Mental Health Bill [Lords]

Iqbal Mohamed Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Wes Streeting]

I am very grateful to the hon. Lady for that intervention. The Bill deals to an extent with cases that would fall under the category she describes, in particular through reforms to community treatment orders. However, it would not necessarily cover the full extent of the sorts of people who might find themselves in that position, which is where I think we can use technology—which is not the answer to every problem in the health service, by the way. However, through better use of data, patient records and analytics, we will be better able in the future to predict risk and prevent tragedies as in the case the hon. Lady describes, which are a tragedy not just for those whose lives are cut needlessly short, but for those who live their lives with that intolerable grief and loss for the many years that follow.

It is a shameful truth about our society that people with a learning disability or autism are detained, sometimes for years, with little or no therapeutic benefit. The Bill will put an end to that injustice, limiting detentions so that people with a learning disability and autistic people are no longer detained beyond 28 days unless they have a co-occurring mental health condition that would benefit from treatment in hospital. This will require the necessary community provision in place to support people with a learning disability or autism, and we are working to set out what strong community services look like and on the resources required to implement them, so that there are robust alternatives to hospital care.

To help to plug the flow of inappropriate admissions to hospital, the Bill places a duty on integrated care boards to improve monitoring and support for people with a learning disability or autism who may be at risk of future detention. The Bill will introduce statutory care, education and treatment reviews to ensure that patients are safe and receiving the right care and treatment when detained, and that a plan to discharge them to the community is being worked up. We will also remove prison and police cells from the definition of “places of safety”. Police cells are for criminals, not patients in desperate need of medical help.

Throughout the development of these reforms, we have maintained the central purpose of the Mental Health Act—to keep individuals and the wider public safe. The vast majority of people with mental illness, including severe mental illness, present no risk to themselves or others, and, for the majority of people, treatment can be provided without compulsion. However, there are some people whose illness, when acute, can make them a risk to themselves, and sometimes to others.

No one knows this better than the families of Ian Coates, Barnaby Webber and Grace O’Malley-Kumar, the victims of Valdo Calocane’s violent rampage in Nottingham, whose campaign for justice and accountability has been truly awe-inspiring, or indeed the family of Valdo Calocane, with whom I have also spent time, listening to their experience of feeling badly let down by health services. As the independent investigation into the murders found, both he and his victims were failed by the health service, and their families have been left to live with the consequences with a level of pain the rest of us can scarcely imagine. I would like to place on the record my thanks to all four families for meeting me as my team and I worked on the Bill.

Thanks to the amendments that we are making to the Mental Health Act, decision makers will have to consider the risk of serious harm when making decisions to detain. That will ensure that any risks to the public and patients are considered as part of the assessment process. We will also introduce a new requirement for the responsible clinician to consult another person when deciding whether to discharge a patient, putting in place robust safeguards against the release of potentially dangerous people.

Finally, as I have said, legislation alone will not fix the wider issues of increasing mental health needs and long waiting times. To do that, the Government are investing in earlier intervention to meet patients’ needs and prevent them from reaching crisis point.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Will the Secretary of State give way?

[Wes Streeting]

I am just coming to my conclusion, I am afraid.

In the past 10 months, we have met the mental health investment standard for 2025-26; invested an extra £680 million in mental health services this year, which is a real-terms increase; funded mental health support teams in schools for almost an extra 1 million pupils; invested an extra £26 million to build new mental health crisis centres; funded NHS talking therapies for an additional 380,000 patients; and begun recruiting the 8,500 mental health professionals we promised in our manifesto. That is all part of the additional £26 billion this Labour Government are investing in health and care services—investment that was opposed by every party on the Opposition Benches; investment that is happening only because we have a Labour Government.

Mental health reform is not just about changing laws; it is about changing lives. The action we are taking will provide support and care to people at their most vulnerable, modernise our mental health services to keep us all safe, and create a safety net that any of us might need one day. I commend the Bill to the House.

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[Edward Argar]

The previous Government published a draft Mental Health Bill based on the recommendations in the report, giving others the opportunity to have their say. The draft Bill was subject to pre-legislative scrutiny by a Joint Committee of Parliament, allowing Members of both Houses to thoroughly review it and make recommendations before the final version was introduced.

Given the importance of this area of policy, which can have such a profound impact on people’s lives, I believe it is right that we took the time to get this right. The work to update the Mental Health Act started under the previous Government and we had a commitment in our election manifesto to update the law in this area, and that has been carried on by the new Government. We continue to believe that this is the right thing to do, so I put on the record our in-principle support for the Government on the Bill.

