Mental Health Bill [Lords]

Nusrat Ghani Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

[Richard Baker (Glenrothes and Mid Fife) (Lab)]

The Bill addresses fundamental flaws in our current mental health legislation in relation to the rights of people with learning disabilities and autistic people. I will focus my comments on new clauses 32 and 33, which I have tabled. They are also about vital rights within our mental health legislation and relate closely to the powerful comments made by the right hon. Member for Salisbury (John Glen) and by my hon. Friend the Member for Isle of Wight West (Mr Quigley).

New clause 32 would provide for mandatory independent care, education and treatment reviews for patients detained in long-term segregation. In her report, “My heart breaks”, Baroness Hollins highlighted the harms and sufferings that are so often associated with long-term segregation, and assessed how introducing care, education and treatment reviews can reduce the incidence and use of segregation. I very much welcome the provisions on reviews of care and treatment that Ministers have already included in the Bill, but it has now been demonstrated that independently-chaired reviews are making a real difference and lead to inappropriate long-term segregation being challenged and addressed. The human impacts are substantial. New clause 32 would make such reviews a requirement when someone has been placed in segregation for 72 hours.

New clause 33 seeks to introduce a new level of scrutiny in cases where patients with autism or learning disability have been detained for more than five years. I believe there is a very strong case for an additional check and balance when people have been under detention and compulsory measures for so many years. I understand that the latest data for England shows that 350 people with a learning disability or autism who are currently in in-patient units have been detained there for more than 10 years.

In a previous role, I provided advocacy for the family of a young man, Kyle, who has a learning disability. He is a patient in the State hospital in Carstairs in Scotland, but his family live in the north-east of Scotland. His mother and grandmother have to make a round trip of nearly seven hours to see Kyle for visits which have in the past been restricted to a single hour. Kyle was convicted of no crime when he was admitted to Carstairs in 2009. He has been there for 16 years. The toll that this has taken on his family has been horrendous. The situation is devastating for them, and there is no end in sight. Although it is a case for the Scottish mental health system, it has provided me with an insight into what many people with learning disabilities and their families will be experiencing in England today, and the limitations of mental health tribunals in dealing with these issues.

People with learning disabilities have been losing their liberty for years because of their disability; this is a human rights emergency. It is clear that we have to do far more to prevent these situations from happening. The Bill will help to do that with its welcome measures on prevention, but where these cases are happening now, I believe there should be an additional level of scrutiny—an extra check and balance so that after so long, someone with the right level of authority and expertise can challenge providers to do better and to ask the question, “How can it be that someone has lost their liberty and their right to a family life, because we cannot make their care and treatment work in a community setting?” Although I very much welcome the introduction of the care, education and treatment reviews, I believe we should go further in these circumstances. That is why new clause 33 would make provision for notification to the Care Quality Commission when someone has been detained for more than five years.

This is an excellent Bill. It will do so much for the rights of people with learning disabilities and autism, but there are several areas where I hope the Minister can outline what further ambitions the Government have to ensure that our mental health system is fit for purpose and based on human rights.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

To squeeze in a few more Back Benchers, the speaking limit is now three minutes.

[Layla Moran]

This is a long-overdue and very welcome Bill, but frankly it will not even touch the sides of what most of our constituents and communities need when it comes to the wider mental health landscape. I support many of the amendments to improve it, not least those laid by my hon. Friends on the Liberal Democrat Benches. I need to make a couple of quick points, because we want the Bill to succeed.

The Minister will know that since December the Health and Social Care Committee has been conducting an inquiry into community mental health services, because we recognise that unless we start tackling these matters upstream, we will not achieve the Bill’s aims. For so many, it feels like they are walking through an NHS desert: they simply cannot get the appointments they need; they do not feel supported; and no one can navigate this complex system.

Just a few weeks ago, while still on maternity leave, I decided to have a keeping-in-touch day and the Committee decided to visit an oasis in this desert—the incredible Barnsley Street neighbourhood mental health centre in Tower Hamlets. Unfortunately, the centre is one of only six pilots set up to this level across the country, but we heard some amazing stories of how people had been diverted away from in-patient mental health units by an approach that truly puts the patient at its centre. It was inspiring. However, we heard from the centre that its funding will not continue beyond April. It is only just starting to gather the data it needs; system change is desperately needed in this space, but the concern is that the system will change without robust data behind it. My question to the Minister is, will the centres be funded beyond April? If not, how can the Department make decisions about the system based on data that does not represent a full calendar year?

