Mental Health Bill [ Lords ] (Ninth sitting)

Debate between Danny Chambers and Zöe Franklin

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

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

Clause, by leave, withdrawn.

New Clause 2

Mental Health Crisis Breathing Space

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

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

Brought up, and read the First time.

[Dr Danny Chambers (Winchester) (LD)]

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

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

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

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

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

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[Zöe Franklin]

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

Clause, by leave, withdrawn.

New Clause 7

Funding and reporting

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

(a) under the Mental Health Act 1983, and

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

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

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

Brought up, and read the First time.

[Dr Chambers]

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

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

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

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[Dr Chambers]

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

Clause, by leave, withdrawn.

New Clause 15

Review of impact of this Act on detention

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

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

(a) sections 4, 5 and 6,

(b) section 8,

(c) section 21, and

(d) sections 46 and 47.

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

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

Brought up, and read the First time.

[Zöe Franklin]

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

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[Zöe Franklin]

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

Clause, by leave, withdrawn.

New Clause 16

Transfer of patients: out of area placements

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

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

‘19A Transfer of patients: out of area placements

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

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

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

Brought up, and read the First time.

[Dr Chambers]

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

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

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

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[Dr Chambers]

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

Clause, by leave, withdrawn.

New Clause 19

Report and Guidance: Improving Outcomes for LGBT Patients

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

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

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

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

(ii) treatment outcomes following detention, and

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

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

(a) mental health hospitals;

(b) places of safety;

(c) crisis accommodation; and

(d) relevant community mental health services.

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

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

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

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

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

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

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

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

(c) relevant professional bodies;

(d) integrated care boards;

(e) local authorities;

(f) providers of mental health treatment; and

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

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

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

Brought up, and read the First time.

[Zöe Franklin]

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

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

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

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[Zöe Franklin]

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

Clause, by leave, withdrawn.

New Clause 22

National strategy on mental health units

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

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

‘118A National strategy on mental health units

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

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

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

(b) patient-to-staff ratios, and

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

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

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

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

Brought up, and read the First time.

[Dr Chambers]

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

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

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

Mental Health Bill [ Lords ] (First sitting)

Debate between Danny Chambers and Zöe Franklin

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Dr Chambers]

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

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

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

[Zöe Franklin (Guildford) (LD)]

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

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