I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his work in this space as a shadow Minister. Not only does he have professional expertise, but he has brought it to the House’s deliberations on this legislation. I suspect that we may hear from him a little later.

There are many areas of the Bill that we welcome, including the strengthening of the patient’s right to express a treatment preference, the expansion of access to independent mental health advocates, and the removal of police and prison cells as places of safety so that patients can be treated in an appropriate setting. That said, of course we will not stand back without scrutinising and seeking constructively to improve the Bill as it passes through the House. Part of our role as the Opposition is to engage constructively in the scrutiny of legislation—to ask questions, to probe further, to seek to prevent unintended consequences, and to identify potential problems and ensure that they are aired in Committee—in order to improve it for everyone’s benefit, and that is what we shall do. I know that my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) will approach the Public Bill Committee in that vein.

We very much welcome efforts to improve patients’ voice and involvement in their own care, including through greater use of advance choice documents. In its current form, the Bill places a duty on NHS England and integrated care boards to make patients aware of their option to have such a document, but this could be as simple as having a poster on a noticeboard, for instance. It does not necessarily require a conversation. Introducing it as a legal right for patients who are being treated or for someone who is at risk of detention would mean that they have to be specifically told about the option, allowing them to make a deliberate decision. I suspect that in Committee we may gently press the Minister to go further in strengthening the patient’s right to have their voice heard. I have been on a number of Bill Committees, and gently hinting to the Minister areas where we might press further may make his and his officials’ lives a little easier when amendments are tabled in Committee.

We were pleased that peers passed an amendment to better protect children who require a nominated person, removing the discretion where a court order regarding parental responsibility is in place. However, we believe there is more we can do to support and protect children, particularly regarding age-appropriate settings for treatment. I hope that when the Minister for Care winds up, or in Committee, he will explore in greater detail the steps the Government are taking to reduce the number of children being treated on adult mental health wards and to ensure that lessons are learned at both national and local service provider level.

Thirdly, we are conscious that a number of elements of the Bill will require additional resources to be put in place. The removal of police and prison cells—sensibly—as places of safety will require sufficient alternative capacity for people to be treated when they are detained. What approach do the Government intend to take in addressing this?

Increasing the frequency with which patients can apply to the mental health tribunal to have their detention reviewed and widening automatic referrals will potentially increase demand and pressure on the system. We know that the legal system is already under pressure, and the impact assessment acknowledges that there will be impacts and costs, so is the Minister confident that the system has the capacity to handle the additional demands? If not, what steps are being taken with the Ministry of Justice to address that?

[Iqbal Mohamed]

The shadow Secretary of State raises an important point about resources. The updated impact assessment estimates that the cost of reform is £5.3 billion. With the Secretary of State having confirmed that mental health spending is falling as a share of NHS expenditure from 9.01% to 8.73%, does the shadow Secretary of State agree that without legislative safeguards to protect mental health funding, the Bill may not achieve the aims it sets out to achieve?

[Edward Argar]

The hon. Gentleman is right to highlight both the costs and the investment that is needed, but the cost does not detract from the importance of and need for the measures set out in the legislation. He points out that as a proportion of overall health spending, mental health spending has fallen slightly in the latest figures. I hope that the Minister in his wind-up will address how the Government will ensure that this legislation, which enjoys broad support across the House, has the resources behind it to deliver the outcomes we all wish to see in practice?

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[Gregory Stafford (Farnham and Bordon) (Con)]

Despite having worked in healthcare for most of my career and serving on the Health and Social Care Select Committee, having listened to the speeches thus far this evening, I feel in awe of the experience of hon. Members on both sides of the House, especially the hon. Member for Sittingbourne and Sheppey (Kevin McKenna) and my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I also commend the hon. Member for Dorking and Horley (Chris Coghlan), who I know is supported by my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), for his extraordinarily powerful speech.

This Bill is essentially about the duty of care not only to those who have mental health issues, but to the public, including the family, friends, carers, public servants and everyone else who interacts with those individuals. The duty of care also exists to protect those individuals from themselves. As many Members have said, our hope and ambition should be that as few people as possible find themselves in a crisis situation. I therefore entirely endorse and support the comments about ensuring that we have proper and well-funded mental health services, both in the community and in the acute setting.

[Iqbal Mohamed]

The hon. Member mentions support for the person needing help—to help themselves, and also to help society. Does he agree that more and more people are getting into situations where they do not feel that they are being helped, and that they just feel incarcerated and restricted?

