Mental Health Bill [ Lords ] (Fourth sitting)

Josh Dean Excerpts

Committee stage
Thursday 12th June 2025 Public Bill Committees

[Stephen Kinnock]

I pay tribute to my hon. Friend for her expertise and am pleased to hear that she feels reassured by my remarks. It is absolutely the Government’s ambition to bring more consistency and clarity to this area. A number of hon. Members have raised issues around racial disparities; I plan to come on to that. That is a specific focus, I know, for her and other colleagues. More broadly, this is about ensuring that the CTO system is proportionate, well regulated and managed on the basis of a patient-centric system.

We therefore wish to remove clause 6(3), as we do not think that it is necessary. It duplicates some provisions in the Bill or, in the case of the review periods, conflicts with existing renewal periods, and under the current drafting it is not clear how the two would interact. Where there are differences, the current provisions are more appropriate, for example in requiring a community clinician to be involved in all decision making.

Let me move on to clause 6 in its entirety. CTOs allow individuals detained under the Mental Health Act to be discharged into the community, under specific conditions, to ensure continued treatment. CTOs aim to maintain contact with mental health services to provide support and prevent relapse. Patients on CTOs can be recalled to hospital under that Act in certain circumstances. The main purpose of introducing CTOs was to improve care for higher-risk patients and to enhance public safety. We believe that community treatment orders remain necessary in a small number of cases to ensure continued treatment and to protect both patients and the public.

However, the independent review rightly noted that considerably more people than expected were being put on a community treatment order—about 5,500 people a year—and that there were racial disparities in the use of CTOs. Clause 6 therefore amends the community treatment order risk criteria in line with the new detention criteria set out in clause 5. It is now the case that, to be put on a community treatment order, the patient must be at risk of serious harm and there must be a reasonable prospect of therapeutic benefit for the patient.

[Josh Dean (Hertford and Stortford) (Lab)]

We have touched already on the stark racial disparities in the use of CTOs and the Mental Health Act more generally, so I welcome these reforms. I appreciate that we will come to this point later in the Committee, but can the Minister set out what interaction the advance choice documents will have in reducing the number of CTOs, particularly for those groups that have seen them used disproport-ionately?

[Stephen Kinnock]

My hon. Friend raises a very valid point that, as he says, we will come on to in greater detail. Right across our health service, in every aspect, early intervention is always better than trying to pick up the pieces after a crisis. That is the same for both physical and mental health. We believe that the advance choice documents will be a helpful tool in building an earlier understanding of the challenges that a particular individual faces and, on the basis of that earlier understanding, enabling earlier intervention. Giving the opportunity to patients, while they are in a position to do so, to set out what their advance choices are will enhance their autonomy and enhance trust in the interaction between the patient and the system. That trust piece is so important to the entire picture.

--- Later in debate ---

I am by no means an expert, but I understand the spirit and nature of what is intended with the amendment. I look forward to the Liberal Democrat spokesperson addressing some of those questions.

[Josh Dean]

It is a pleasure to serve under your chairmanship, Mr Vickers. I start by recognising the extremely difficult circumstances that the provisions deal with. I will speak to clauses 15, 17 and 18 and the Liberal Democrat amendment.

I welcome the additional safeguards set out in these provisions by the Government, particularly clause 15 and the role it plays in ensuring that the approved clinician can decide whether a referral for a second opinion appointed doctor is required. I note that there is a slight contrast, as the Opposition spokesperson touched on, with 57A, but I believe that recognises the unique circumstances of ECT, and that is important.

Clause 17 is important because of the way in which it—like these clauses generally—respects patient choice, embedding the central principles of choice and autonomy into this form of treatment and building on the framework set out earlier. I also note that clause 18 inserts a particular safeguard on certification that is really key to ensure that ECT therapy is administered according to strict safeguards. That is key in the context of the type of therapy that we are talking about.

I commend the spirit of amendment 13 and the intention behind it, and I really welcome the positive cross-Bench engagement on this issue. It is one of the most challenging circumstances and types of therapy that a patient will experience, but I echo the Minister’s points that such provisions have been covered elsewhere, particularly the changes in some of these clauses.

To make a brief point about invasive treatment generally, I note that we are talking specifically about ECT, but I would be very grateful if the Minister could set out what consideration the Government have given to additional safeguards on nasogastric tube feeding, for example, which is another type of extremely invasive treatment. While I would not seek to draw an equivalence between the two, I would be grateful if the Minister could touch upon that in his response.

[Gregory Stafford]

I rise to speak to clauses 15, 17 and 18 and Liberal Democrat amendment 13 to clause 18. I note the hon. Member for Winchester is not here; I do not know whether he intends to push amendment 13 to a vote but, just in case he does, I shall speak to it.

As colleagues across the Committee have said, ECT is a very controversial treatment, particularly when administered without consent. Under current law, it can be given to patients who lack capacity, but concerns have been raised about insufficient safeguards, especially where the treatment may conflict with prior decisions or a legal representative’s view. Clause 15 responds to recommendations from the 2018 independent review of the Mental Health Act and aims to ensure that ECT is used only when absolutely necessary, with independent oversight and respect for patient autonomy—something that everyone in this House can agree with.

I have a couple of questions for the Minister on clause 15. Clearly, the Opposition support the intention of the clause, but I would like to ask him about the challenges in interpretation. For example, determining whether a decision conflicts with an advance directive may be complex, so has he or his Department given any thought to how we might deal with some of those potentially complex, conflicting points of view?

Likewise, clause 17 updates section 62 of the Mental Health Act, allowing for urgent treatment without consent in specific circumstances. Once again, I welcome this provision because it gives some new legal clarity, supports clinical judgment, safeguards capacity and, most importantly, protects life and health. However, without strict oversight, there is a risk that the urgent treatment exception could be overused. What discussions has the Minister had with both his Department and, more importantly, campaign groups and mental health professionals to ensure that the urgent treatment exemption is understood and put forward in a way that satisfies both those undertaking the treatment and those receiving it?

Clause 18 also changes section 62 of the Act, which I again support; I mention this clause only because I wish to talk briefly about Liberal Democrat amendment 13. Like other Members, I believe that this amendment is extraordinarily well intentioned, but I have some questions about its wording. Specifically, subsection (c) says “the treatment is reversible”, but I do not necessarily know what the legal or medical definition would be of a reversible treatment. I cannot think how ECT could in any way be reversible, so paragraph (c) of the amendment would potentially mean that nobody could receive ECT. I do not fully understand how it could ever possibly be reversible. I think I have made that point as strongly as I possibly can but, if the Liberal Democrats are going to move the amendment, I ask for some understanding of what definition—either legal or medical—is being used for paragraph (c).