired brain injury? That is an emerging field—the House has looked at it and has put a strategy in place. However, there could be problems in the legislation going forward.

The amendment is asking, I think, how we scientifically proof the Bill so that we do not need to introduce further primary legislation. That is the question that the Government need to grapple with. As a doctor, I have seen the difficulties and practicalities of these definitions, and of trying to put people in a box. For example, where does Asperger’s fit on the autism scale? What does that look like on the spectrum of conditions? Are we trying to codify that? These are the real, pragmatic problems of putting definitions in place. That means it is all the more important to look at definitions, but, as the hon. Member for Shipley has rightly pointed out, the definitions have already moved on while we have been discussing the Bill. Introducing a mechanism that allows the House to update the legislation in keeping with advances in scientific knowledge is really important. The question is whether this is the right amendment to do that.

The amendment would allow the Secretary of State to make updates through regulations—secondary legislation—which would thereby enable a more flexible and responsive approach. Importantly, it requires that any such regulations must be laid before Parliament and approved by both Houses, which maintains parliamentary scrutiny and democratic oversight.

The potential benefits of this approach are clear. It offers the possibility of allowing the law to evolve and stay aligned with scientific evidence and clinical best practice without undue delay. That could prevent outdated or overly rigid definitions from adversely impacting vulnerable people, and better reflects the complexities of mental health conditions. It would allow the law to keep pace with advances in the scientific understanding of autism, learning disability and mental disorders, without the need for primary legislation. It could help ensure that the definitions remain clinically accurate and relevant, improving how the law is applied and reducing the risk of outdated criteria causing harm or confusion.

As the hon. Member for Shipley pointed out, that is part of the problem. As new criteria come up, there is a delay in the uptake of definitions. From my experience in clinical practice, keeping up to date with definitions can sometimes be a challenge. It is part of the personal development plan to make sure there is that understanding, but there is always a drip through as change in practice comes through, along with clinicians being comfortable and happy to use the new definitions. With any new medication, it is important to understand the side effects and the pros and cons of what it is trying to achieve, and to be able to explain that fully so that a patient can consent when taking that medication. The same applies when trying to explain a condition to patients. If there is a change and a new aspect to the way in which a definition is being applied, it is important that we have some flexibility.

The affirmative procedure preserves Parliament’s role, offering safeguards against unchecked ministerial power. However, there are some important considerations and potential drawbacks. Definitions of mental health conditions have profound legal and social implications. Delegating this power, even with parliamentary approval, risks politicisation or inconsistent application if regulations are used too frequently or without adequate consultation.

Secondary legislation typically receives less parliamentary debate and public scrutiny than primary legislation, even with the affirmative procedure, which may not suffice for such significant changes. There is also a risk that the changes could be made in a reactive or piecemeal way rather than with a coherent legislative framework, potentially leading to legal uncertainty or unintended consequences.

Given those points, I have several questions for the Minister. How do the Government propose to keep the legislation updated, given that we are only updating the Mental Health Act now, 40 years on? Do they have a mechanism in mind to ensure that any updates to the definitions are accompanied by robust clinical and expert consultation, while reacting to advances in medical understanding? Would the Government consider a formal review mechanism such as a mandated periodic independent review of the definitions? That could solve the problem of legislation becoming outdated, and put the safeguards in place. If there is a difference in the scientific community, we need to make sure that any changes are broadly in agreement with the direction of travel of scientific knowledge.

Furthermore, in considering the need for balanced, flexible and democratic accountability, the Government could introduce a sunset clause on any regulations, so that any changes would be revisited and renewed by primary legislation within a set period, unless Parliament agrees otherwise.

Crucially, to my knowledge, there are no standing statutory bodies or panels tasked with reviewing or advising the Government on the legal definitions of mental health conditions. There is an argument that without a dedicated expert body to guide the Secretary of State, we cannot be sure that any changes are robustly evidence-based and clinically sound. Currently, we have the National Institute for Health and Care Excellence, the royal colleges, the Department of Health and Social Care and the intermittent mental health review bodies, but have the Government considered establishing a formal advisory mechanism to address problems in the future? The Opposition can see the argument both ways, but to govern is to choose, and it would be useful to understand the Minister’s thoughts on this area.

[Anna Dixon]

The hon. Gentleman seems to be overcomplicating the need for additional scrutiny. Will he acknowledge the work of the World Health Organisation to review the evidence on a global basis and update the definitions of psychiatric disorders?

[Dr Evans]

The hon. Member is correct about the way in which the world looks at this issue. The problem is that we are sat here debating definitions in legislation that is 40 years old. Will we be here in 40 years debating definitions that have moved on? The amendment suggests that, somehow, we need to try to ensure that legislation is flexible and updated enough, and has the scrutiny and safeguards in place. That relates to not just health, but any part of government that we tend to look at in the House.

I wanted to speak to the amendment to probe the Government on how they will safeguard the legislation. I do not have all the answers, but this is important. I do not want to see my successors—the hon. Member for Hinckley and Bosworth from whatever party—sat here debating this issue in 40 years’ time because the definitions that we happen to set today have become outdated and have unintended consequences.