I also want to speak in support of amendment 9. I pay tribute to Cyril and Dianne whose son Leon suffered from schizophrenia for many years and sadly completed suicide in January 2019. He was let down by community mental health services. Leon’s mother, Dianne, saw the illness get worse and worse, and when she tried to re-refer him into the system after he had been detained, she was told, “Computer says no.” This Bill will improve the lives of families like Dianne and Leon’s, because Dianne’s pleas would have been heard under the new nominated persons provisions. Amendment 9 would be an extra step, ensuring that the plan is shared with parents and carers—with the nominated person. I pay tribute to those who have campaigned so doggedly for the inclusion of nominated persons in the Bill.

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[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Jen Craft to make the final contribution. All those who have contributed to the debate should make their way back to the Chamber.

[Jen Craft (Thurrock) (Lab)]

Thank you very much, Madam Deputy Speaker—I will be as brief as possible. I will speak to new clause 37, which stands in my name and which seeks to support the Government in ending the scandal of the inappropriate detention of people with a learning disability and/or autism. I declare an interest as the chair of the all-party parliamentary group on learning disability.

Currently, a learning disability or autism, in and of itself, can be grounds for detention under the Mental Health Act. As we all know, this is an absolute scandal—something from a previous age that should be a source of moral shame to everyone in our community. The Bill seeks to address this by removing autism or a learning disability, in and of themselves, as criteria for detention under the Mental Health Act. That offers a lifeline—a light in the tunnel of darkness that a number of people who are detained under the current Act face.

However, the impact assessment for the Bill states that the proposed changes to the detention criteria in clauses 3 and 4

“will only be switched on when systems are able to demonstrate sufficient level of community support”.

The families and carers of those have a learning disability or autism and who are detained under the Mental Health Act, and the organisations that support them and people who advocate for them, know that too often this vulnerable group of people are pushed to the bottom of a list of competing priorities, and very often slide off it.

We know that this Government and the Department of Health and Social Care have a number of competing priorities to deliver on, and the concern for people who fall into this bracket under the legislation is that their concerns just will not be addressed and that this absolute scandal will continue in perpetuity. People who have a learning disability or autism will be detained because our community services just are not up to snuff; we have so categorically failed them that the only thing we can think to do is to lock them away from society.

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[Stephen Kinnock]

I am really struggling for time. I am sorry, but I cannot take any more interventions, because it is not fair to Members who have tabled amendments.

Amendments 41 and 42 would prevent children with competence from choosing a step-parent or kinship carer as their nominated person if that is the most appropriate person for them. A nominated person can be overruled or displaced if acting against the child’s best interests. Parents will always maintain their rights under the parental responsibility.

Many amendments concern statutory care and treatment reviews designed to help to ensure that people with a learning disability and autistic people receive the right care and treatment while detained and barriers to discharge are overcome. Reviews will happen within 28 days of detention, and at least once a year during detention. This can be more frequent, depending on needs. Patients’ families and advocates can request a review meeting at any point. In respect of new clause 32, we have consulted on making some restrictive practices, including long-term segregation, notifiable to the Care Quality Commission within 72 hours.

Let me now deal with amendments 14 and 26 and new clauses 31 and 37. I acknowledge the importance of having a clear plan to resource community provision for people with a learning disability and autistic people to implement these reforms. We have committed ourselves to an annual written ministerial statement on implementation of the Bill post Royal Assent. Following conversations with my hon. Friend the Member for Thurrock (Jen Craft), we will work with stakeholders, including people with lived experience, to shape our road map for commencing changes to clause 3. The written ministerial statements will give updates on progress, as well as setting out future plans. It is not possible at this stage for us to commit ourselves to the specifics of implementation and community support, which depend on the final legislation passed, future spending reviews, and engagement with stakeholders to get implementation planning right.

