Mental Health Bill [Lords]

Josh MacAlister Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

[Josh MacAlister (Whitehaven and Workington) (Lab)]

It is humbling to contribute to a debate with contributions like that from the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). I pay tribute to him for sharing Declan’s story in this place, and to my hon. Friend the Member for Thurrock (Jen Craft) for her very personal contribution.

I warmly welcome the fact that the Government are giving this issue the prioritisation that it richly deserves. The reforms will give patients greater choice and enhanced rights, and ensure that everybody is treated with dignity and respect throughout treatment. I will make three broad points about mental health services in England and how they relate to the passage of this Bill. The first is about Cumbria’s hidden crisis.

Cumbria’s suicide rate is 50% higher than that in the rest of the country. Over five people die from suicide every month in Cumbria—more than double the number of road deaths. Each one of these lives lost is a tragedy. They leave behind families, friends, co-workers, neighbours and emergency workers—a web of people in the community who try to make sense of the grief, loss and shock. Some fantastic local organisations in my constituency are working to bring that number down, including Every Life Matters, Andy’s Man Club and the West Cumbria Mental Health Partnership, but they are fighting a growing problem of depleted resources. It is in this context that we need excellent mental health services, so it was particularly welcome that, weeks after the general election last year, the Government funded a new initiative called Hope Haven, an open-access mental health hub with some accommodation attached to it. This new service is being built by brilliant local partners in my constituency as we speak, and I have high hopes for the contribution that it can make.

However, the new service has come at the same time that Cumbria, Northumberland, Tyne and Wear NHS foundation trust has made the regrettable decision to close Yewdale ward, an in-patient mental health ward in Whitehaven that is the only in-patient service in the area. If it does close, patients will need to travel for over an hour to reach the nearest in-patient service, and the community has very poor public transport options. I have called for the ICB to investigate the process that has been followed to reach the decision, so that we can pause the closure. If we are to improve mental health services across our country, the reforms need to work for rural, isolated and coastal areas too.

My second broad point is about the needs of people with experience of growing up in the care system and the link to mental health services. Care-experienced adults are hugely over-represented in our systems of mental health detention, assessment and treatment, so the much-needed reforms will be a particularly welcome change for this group.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

On the important issue of suicide and the extremely high rate in Cumbria, does my hon. Friend and constituency neighbour agree that it is extremely important that coroners work with, and provide information to, local authorities and local health services to ensure that we can deliver meaningful policies on anti-suicide strategies in areas like Cumbria?

[Josh MacAlister]

I thank my constituency neighbour for suggesting the types of solutions that we should look at. Some areas of the country have much higher rates of suicide than others, and we know far too little about why those areas have those trends.

Around half of children in care are expected to have some sort of mental health disorder, and they are estimated to be four to five times more likely than the rest of the child population to have a mental health need. Despite that, children in care are disproportionately rejected for support from CAMHS services, and this builds up unmet mental health needs for which we as a country are paying the price in social and economic costs further down the line.

Just one example of that is the surge in deprivation of liberty orders that we have seen in recent years. In 2017-18, there were 103 applications; in 2024, the figure was 1,280. Deprivation of liberty order applications often leave judges in our family courts with impossible choices over the secure accommodation option for children. Young people who grow up in the care system should receive the very best that our country has to offer, with help being speedy and tailored. Although wider changes are needed to make that a reality, humanising our mental health legislation in the ways set out in this Bill will make a difference.

[Chris Vince]

My hon. Friend has talked with real passion and expertise about children in care, and he makes some really important points. Does he agree that the mental health support we give to young carers—young people who support a family member—is equally important? They make such a huge difference to our communities and the NHS, and they too should be supported.

[Josh MacAlister]

Absolutely. We need to support young carers and young people in care. One of the common challenges facing both of those populations is that services sometimes fail to look at what support can be provided to the whole family unit, so I take my hon. Friend’s point.

Finally, I will say a few words about a sensitive issue that is a growing trend. Most weeks, I visit a school in my constituency, and there is a growing theme: teachers, and now parents, are raising concerns about the potential over-diagnosis or misdiagnosis of ADHD and mild autism. I raise this point for two reasons: first, because the risk is that the scale of the increase in diagnosis is so great that it may take away much-needed mental health services from those with acute and genuine need; and secondly, because we have yet to grasp the potential negative impacts of treating what may be social challenges as medical disorders.

Some 400,000 children are currently awaiting an ADHD assessment, and rates of diagnosis have risen sharply in recent years. Diagnosis varies dramatically depending on where someone lives, who does the assessment and, worryingly, the socioeconomic background of the individual.

[Jen Craft]

Is my hon. Friend able to name an intervention for a diagnosis of mild autism that could be considered a medical intervention, not something to address one of the social issues he has identified, that could harm the individual?

[Josh MacAlister]

Yes, in a number of schools we have seen a growing number of ADHD and mild autism diagnoses that do not come with any form of treatment. That is in a system where there is an expectation that education, health and care plans will be filled and met by multiple agencies, and the families are often left battling the system, having to fight for a diagnosis to get that label and then finding that the help is not there. My argument is that those families—not all, but some of them—are battling a system that already has finite resources and now spends a huge proportion of its resources gatekeeping, when actually we should step back and look at what support the young person and their family need.

In the case of ADHD, the National Institute for Health and Care Excellence guidelines set out very clearly that, before an assessment is made, it should be established whether parenting support could be put in place to help. My guess is that, in many cases at the moment, that offer of parenting support is not in place before an ADHD diagnosis is made.

Diagnoses of autism have doubled in the last five years. I am not saying that that is incorrect, but I think the question needs to be asked, as part of the wider debate, whether that growing trend is a reflection of previously undiagnosed autism or, because of recent changes in the ICD-11 manual—the 11th edition of the “International Classification of Diseases”—people are being brought into that diagnosis who would previously have been supported in other ways.

I close by urging the Government to consider the implications of the reform of mental health services for those in rural and remote communities. They need to acknowledge the benefits that will come from these measures for those with a care experience, but also to think deeply about the need for residential care that can meet their need for a secure setting. They should also consider ways in which we as a country can have a full and rich conversation about the growing diagnosis of ADHD and mild autism, so that we can establish the best routes of support for the children crying out for support and the parents often battling against the system, who may be building up a future need for the crisis mental health services we have been speaking about this evening.