That is the balance that I am looking for. I do not see a body across the UK, given that this is UK legislation, that fulfils this role. It could be a transitory role or fully established. A psychiatrist could take it on, or it could come under NICE. With the abolition of NHS England, it could be a new role for the Department of Health to take on. All those are viable vehicles that could potentially look into the definitions. I want to ensure that what we pass in Parliament actually translates into the real world for clinicians, patients and the public.

The Opposition can see the argument both ways, as I mentioned. Perhaps it would be useful to have an expert panel, with representatives of clinicians, legal experts and service users to support regulatory updates. I put those questions to the Minister and I look forward to his answers.

--- Later in debate ---

[Dr Evans]

It is a pleasure to speak to clause 3, which brings forward the vital and long overdue changes to the way our laws treat autism and learning disabilities under the Mental Health Act. The clause responds to a persistent injustice: the inappropriate detention of autistic people and people with learning disabilities in mental health hospitals, often for years at a time, without meaningful therapeutic benefit. Those individuals are not mentally ill, yet they have too often been detained, medicated and restrained as if they were.

As the law stands, individuals with learning disabilities and autistic people can be detained both for assessment, under section 2 of the Act, and for treatment, under section 3. Notably, people with learning disabilities may be detained under section 3 when their condition

“is associated with abnormally aggressive or seriously irresponsible conduct”,

whereas that does not currently apply to autistic people. Evidence and reports show that some such detentions can be lengthy and may not always provide therapeutic benefit. That raises concerns about the appropriateness of detention on the basis of disability alone. In my time on the Health and Social Care Committee, we looked specifically at this topic and produced a report, some of which has influenced the Bill.

The clause aims to directly address the issue of lengthy detentions for such individuals. For the first time, the law will clearly define autism and learning disability—something that has not happened for 40 years. As science has moved on, legislation must follow. Autism will now be recognised as a “lifelong developmental condition” that affects perception, communication and interaction, and learning disability will be defined as “significant impairment” of intellectual functioning.

Supported by schedule 1, the clause seeks to clarify and refine that position by introducing formal definitions of “autism”, “learning disability” and “psychiatric disorder”. Crucially, it removes autism and learning disability as stand-alone grounds for compulsory treatment and detention under section 3. Instead, detention for treatment will be permitted only if a person has a co-occurring psychiatric disorder—that is, a mental disorder other than autism or learning disability. Additionally, the change applies to community treatment orders, meaning that they cannot be applied solely on the basis of autism or a learning disability. However, the Act makes it clear that the changes do not apply to people detained under part 3 of the Act who are within the criminal justice system. For that group, autism and learning disabilities with serious behavioural consequences remain grounds for detention and treatment disorders.

The Bill introduces the new term, “psychiatric disorder”, meaning any mental disorder excluding autism or a learning disability. That distinction matters because detention under section 3 of the Act—compulsory admission for treatment—will no longer be permitted solely on the basis of someone being autistic or having a learning disability. From now on, a person may be detained only if they have a co-occurring psychiatric disorder or their learning disability is associated with “serious behavioural consequences”, such as

“abnormally aggressive or seriously irresponsible conduct”.

That reflects a fundamental shift in the philosophy of the Act from using hospitalisation as a containment tool to ensuring that any detention has a clear clinical and therapeutic purpose.

This reform is rooted in the recommendations of the 2018 review of the Mental Health Act, which was led by Professor Simon Wessely, and has been championed by groups such as the National Autistic Society. It represents a more modern understanding, as we currently see things, so there are many positives—it protects people’s rights, preventing detention simply for being different, it promotes community-based care rather than institutionalisation, it modernises the law in line with current clinical understanding and it seeks to end the harm caused by prolonged non-therapeutic hospital stays, which often involving over-medication and restraint.

However, I also sound a note of caution: the clause alone will not be enough. There is rightly concern about the provision for robust community services. We risk creating legal protections that are admirable on paper but ineffective in practice. I know that the Minister appreciates this dilemma. If people cannot get the right support in the community, they will still end up in crisis, and possibly still be detained—just under a different part of the law.

There are also concerns about ambiguity. The phrase “serious behavioural consequences” may be open to a wide interpretation. Without clear guidance and training, we risk inconsistencies and even potential loopholes that could undermine the intent of this reform. I commend the Government’s intention to protect autistic people and people with learning disabilities from potentially inappropriate detentions, and to ensure that compulsory treatment is targeted to those with mental disorders warranting hospital care.

The emphasis on therapeutic benefit and the principle of least restriction aligns well with the human rights standard and the UN convention on the rights of persons with disabilities. However, I have several questions that I hope the Government will be able to address. How will clinicians reliably distinguish between behaviours arising from autism and learning disabilities and behaviours arising from co-occurring psychiatric disorders, given the complexity of presentations in this population? Is there, or will there be, clear guidance and training to support those assessments? For individuals with severe autism or learning disabilities who display challenging behaviours but do not have a diagnoseable psychiatric disorder, what alternative pathways and supports are envisaged to ensure their safety and wellbeing without resorting to detention?