As for the concerns raised by my hon. Friend the Member for Shipley (Anna Dixon) about the detention criteria in the Bill, it is vital that the work “likelihood” is included in those criteria to set clear expectations of what clinicians need to consider. However, we are clear about the fact that our intention is not to set a threshold for detention. Under the new criteria, a harm does not have to be likely to justify detention. The criteria require likelihood to be considered holistically, alongside the change, nature and degree of the harm.

I know that the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans) is keen for me to deal with the question of public safety. The key point is that there are detention criteria in clause 5, which makes a clear reference to harm either to the patient or to other persons. That is clearly a consideration of public safety, and we therefore believe that amendment 40 is surplus to requirements.

I trust that, on the basis of the assurances I have given, Members will be content not to press their amendments and new clauses.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Zöe Franklin, is it your pleasure that new clause 2 be withdrawn?

[Zöe Franklin]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 26

Duty to establish carer liaison service

“(1) The Mental Health Act 1983 is amended as follows.

(2) In Part X (Miscellaneous and Supplementary), after section 133 insert—

“133A Duty to establish carer liaison service

(1) The managers of every hospital providing services under this Act must establish and maintain a dedicated carer liaison service.

(2) A service established under this section must provide—

(a) support to unpaid carers when a patient for whom they provide care is—

(i) awaiting admission to hospital for treatment under the Act;

(ii) receiving treatment in hospital under the Act;

(iii) set to be discharged from a hospital where they had been receiving treatment under this Act;

(b) timely and accessible information regarding the discharge of the patient they care for, including details of—

(i) the patient's discharge plan; and

(ii) aftercare arrangements under section 117 of this Act;

(c) support for unpaid carers to identify their own needs and connect to relevant local services for post-discharge support, including local authority adult social care services, general practitioners, and local carers' centres;

(d) facilitation of effective communication and collaboration between unpaid carers and the patient's multidisciplinary clinical team regarding the discharge process;

(e) assistance to unpaid carers in developing or updating a carer's support plan in the context of the patient's discharge, including guidance on—

(i) their rights to assessment and support as carers

(ii) their participation in education or employment;

(iii) available counselling services;

(iv) support in planning for emergencies in relation to the patient;

(v) benefits for the carer and patient; and

(vi) other forms of local support; and

(f) services to ensure that the perspective of the unpaid carer, as a key provider of support, is considered during discharge planning, where appropriate and with due regard to patient confidentiality and consent.””—(Dr Chambers.)

This new clause would require hospitals to establish a dedicated liaison service for the carers of patients detained under the Mental Health Act.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

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[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Before I ask for the next decision, I remind colleagues in the Chamber that once the doors are locked, Members should not be forcing themselves through the doors to either Lobby.

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[Stephen Kinnock]

I beg to move, That the Bill be now read the Third time.

Since the Mental Health Act 1983 was passed, and since it was updated in 2007, attitudes towards mental health have shifted dramatically, and our understanding has grown, but the law has been neglected. That is why this Government were proud to announce this Bill in our first King’s Speech, fulfilling our manifesto commitment and taking the first steps towards ensuring patients are consistently treated with dignity and respect—promise made, and promise delivered.

It is clear that adults and young people with mental health issues have been let down for years, which is why we are transforming the current mental health system through our 10-year health plan, including through recruiting more than 8,500 additional mental health workers, delivering more NHS talking therapy appointments than ever before, increasing the number of mental health crisis centres, and providing access to a specialist mental health professional for every school in England.

Today, we are another step closer to delivering the reforms to dealing with people with severe and acute mental health disorders, a step closer to strengthening and clarifying the criteria for detention, and a step closer to better supporting clinicians to make the right decisions around appropriate care and treatment, including community treatment orders. We want to make sure that patient choice and patient needs are at the heart of decision making. That is why we are introducing these reforms to enshrine in law measures such as the clinical checklist, the use of advance choice documents, the role of nominated persons and the expansion of advocacy services.