[Gregory Stafford]

I agree with the hon. Gentleman that more can be done to help people in crisis. What I would say, however—I think my hon. Friend the Member for Runnymede and Weybridge also made this point—is that there are people who are at such a point that, unfortunately, they need to be incarcerated in order to be able to help themselves. Hopefully, they spend their time incarcerated not just away from society but being treated effectively and appropriately.

That brings me to the point that this is a balancing act and a difficult situation. I think all of us of all parties are clear that the current Act is no longer fit for purpose, especially when we think about forensic mental health. As such, I am glad that the Government are taking forward this legislation, which was started under the previous Government. The cross-party consensus we have heard this evening reflects the fact that this piece of legislation has come from both of the major parties. I am likely to be on the Bill Committee after the Whitsun recess, so I will not test the patience of the House by going through every single bit of the Bill I have some interest in or concerns about, but I will briefly raise three important areas, which I am pleased were raised by Members in the other place. A number of Opposition amendments were tabled in the other place which would have strengthened the Bill, and I hope they will be made in Committee in this place.

The first area is reducing unnecessary police involvement. The noble Lord Kamall and Baroness May tabled some amendments that in my view represent a very significant and much-needed shift in how detentions and removals under the Mental Health Act can be managed. Under the current framework, the power to detain individuals and move them to a place of safety—particularly under sections 135 and 136—is largely restricted and falls under the responsibility of police officers. Although those provisions are designed to protect the public, they can often result in the criminalisation of people in acute mental health crisis, even when there is no threat of violence or risk to others.

The amendments tabled in the other place would have allowed authorised and qualified health professionals such as paramedics, approved mental health professionals or specialised nurses to carry out those detentions and to move individuals under sections 2, 3 and 5 of the Act. That would relieve police officers of responsibilities that fall outside their core expertise while reducing the stigma and trauma associated with police-led interventions. It would streamline the process, ensuring that individuals were supported by professionals trained specifically in mental health care and would maintain police involvement only where there was a clear and present risk to safety. That would significantly change and strengthen the system, placing mental health crises more firmly within the domain of health rather than law enforcement.

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[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Before I begin, I want to pay tribute to right hon. and hon. Members for their extremely informed, personal and moving speeches in support of the positive elements of the Bill, and for making extremely important, constructive suggestions about how to make it even better than it is.

I stand today to speak in strong support of the Bill, and the urgent and long overdue reform of our mental health legislation. The Mental Health Act 1983, now 40 years old, was designed for a different era. While it has provided a legal framework for detaining and treating individuals in crisis, it no longer reflects our modern understanding of mental illness, patient rights or best clinical practice. As we have heard, the Act governs both civil patients and those involved in the criminal justice system, and it includes powers such as community treatment orders, but it is clear that the system it underpins is no longer fit for purpose.

The need for reform is stark and obvious. Patients detained under the Act often have little say in their treatment or about who is involved in their care. As we have heard, racial disparities are deeply entrenched, with black or black British people 3.5 times more likely to be detained and 11 times more likely to be placed under a community treatment order. The journey towards reform began with the 2018 independent review, led by Sir Simon Wessely, which identified rising detention rates, poor patient experience and systemic disadvantages for people with learning disabilities and autism. A draft Bill followed in 2023, and I commend the Government for taking forward the proposed Bill.

Each year, approximately 54,000 individuals are detained under the Mental Health Act. Alarmingly, as I have mentioned, black individuals are nearly four times more likely to be detained and 11 times more likely to be placed under a CTO. Furthermore, nearly 1,000 young people are detained annually, yet over half report that their hospital stay did not aid their recovery. These statistics are not just numbers; they are a call to action. There are serious concerns about the treatment of people with learning disabilities and autism. While the Bill rightly ends inappropriate detentions under section 3 of the Mental Health Act when there is no co-occurring mental illness, the delay in implementation due to the lack of resources raises fears of criminalisation, misdiagnoses, and exclusion from aftercare. We need a fully costed plan, with clear targets and accountability, to support this vulnerable group.

Mind, the leading mental health charity, has identified a further three critical areas in which the Bill must go further. The first is tackling racial disparities. The disproportionate detention of black individuals under the current Act is a glaring injustice. The Bill must include measures to reduce this disparity, such as limits on the use of community treatment orders, and the introduction of a “responsible person” to oversee treatment decisions. Additionally, a statutory duty to monitor and report on progress against these inequalities is essential. I therefore support the creation of a dedicated role to monitor and act on racial disparities in detention and treatment.

Secondly, the principle of least restriction is central to the Bill, yet it remains aspirational; there are no enforceable rights. Patients should have a statutory right to assessments and treatment, the ability to appeal treatment decisions, and expanded access to advocacy services. These rights are about not just legal protection, but respecting the dignity and autonomy of individuals facing mental health challenges.

