Mental Health Bill [ Lords ] (Ninth sitting)

Debate between David Burton-Sampson and Jen Craft

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Jen Craft]

I completely agree. The long-term implications and impacts of restraint on health and wellbeing have been widely documented and acknowledged. It is vital, if a patient is subjected to these measures, that their use is recorded and the patient, in turn, can understand why.

The Committee has spent significant time talking about the importance of patient inclusion in their treatment plans. Earlier clauses, which I will not revisit at length, deal with the importance of enabling patients to select how and where they are treated, as well as advance choice documents. They are vital to the patient experience, because they involve and include them in how they are treated. We acknowledge that such involvement has a massive impact on the patient’s ability to heal, get better, recover from their mental illness and, in some cases, get well enough to go home. It is vital, if people are subject to restraint and the use of force, that it is recorded in an appropriate manner.

This new clause seeks to mandate the recording of its use by staff, as well as information such as the member of staff who applied the force, whether they are medical, and, vitally, demographic data. My hon. Friend the Member for Southend East and Leigh—I hope I have that right—

[David Burton-Sampson]

Southend West.

[Jen Craft]

My apologies; they are both lovely places. My hon. Friend spoke earlier about the impact that mental health treatment can have on people in regard to race and ethnicity, and the importance of including demographic data. We know that black people are disproportionately subject to use of force and restraint, which is why recording this data in a mental health unit is acknowledged as important. However, if a patient is subject to restraint outside a mental health unit, there is currently no mechanism to record that.

The new clause would also require the Secretary of State to publish annual statistics on how restraint has been used outside a mental health unit. I believe that the Minister’s predecessor agreed to look at closing this loophole. To date, however, action has not necessarily been forthcoming. People continue to be subject to the use of force or restraint, and we have no means of knowing how often it has occurred, to whom it has occurred or whether it has taken place inappropriately. I encourage the Minister and other members of the Committee to consider how we can ensure that the use of restraint and force is appropriately recorded in all medical settings, not just in mental health units.

Mental Health Bill [ Lords ] (Fourth sitting)

Debate between David Burton-Sampson and Jen Craft

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Jen Craft]

I rise to speak in support of clause 8, and I will briefly speak to the Liberal Democrats’ amendment 12. I have already flagged my concerns with the Opposition’s amendments 44 and 45.

Clause 8 introduces and puts front and centre the notion of therapeutic care for those detained under the Mental Health Act 1983. I strongly welcome clause 8, as drafted. For far too long, for people who have been deprived of their liberty and detained in a secure mental health setting, the main focus has been risk management and harm minimisation rather than therapeutic care.

[David Burton-Sampson]

The Lampard inquiry, which relates to my area of Essex, is ongoing. It highlights the issue of people being detained without any clear therapeutic plan or clinical justification. Does my hon. Friend agree that the clause will start to address some of the concerns raised by the inquiry?

[Jen Craft]

I thank my hon. Friend for highlighting the Lampard inquiry, and highlighting the impact of the treatment that the inquiry is looking at on the lives of the patients who were subject to it. I do not wish to get ahead of the inquiry because it is still under way, but I have met with some of the families involved, and there is a feeling that there has been a complete breakdown of trust in the care of patients in our part of the world. That trust is difficult to rebuild, particularly for people in a locked mental health setting, who have no choice but to trust that the providers of their care are acting in their best interests. The lack of trust is almost harmful to their continued recovery. I thank my hon. Friend for raising that particular point.

As I was saying, for too long the focus in a locked setting has been on management of risk and harm reduction, rather than actually treating the condition that the patient may have. Clause 8 looks almost to reverse that. It advances the idea that therapeutic care is the aim of detention under the Mental Health Act and that it is fundamentally important, when someone is deprived of their liberty, that there is a therapeutic benefit to the patient, and it places that aim in a prominent position at the start of the Act, so that it is not buried further down.

Although I understand that the Minister will probably state that the clause advances the principle of “therapeutic benefit”, I believe it also touches on two of the other key principles developed by the independent review: the principles of seeing “the person as an individual”, and of “least restriction”. We can all appreciate that if someone is in a setting for their own therapeutic benefit, rather than just being contained because of the risk that they might pose to themselves or others, then they are being less restricted, in a way that is real and important to them, and will have the benefit of being seen as an individual. For some individuals who have spent a significant amount of time in a locked unit, the prospect of them receiving therapeutic care is very low, and the prospect of them receiving therapeutic care that leads to them recovering sufficiently to leave those units is about nil.

The talking therapies taskforce highlights that some of the most severely complex patients with personality disorder—the most severe 1.5%—make up nearly one third of the annual spend on in-patient treatment costs. That group of people have very little prospect of receiving appropriate therapeutic care in an in-patient setting. A system-wide change looking at community-based care, sometimes intensive community-based care, would be much more effective than what they currently receive. The cost was looked at in areas in the south-west—in Devon—and in London, and it was found that a third of spending from hospital trusts was going towards this very tiny group of people. That is not to say that we should always look at the cost of care, because that can seem reductive to someone as an individual, but clearly, these people are not getting effective treatment that is good value and makes sense for them.

I would welcome the Minister’s thoughts on developing system-wide and community-based change for some of the most complex cases in an in-patient setting. How does he see the clause interacting with that? Does he believe that providing therapeutic benefit for all patients in a secure setting will have a positive impact on that complex 1.5% group of patients?

I will speak briefly to amendment 12, tabled by the Liberal Democrats. I may have slightly misunderstood the intent of the amendment. It was my understanding that naming the setting where medical treatment takes place—putting it on an equal footing with the treatment—was aimed at looking at the impact on people with learning disabilities and autism. For that specific group, detention in a secure unit is often counter-productive to their recovery. A review undertaken by Baroness Hollins found that there was no therapeutic benefit for long-term segregation of patients with a learning disability, and that attempting to deliver a therapeutic benefit for some of those patients in a locked setting is all but impossible. Although I support looking at whether a specific setting is appropriate for certain groups of people, there needs to be heightened awareness of the impact that a locked setting can have on people with a learning disability or autism.

I spoke about this on Second Reading. If someone is sensitive to over-stimulation and has an increased sensory need, need for routine and need for familiarity, taking them away from a place that feels safe and putting them in a ward with strip lighting—autistic people talk about strip lighting as being particularly harmful—that is noisy, unfamiliar and completely out of their routine can feel extremely harmful. Therapeutic care in that setting may never be effective enough for that group of people to be released. Not to read this against the earlier clauses that take autism and learning disability away from the definition of a mental health condition, which I strongly welcome, I would welcome the Minister’s thoughts on capturing how, for this specific group of people, detention in a secure mental unit is probably more harmful to them than it is for the majority of the population.

I cannot, however, support amendment 12, because of the catch-all nature of looking at the setting in which a treatment takes place. I speak as someone who has had lived experience of this issue and I have to say that quite often a secure unit is probably not conducive to anyone’s mental health; indeed, it is often a place of last resort, and I think that it poses a risk. If we have to take the accommodation into consideration, that might mean that it would never be an appropriate setting for someone to receive therapeutic care, even though we know that quite often it is the only setting where someone can be for a short period.