We are increasing the scrutiny and oversight of compulsory detention. We are making sure that those patients who are detained have a clear path to recovery and to discharge. We are introducing statutory care and treatment plans for all patients, so that their needs are met both during and after their hospital stay. To reduce reliance on in-patient care and ensure that people with a learning disability and autistic people get the right support, we are limiting the scope for detention. We are also introducing a package of measures to improve community support, including statutory care, education and treatment reviews and dynamic support registers. We are introducing stronger safeguards for people who lack capacity or competence to consent to treatment—a potentially highly vulnerable group. Those patients will receive a second opinion-appointed doctor at an earlier stage in their treatment.

This Bill has been the product of years of work predating this Government, and it is right that we thank hon. Members and peers for their scrutiny and support over many years. We should particularly note the work of the former Prime Minister Baroness May for launching the independent review that paved the way for this legislation, along with the review chair, Sir Simon Wessely, and his vice-chairs, Steven Gilbert, Sir Mark Hedley and Baroness Neuberger.

I thank Members who served on our Public Bill Committee, including the Chairs, and the clerks and all the parliamentary staff who have worked hard to ensure that the Bill was subject to the proper scrutiny while ensuring smooth and quick passage. I also thank the Joint Committee on Human Rights and particularly Lord Alton for its report and recommendations. I am grateful to the devolved Governments for their support during the Bill’s passage and to the Welsh Senedd and Northern Ireland Assembly for granting legislative consent. I thank the Bill team, my private office and all the officials and stakeholders over numerous years who have worked hard to get this legislation to where it is today.

Above all, thanks go to those with lived experience who have bravely shared their personal experiences with us through the independent review, through our consultation with stakeholder groups and through Members across both Houses. The Bill is the product of sustained effort over a number of years. That work will continue following the Bill’s Royal Assent, but none the less it is an important moment to acknowledge and pay tribute to those who have got the Bill to where it is now.

The work continues as we look to implement the legislation. The first priority once the Bill gets Royal Assent will be to draft and consult on the code of practice. We will engage closely with people with lived experience and their families and carers and with commissioners, providers, clinicians and others to do that. Much has been done, but there is much more to do. This Government are delivering on our commitment to modernise the Mental Health Act, and the work begins now to deliver that change on the ground. The Bill will of course now go to the other place, and I thank peers for their previous extensive consideration. I hope the noble Lords will be able to agree to the changes made in this House, so that the Bill can make swift progress to Royal Assent. I commend this Bill to the House.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Secretary of State.

[Stuart Andrew (Daventry) (Con)]

I want first to recognise and thank everyone for the constructive debates we have heard here and in the other place throughout the Bill’s passage. In particular, I thank the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), for everything he has done on the Bill, especially in Committee. I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his expertise, whose involvement with the Bill began before he was elected to this place. I also pay tribute to my right hon. Friend the Member for Salisbury (John Glen) and my hon. Friend the Member for Farnham and Bordon (Gregory Stafford) for their thoughtful contributions.

This is clearly an important and emotive issue, and the respect and sensitivity that have been shown by all sides is a testament to this House. Since the election, we have said that we would not oppose for the sake of opposition. While we have rightly asked tough questions of the Government, we have done so with the best interests of patients at heart, because everybody here wants to help and support vulnerable people better—those patients with the most severe and complex mental health needs. This Bill, which started under the previous Government—I pay tribute to former Prime Minister Baroness May for that—and continued under this Government, will achieve that. We welcome efforts to improve the patient’s voice and involvement in their own care, to ensure that patients receive effective and appropriate treatments, to minimise restrictions on liberty so far as is consistent with patient and public safety, and to treat patients with dignity and respect.

Although we are disappointed that opportunities to strengthen the Bill further have been missed, especially in public safety and the protection of vulnerable children, we listened closely to what the Minister said and to his assurances on action, for which we thank him. We will of course continue to push on these matters, not on party political grounds, but because doing so is the right thing for patients.

We are very disappointed that the proportion of health spending on mental health has been reduced. We welcome the Government’s continuation of our work looking again at how we treat and protect people with the most severe mental health illnesses, so that we can improve the safety, treatment and dignity of patients and the wider public, and ensure that our laws remain relevant and proportionate in the modern world. The Government must now turn their words into action and deliver on the commitments that they have made.

I thank everybody again for the constructive way in which they have dealt with the Bill. We are pleased to support its Third Reading. We hope that it will bring improvements for those we all care about: the patients.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.