Thirdly, young people detained under the Mental Health Act often find themselves without adequate support or a voice in decisions about their care. The Bill must include a transparent decision-making test, tailored for children and young people, to ensure that their best interests are at the forefront of all treatment decisions. There should also be safeguards and the standardisation of advance choice documents. The Government say that the implementation timelines could be up to a decade, but I urge them to implement each element of the Bill as soon as is practically possible.

This Bill is very welcome, and this is a pivotal moment in the history of mental health care in our country. It is a huge step forward, but it could go further. To truly transform mental health care, we must ensure that the legislation is not only progressive in its intentions, but robust in its protections. We have the opportunity to create a system that upholds the rights, dignity and humanity of every individual. Let us therefore not pass up this chance to make all the necessary changes. Let us amend this Bill to reflect the values of equality, autonomy and respect, and take this once-in-a-generation opportunity to build a fit-for-purpose mental health system that is fairer, more compassionate and more effective. I urge the Government to take this opportunity to address the gaps, take heed of the recommendations and concerns, and make the Bill right and proper.

[Several hon. Members rose—]

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[Zöe Franklin (Guildford) (LD)]

I welcome the direction of the Mental Health Bill. It marks a long-overdue shift in how we treat some of the most vulnerable in our society, recognising that people deserve more than crisis care—they deserve dignity, choice and autonomy. It has been a real privilege to be in the Chamber for this important debate, and to hear the very moving speech by my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and by so many others across the Chamber who shared their constituents’ stories, and their own.

The Bill rightly puts patients at its centre. It gives them more say in their treatment, improves the complaints process and introduces personalised care plans. Replacing the outdated “nearest relative” with a nominated person reflects a broader move toward a more respectful, person-centred system that listens, empowers and supports recovery. But here is the uncomfortable truth: however well-intentioned, the Bill will achieve little unless we confront the funding crisis already engulfing our mental health services. The Bill asks overstretched and underpaid staff to deliver changes that demand time and care when many are already at breaking point. My constituents across Guildford see that every single day. Jennifer came to me in despair over the care that her daughter Leah is receiving at a local mental health unit. Chronic understaffing and a lack of support mean that concerns go unanswered. Underfunding has created a cycle of inadequate care—treatment refused, early discharges to free up beds, and inevitable readmissions when Leah’s needs are left unmet. I have heard from Samantha, whose son suffered a psychotic episode that ended in tragedy—a stark reminder of what happens when crises go unsupported. I also want to mention the story of a young woman whom I will not name, but who made a series of attempts on her life until she tragically succeeded, after gaining access to a poison from overseas. I know this is not a unique story, and that multiple coroners have written to the Secretary of State for Health and his predecessors on this issue. Will the Minister agree to meet me to discuss the case and whether it may be possible to use the Mental Health Bill to prevent further similar deaths?

There is also the fact that across the country people are waiting months and sometimes years for mental health care. Children and young people are falling through the cracks, as CAMHS is overwhelmed and referrals are delayed; patients are sent miles from home due to local bed shortages; and police are left to respond to mental health emergencies because there is no one else to call. Our system is not just stretched; it is at breaking point. Yet the proportion of NHS funding going to mental health care is falling—despite soaring demand, despite mental illness making up a fifth of the NHS’s burden, and despite the Government’s promises. These are not just gaps in the system; they are failures of political will.

[Iqbal Mohamed]

As well as NHS funding for direct mental health services, does the hon. Lady agree that we should invest in preventive steps to help children to avoid the mental health anguish that they are suffering today?

[Zöe Franklin]

Absolutely. I know from my own caseload of too many stories of where if young people had received preventive care and support, they would not be facing the tragic situations they and their families are now living through.

This Government have scrapped key mental health targets, including goals for early intervention, therapy access and physical health checks for people with mental illnesses. I am sorry, but this signals a retreat at the very moment we need to advance.

I support the vision outlined in the Bill, but its success depends entirely on the foundation on which it stands. Without adequate investment, even the very best intentions will struggle to take root. Ensuring that people can exercise their rights and that staff can support them demands more than legislation; it demands real resources and sustained commitment from this Government.

We need a national effort to rebuild mental health care from the ground up, with early intervention for young people, trained professionals in schools and communities, continuity of care and a culture shift that treats mental health with the same urgency and seriousness as physical health. Failure is not an option—not for the thousands still waiting, not for the staff stretched to their limits, and not for the communities left to pick up the pieces. We can and must do better.