Mental Health Bill [ Lords ] (Seventh sitting)

Debate between Aphra Brandreth and Jen Craft

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak in support of amendment 46, tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, which seeks to strengthen clause 45, an already welcome and progressive clause, by creating a statutory right for all eligible patients to create advance choice documents if they so wish.

Let me begin by saying that I think everyone on the Committee recognises the importance of advance choice documents. They are an excellent initiative, and I am glad that the Bill introduces a framework to support their use. I hope we can all agree that they represent a constructive and compassionate shift in how we think about mental health care—one that puts the patient’s voice at the centre. ACDs are fundamentally about empowerment. They allow individuals, while they are well and have full capacity, to record their wishes, preferences and concerns regarding their treatment, so that during future periods of unwellness, when they may lack capacity, their past self can still be heard and respected. As Bipolar UK has rightly put it:

“The idea behind an ACD is that you use your past to plan your future.”

That simple principle holds immense power. Individuals with lived experience of severe mental illness like bipolar disorder are often experts in their own care. They know what works, what does not and what signs to look out for. An ACD allows that hard-earned knowledge to be recorded, shared and used to guide clinical decisions. By identifying early warning signs and outlining preferred treatments, ACDs can enable families, friends and professionals to intervene earlier, potentially avoiding a crisis or reducing the severity of an episode. This is not just about better care; it is about safer care and, crucially, more timely care.

The research is persuasive. Studies suggest that ACDs can reduce rates of compulsory detention under the Mental Health Act by up to 25%. That is not a small statistic; it is a significant reduction in trauma for patients, in the use of force and in resource pressures on services. It is hard to think of a better example of a policy that both improves outcomes and reduces system strain. ACDs can also play a vital role in reducing inequalities, especially among racial minority groups, who, as we have all said, are statistically more likely to be detained under the Act. Ensuring that those patients can express their wishes in advance gives them greater agency and helps to address long-standing disparities in the system.

ACDs are not just a useful administrative tool; they are, as Earl Howe put it in the House of Lords,

“are a major component part of one of the Bill’s key strands, which is to give mental health patients better control over their own care—which, of itself, carries a therapeutic value.”—[Official Report, House of Lords, 27 January 2025; Vol. 843, c. 79.]

I absolutely agree, which brings me to amendment 46. The clause as drafted places duties on NHS England and integrated care boards to consider making information about ACDs available, and to help those people whom they consider “appropriate” to create one. That is a start, but it falls short of what is needed. The shadow Minister’s amendment would take us further and create a statutory right for eligible patients to create an advance choice document. It would define clearly who is eligible—for example, those previously detained under the Act, those diagnosed with a condition that may require future detention and qualifying informal patients—and would put a clear duty on NHS bodies to inform these patients of their right and to help them to exercise it. This is not about placing a burden on services; it is about ensuring that everyone who stands to benefit from an ACD knows that they can make one and is supported to do so if they wish.

I appreciate that the Government have tabled amendments 32 and 33 to clause 45, and I welcome the intention behind them. Amendment 32 requires that NHS England and integrated care boards must bring the availability of this information and help to the attention of such people “as it considers appropriate.” Amendment 33 expands on how that might be delivered, including through conversations with qualified individuals and by having specific regard to the benefits of ACDs in the 12 months following discharge from hospital.

Although these are improvements, I must respectfully say that they stop short of what is needed. They continue to frame the duty in terms of who the board considers appropriate, yet the very point of ACDs is that we should not be gatekeeping access. We should not be making assumptions about who would or would not benefit from having one. Every eligible patient should be offered the choice, not just those whom the system deems suitable. We are dealing here with people’s autonomy and right to shape their future care, and if we start from a place of selective provision, we immediately disempower many of the very individuals we claim to support.

[Jen Craft]

I would welcome the hon. Lady’s thoughts on where clause 45 or the Government’s amendments allow for selective provision. My understanding is that they place an onus on mental health commissioners to make sure that all those who are deemed appropriate to be in receipt of an ACD should be given the ability to make one. I do not think that is selective; it is very much related to the purposes of the Bill, and it spells out who may come under the provision.

[Aphra Brandreth]

The hon. Lady has just made my exact point: that it is who they deem appropriate. That is the point I am trying to make. It is for the individual—of course, with support of people looking after them—to decide whether it is appropriate for them and to be offered it.

[Jen Craft]

Will the hon. Lady give way on that point?

[Aphra Brandreth]

I will make progress, as I know that a few Members wish to speak on this point, and we have a long day ahead.

I will touch briefly on amendment 18, tabled by the hon. Member for Winchester, which suggests that ACDs should include a person’s financial circumstances. I recognise the sentiment behind the amendment. As both I and the hon. Member for Winchester have said in Committee, financial stress can be a major factor in mental health, but I gently suggest that prescribing the content of an ACD in this way is unhelpful. The point of the document is choice. The individual decides what they want to include, not us. That is the strength of the approach. It is personal and voluntary; it is theirs.

