Mental Health Bill [ Lords ] (Fourth sitting)

Jen Craft Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Dr Evans]

My hon. Friend is a shrewd surveyor of legislation, and even foresees the amendments that I have tabled, which may well expose and shine a little light on something that might make a difference. In essence, he is right: trying to future-proof the Bill, while ensuring that it is robust and applicable, was at the heart of the first day’s debate and seems to be at the heart of today’s debate.

As I said, the Mental Health Act confers extraordinary powers to detain and treat without consent and to deprive someone of their liberty, but in exchange there needs to be a clear, evidence-based justification for doing so. The clause goes some way to strengthening that justification, but only if the principle of therapeutic benefit is applied rigorously and not just diluted.

Let me turn to amendments 44 and 45, tabled in my name on behalf of His Majesty’s Opposition, which speak to what my hon. Friend the Member for Farnham and Bordon just said. They seek to embed trauma- informed principles into the definition of “appropriate medical treatment” under the Mental Health Act. These amendments aim to ensure that medical treatment for mental disorder not only addresses symptoms but actively minimises patient distress, promotes psychological wellbeing and supports recovery from childhood trauma.

There is robust and compelling evidence demonstrating that childhood trauma is a causal factor in the development of a wide range of mental health conditions. The “Adverse Childhood Experiences Study”, by Felitti et al. in 1988, demonstrated a strong dose response relationship between the number of traumatic experiences in childhood and the likelihood of developing of mental health disorders later in life, including depression, anxiety, psychosis and substance misuse.

Neuroscientific studies such as Teicher et al. in 2016 have revealed how early maltreatment alters brain structures and functions critical to emotional regulation and stress response. A review of trauma and psychosis by Read et al. in 2005 identified childhood trauma as a significant risk factor for several mental illnesses, including psychiatric disorders. Furthermore, clinical guidance such as NICE’s 2018 recommendations emphasises the importance of assessing trauma history and incorporating trauma-focused interventions into care. These findings are reflected in UK health policy, with the Department of Health recognising trauma-informed care as essential for effective mental health services.

We also know from clinical studies that trauma history influences treatment outcomes, with trauma-uninformed care risking re-traumatisation and poor recovery. It is vital to stress that recognising trauma as a causal factor is not about excusing behaviour but about understanding behaviour. Such understanding enables clinicians and services to respond more compassionately and effectively, supporting genuine recovery and healing, rather than merely managing symptoms or controlling behaviour. Embedding trauma-informed care in law is a progressive step that aligns with modern mental health best practice and respects the lived experience of many retained under the Act, the majority of whom have experienced significant trauma in their lives.

If the Government do not accept these amendments, can the Minister clarify what steps they will take to ensure that trauma-informed approaches are embedded in mental health services? Will there be guidance, training or oversight in the mechanisms to ensure that patient distress is minimised and psychological wellbeing promoted?

[Jen Craft (Thurrock) (Lab)]

On a point of clarification, I note that the amendments tabled by the shadow Minister specifically say

“recovery from any childhood trauma”.

Why has he opted for the word “childhood”, rather than general trauma-informed care? A number of female in-patients in mental health units are recovering from past sexual trauma or domestic violence—I know such abuse is not committed exclusively against women, but it tends to be more prevalent in that group—and the mental health unit can potentially exacerbate that traumatic experience. I seek clarification on why childhood trauma has been made so prominent, as opposed to general trauma.

[Dr Evans]

It is an excellent and eagle-eyed point. I would point to the evidence base that I cited, starting from 1988 onwards. That is three and half decades’ worth of evidence that points to a causal factor. In my clinical background, I have seen patients that I think it relates to. Perhaps I will stand corrected, but I am not sure that domestic violence has been shown as a causal factor of mental health conditions.

We know that in the developmental stages that children go through, when their brains are developing and growing, as the 2016 study showed, there are intrinsic changes. That is why the Opposition chose to put that wording in. I agree that the definition could be wider, and we discussed that on the first day of debate with the Liberal Democrat definitions. I see the hon. Lady’s intent, but the main point is the evidence base. Maybe in the future that would be something, if we have evidence, that the Minister could consider taking forward. At this point in time, I think it is undeniable that childhood trauma makes a difference, and that is why the amendments specifically say “childhood trauma”, not anything wider.

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In summary, the amendments would strengthen the Bill’s commitment to ensuring that detention and treatment are clinically justified and therapeutic in purpose. That would align with the Bill’s overall goal of promoting patient-centred, evidence-based mental health care.

[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.

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[Jen Craft]

I rise to speak in support of this important clause, which puts patient experience and individual choice at the heart of treatment. It is a brilliant focus on seeing the individual as a person, and ensuring that they have a strong role to play in deciding their treatment pathway going forward.