On the issue of patients under part 3 of the Bill, I know the Government’s rationale for maintaining broader detention definition criteria, but will there be additional safeguards or oversight to ensure those patients are not subject to unnecessarily prolonged or restrictive detention? The removal of “social functioning” from the definition of learning disability is intended to create a clearer distinction from autism, but could the changes create any unintended legal or clinical ambiguities in practice?

The changes could introduce some unintended consequences. Previously, impairments in social function were considered part of the learning disability definition, which helped capture individuals whose social difficulties accompanied intellectual impairments. Without that, there may be legal and clinical uncertainty for people with borderline or overlapping conditions. For example, someone with moderate intellectual impairment and significant social difficulties might no longer clearly fit the learning disability definition. Similarly, autistic individuals with mild intellectual disability who experience social challenges could find their diagnosis and legal status less certain. Those ambiguities risk inconsistent assessments and potential gaps in access to appropriate care unless the Government provide clear guidance to clinicians and tribunals on how to navigate complex presentations. What plans are in place to monitor and evaluate the impact of the changes on detention rates, patient outcomes and the availability of community-based alternatives?

In closing, this is an important clause that moves us closer to a system that respects autonomy, delivers appropriate care and upholds the rights of neurodivergent people. But we must be mindful that passing this legislation must not be seen as the end of the job. As the Minister understands, it is the beginning. If we are to drive reform, the Government will need to set out the funding and workforce pathway for the services that will deliver it. We must train professionals, empower families and support voices of lived experience at every level. Only then will clause 3 deliver on its promise not just to change law, but to change lives.

I turn to schedule 1. Schedules are an important and yet often overlooked part of the legislative process. It is worth reminding the Committee that a schedule is a part of a Bill’s function, like a detailed appendix. It contains the granular, often technical amendments that give practical and legal effect to the broad principles set out in main clauses. In other words, the clause tells us what Parliament intends to do and schedules show us how it will be done: amending existing statutes, updating definitions and ensuring consistency across legal frameworks.

In this Bill, schedule 1 is particularly consequential. It does the heavy lifting of applying the reforms in clause 3 to the existing Mental Health Act 1983, especially with regard to how we treat autism and learning disabilities within the scope of mental health law. Let us be clear that the schedule is not simply technical. It is transformational in what it attempts to do. Where the 1983 Act spoke broadly of mental disorder, schedule 1 now creates a more precise legal category—“relevant disorder”—defined to include psychiatric disorder, autism and learning disability with serious behavioural consequences. That matters enormously. In fact, it is one of the key reasons for the review of this entire piece of legislation. Individuals with autism or learning disabilities have been subject to compulsory powers, including detention, as we have heard, in the absence of any co-occurring mental illness. That is a practice with which the Committee should rightly be uncomfortable.

Schedule 1 amends not only the criteria for compulsory admission under section 3, but those for guardianship, community treatment orders, tribunal discharge and even the treatment provisions in part 4 of the Act. This breadth shows that clause 3 is not merely a rhetorical shift; it is being operationalised throughout the entire Act. With such significant implications, the schedule raises serious and legitimate questions that I am sure will form the backbone of the ongoing discussions in Committee over the next few weeks.

First, what is the threshold for serious behavioural consequences? Will that be clearly defined? Without precision, we risk substituting one vague standard for another. Secondly, do the transitory provisions offer enough clarity for frontline practitioners, in particular approved mental health professionals and tribunal panels who will be making decisions in grey areas between new and old law? Again, what about the cross-border issue between Wales and England? Thirdly, given the change from mental disorder to psychiatric disorders in some sections but not others, what is the Government’s rationale for that linguistic differentiation? Is there a risk of confusion among legal and clinical practitioners? To clarify—I am happy to share this with the Minister—I went through it and there appear to be a few occasions where the definition was changed, but some areas where it was not. Now, that may be my naïve understanding as a mere shadow Minister, but I would welcome the clarification and I am happy to pass them on to the Clerks to ensure that, if we are going to update the Bill, all parts are updated. Finally, and critically, do we have the workforce, training and services in place to support this cultural and clinical shift away from paternalism towards community-based and rights-respecting alternatives?

Schedule 1 shows us that reform is not just about good intentions, but getting the detail right. It is about ensuring the law reflects modern clinical understanding and human dignity. I support the direction of travel, but I gently remind the Minister to ensure that the operational mechanisms of the schedule are tested, clarified and, where necessary, strengthened. We owe that to the individuals and the families for whom we are producing this legislation to improve their lives.

[Anna Dixon]

It is a pleasure to serve under your chairship, Mr Vickers. I will make a few brief remarks on clause 3. For many of us, the detention and long-term institutionalisation of people with autism and learning disabilities is a shameful part of the NHS’s history. The Bill, and particularly this clause, will finally make it very clear that that is no longer acceptable. It is a further shame that, despite the Winterbourne View report in 2012, so little progress has actually been made on providing for people to be cared for in the community and closer to home.