Amendment 46 respects that principle. It does not tell patients what to include in their ACD; it simply gives them the right to make one, and ensures they are informed of that right and supported to act on it. ACDs can be lifesaving, and they help people to stay well, safe and in control. They are especially valuable for those who have been detained before or who are at risk of detention in the future. We know that they are already supported by a wide range of stakeholders and experts by experience.

The question for us is not whether to support ACDs—I think we all do. The question is: do we want to make access to ACDs a universal right for those eligible, or do we want to continue to leave it to the discretion of the system? I believe the answer is clear: we must empower people, honour their voice and do so not only when they are well and able to speak, but when they are unwell and most vulnerable. That is what the amendment seeks to do. I urge all colleagues on the Committee to support amendment 46 and strengthen clause 45. Let us make the right to create an advance choice document a reality for everyone who needs one.

Mental Health Bill [ Lords ] (Third sitting)

Debate between Aphra Brandreth and Jen Craft

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is a pleasure to serve under your chairship, Ms Furniss.

Government amendments 26 to 29 risk undoing some of the good work done in the other place, where careful improvements were made to strengthen the Bill and ensure a more compassionate and effective response to mental health crises. I am concerned that by removing the words

“by a constable or other authorised person”

and deleting clause 5(7), which provides a clear definition of who the authorised persons are, we will open up ambiguity about who is permitted to detain someone under the Mental Health Act. This is not just a technical or drafting issue; it has very real consequences for the people involved.

I understand and support the principle of enabling more flexible and clinically led responses to mental health incidents. We all recognise that the police should not be the default option in every case. The amendments made in the Lords acknowledged that and broadened the group of people who could respond to mental health crises beyond police officers to trained and equipped professionals: mental health nurses, approved mental health professionals, paramedics and, crucially, someone trained and equipped to carry out detentions under the Act and who would not be put at unnecessary risk by doing so. “Trained and equipped”—that is the key point.

The definition of “authorised person” in the Bill as it stands makes it clear that those given such a serious responsibility must have the appropriate training and experience and must not be “put at unnecessary risk” when carrying out that role. That wording is important. As the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, said, it provides a framework of accountability, not a free-for-all. By removing that structure, the Government’s amendments will leave a legal vacuum. The law will say that someone must be detained, but not by whom. That uncertainty will create a risk that services will simply revert to defaulting to the police.

I stress again that that is not fair on the police, who are already under immense pressure. Yes, they are used to seeing people at their most vulnerable, but dealing with someone in a mental health crisis is a very particular challenge, and one that they might not be fully trained to manage. The College of Policing’s 2019 mental health snapshot found that almost 95% of police call-outs flagged as involving mental health did not actually require a police response, yet police officers continue to be sent out because the system lacks clarity and capacity elsewhere.

Baroness May, speaking from real experience as a former Home Secretary, made that very point in the other place. She said that police officers were being sent to mental health incidents for which they had no training or clinical expertise, and were being asked to make judgments that they simply were not equipped to make. She went on to say that

“the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation”.—[Official Report, House of Lords, 20 January 2025; Vol. 842, c. 1525.]

I would add that, for the individual experiencing a mental health crisis, being approached by the police may feel criminalising rather than supportive. It reinforces a justice-led response rather than a health-led one. That is not the direction in which we should be going.

Although I welcome the Government’s intention to offer more flexibility in emergency and clinical settings, we have to be careful about how we achieve that. Removing the wording inserted into the Bill will not create clarity; it will create confusion. In a system already under pressure, confusion tends to mean delay, risk aversion and inappropriate responses. Removing the specification will not free professionals; it will expose them, and it will expose patients to the possibility of being handled by someone without the right qualifications, which may worsen their condition or create a longer-term distrust of mental health services.

I hope that the Minister can offer some reassurances, both about who will be expected to carry out these detentions and about how we can ensure that they have the proper training, resourcing and protection. Without a clear definition of “authorised person”, we cannot be confident that those involved will have the right expertise to support extremely vulnerable individuals at times of acute need.

I want to touch briefly on the importance of early intervention and de-escalation. Situations involving mental health crises can often be tense, and support in the early moments can be critical. De-escalation is a vital skill; the presence of a calm, trained mental health nurse, for example, in those early moments can change the outcome of a person’s crisis. Having the right professional present—someone who can act without waiting for the police to attend—can be the difference between escalation and calm. The identity of the responder matters.

This is not just about outcomes, but about the experience of the individual. Removing the criminal justice framing from the outset is essential to delivering dignity and the right kind of care.

[Jen Craft (Thurrock) (Lab)]

There seems to be some circular talk about the level of risk that clinicians and medical professionals can be expected to shoulder. I notice that clause 5(7), inserted in the other place, specifies that they would

“not be put at unnecessary risk”.

Is there not an inherent risk involved in detaining people who need to be detained under the Mental Health Act? Those people are not in a position to give consent and quite often do not wish to be detained. By stipulating that the police will not be involved in situations or by making medical professionals the first responders, is there not a risk of putting them in harm’s way?

[Aphra Brandreth]

It is extremely important that people are not put at risk, and that is exactly the point I have been making. People need to be properly trained, and we need to set out who those individuals can be, rather than leaving ambiguity in the wording. The Government amendment will undo exactly the protection that the hon. Lady rightly points out.