I very much welcome the development of a clinical checklist that includes looking at a patient’s past and present wishes and feelings. That is important because, when someone is in a mental health crisis, they might not be in the best possible place at that moment to articulate what their wishes are. Looking at how they may have acted in the past, or may have opted for treatment when not at a crisis point—including, I note, through the introduction of advance choice documents, allowing people to choose how they would like to be treated if they have lost the ability to make those decisions for themselves about the best way forward and, indeed, if they have to be detained—and taking their wishes into account, as well as their beliefs and values, is important in developing an individual treatment plan that allows them to be seen as an individual deserving of care, in order to achieve the best possible outcome for them. Across the House, we have noted the important fact that, when patients are involved in developing their treatment plans, they are much more likely to engage and have significantly improved outcomes.

I do not want to get ahead of the Minister, but I want to address a few points that the shadow Minister raised. I want to say this as someone with lived experience of severe mental illness; it is important to have someone on the Committee that can speak to that, so I probably should when I can. This clause speaks to the patient experience. There are other parts in the Bill that deal with potential risk to the public and risk of harm. In the first example the shadow Minister gave, he mentioned that the woman in question said that her wish was to be admitted to a secure unit. I would say that, under this clause, had they had regard for her wishes and how she wanted to be treated, that would have mitigated some of the risk.

I know that there are times when people will act in a way that may be at odds with the risk that they pose to the public, but these matters are properly addressed elsewhere in the Bill. What the clause speaks to, and what we should try not to dilute, is the patient experience.

[Dr Evans]

I appreciate the hon. Lady’s insight, both as a politician and as a patient. I guess the Opposition are concerned that there is no explicit duty here, which is why legislating for that is so important. There was a huge number of inquiries about the case from 2011. There have been sufficient changes, but in 2023, as we saw in Nottingham, there was yet another case. There are still ongoing proceedings, so I will not comment too much on that, but this is an opportunity that the Committee should seriously consider.

This harks back to what I was talking about on Tuesday. It is another step—an escalation—in this concerning pattern of behaviour, and it is hard, from a clinician’s point of view, to work out whether something is going to happen. I see this as part of the checklist to make sure that consideration is there, or, if public safety is not there, that it does not fall into a statutory role as it would anywhere else. Those are my concerns. We have not put down an amendment, but I am interested in the hon. Lady’s thoughts on how that should be approached from both the politician and the patient side.

[Jen Craft]

I welcome the hon. Member’s intervention. On Tuesday we discussed clauses on who can be detained and when, and earlier today we discussed the necessity of detention, and there was some debate about the amendment in the other place. Other bits of the Bill focus on when it is necessary to detain an individual for public safety and not just for their own treatment; I will not re-litigate who should be performing that function, but earlier clauses deal with that.

The importance of this clause is the patient perspective. There is a significant stigma associated with severe mental illness. I have been reticent about my own conditions in the past because of that, and because of how I would be perceived. It has been particularly hard to be open about the fact that I might be subject to in-patient mental health treatment; I probably see that as a likelihood in my future at some point, although I hope it is not and I work very hard every single day to avoid that. However, it is important that there is a part of the Bill that speaks to me as an individual. I speak to the Committee today as an articulate individual—I do not want to say intelligent; I will not blow my own trumpet—who can say what treatment option I would like.

It is incredibly important to recognise that people who are subject to detention under the Bill are individuals who have opinions on their treatment. I have lived with these conditions for the best part of two decades, and the biggest expert on them is me. If I was in a mental health crisis, I might not be in a place to articulate the best treatment for me, but right now I can say what works. I will not go into that, because it is private, but I know that the best course of care for me would involve someone taking advantage of my knowledge of my condition and working with me to allow me to get the care I need to get better.

The point is that the clause’s stand-alone focus on the patient experience deals with some of that stigma. It puts the patient’s experience at the heart of treatment, it speaks to some of the issues mentioned about what happened in Essex, which is now the focus of the Lampard inquiry, and helps to deal with some of that. It sees us as individuals.

[Anna Dixon]

I commend my hon. Friend for her honest account of her personal experiences and thank her for bringing that experience into our discussion of the Bill. It is absolutely right that the welfare and wellbeing of individuals who are living their lives, at such distressing times as when they need mental health support, should be at the heart of the Bill. I want to acknowledge her contribution to the debate.

[Jen Craft]

I thank my hon. Friend for her kind words.

That concludes what I was trying to get at: the importance of a clause in the Bill that is focused on patient experience. Understanding and acknowledging the sheer importance of that person’s experiences, and the value that brings to their care plan, cannot be overestimated. I hope that members of the Committee will support the clause, because it represents quite a sea change in how people subject to treatment under the Mental Health Act are treated.