Mental Health Bill [ Lords ] (Ninth sitting)

Debate between Stephen Kinnock and David Burton-Sampson

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Mr Vickers. Sadly, there are clear racial inequalities within the mental health system, as in other areas of health, and this must change. People from ethnic minority communities are more likely to experience a mental health problem, are less likely to receive support, and have poorer outcomes from services. It is very concerning that black and ethnic minority people are over-represented in detentions in our mental health system, and there are well-documented worries over disparities in the quality of care that they receive.

Decades of evidence and lived experience testimony point to systemic injustice. Black British people suffer a 6% higher rate of common mental health problems than white British people, and black adults are twice as likely to show symptoms of post-traumatic stress disorder—at 8%, compared with 4% of the white British population. Black men are over 10 times more likely to be placed under community treatment orders, and black women are more likely than any other group of women to experience common mental health problems. Studies have shown that experiences of racism link to depression, psychosis and post-traumatic stress. When people are assaulted—not just physically, but emotionally and psychologically—by the structures around them, it leaves a lasting impact.

I have witnessed at first hand the racial disparities at a visit to my local in-patient mental health care at Rochford community hospital, where I could see a visibly disproportionate number of black men on the ward, compared with the percentage of black men I know live in my community. People from ethnic minority communities are more likely to come into contact with mental health services through crisis pathways, the police, accident and emergency, and detention. They are more likely to be restrained, isolated and subjected to coercive treatment. We must listen to what these communities are telling us.

Research by Mind identified nine key barriers to accessing care, from stigma and discrimination to Eurocentric models of treatment, language and cultural barriers. People feel othered by a system that was not built with them in mind. We need to rebuild trust and recognise that mental health cannot be separated from the broader social and political context. Austerity, Brexit, the Windrush scandal and covid-19 have all disproportionately affected the black, Asian and minority ethnic community. That has led to a decrease in trust towards the establishment, and that bleeds into general distrust of organisations and officials working in healthcare settings and mental health.

People from BAME communities have shared many examples of direct and indirect discrimination they have experienced within mental health services. Those negative lived experiences further erode trust in the system and often deter people from seeking help. Racial disparities in mental health are a pressing issue that requires immediate and sustained action.

New clauses 1 and 3, tabled by the hon. Member for Winchester and outlined by the hon. Member for Guildford, have good intentions, but we need to reflect on whether they fit in the Bill. I would suggest not. The drivers of disparity here are much deeper than the scope of the Bill, and it would be wrong to attempt to wrap up the solution to this issue within it. That does not mean that action should not be taken.

I am hopeful that this Government are doing wider work to drive down racial inequalities, including with the challenge we can see here with mental health. Perhaps the Minister will outline more about the Government’s work, and therefore why the new clauses are not needed. I support the intent of the hon. Member for Winchester, but I cannot support the new clauses as an addition to the Bill. I would be happy to meet the Minister and others to discuss further ongoing overall inequalities for the BAME community.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship this morning, Mr Vickers.

New clause 1, tabled by the hon. Member for Winchester, would require the Secretary of State to undertake a review of racial disparities in the use of community treatment orders. It is our view that the evidence base is already strong, and further reviews are not necessary. There are significant racial disparities in the use of community treatment orders. In 2023-24, black or black British people were issued with CTOs at seven times the rate of white or white British people. The use of community treatment orders as a proportion of overall detention numbers is higher for all minority ethnic groups compared with the white British population.

We are committed to reducing these disparities through our reforms and through the patient and carer race equality framework, which was a recommendation of the independent review. This includes a greater focus on prevention and early intervention, in part by promoting the use of advance choice documents, rather than an approach that simply makes it harder to impose CTOs. We are developing and monitoring an evaluation strategy, and we will continue to monitor and report on ethnic disparities via the published Mental Health Act statistics and our annual implementation report to Parliament.

New clause 3 would create the new “responsible person” role. They would have a duty to report on racial disparities and other inequalities in the use of the Mental Health Act. However, as drafted, the remit is significantly broader than that, to the extent that it would not be practical to combine all the stated functions into one role. We agree that there is a need to strengthen organisational leadership, improve data collection and change cultures across the mental health system. We also agree that it is important to have more targeted responsibilities to monitor and address racial disparities at board level in trusts, and that is already an explicit requirement of the PCREF.

The PCREF is a contractual requirement of mental health providers under the NHS standard contract. It builds on the statutory duties that apply already under the Equality Act 2010. These existing requirements cover the key responsibilities needed to monitor and address racial disparities. The PCREF can be updated more regularly than primary legislation, allowing us to take an iterative approach throughout implementation to ensure that we are capturing reporting and acting on the right data from frontline services. Ultimately, we feel that the PCREF will be more effective at reducing racial inequalities than the very broad remit outlined in this new clause, and that the addition of a responsible person in legislation is duplicative and unnecessary.

My hon. Friend the Member for Southend West and Leigh asked about implementation. The PCREF is the key instrument that we will use, but we are seeking to improve and strengthen decision making in three important ways: first, by requiring that an individual must be at risk of serious harm to be made subject to a CTO; secondly, by requiring the community clinician to be involved in all community treatment order decisions; and thirdly, by increasing the frequency of automatic reviews of patient cases by the tribunal, so that CTOs can be removed as soon as it is safe and appropriate to do so. I hope that that gives my hon. Friend some reassurance around the work that we are doing, but of course I would be happy to discuss these matters with him.

For those reasons, I ask the hon. Member for Guildford to withdraw new clause 1, on behalf of the hon. Member for Winchester.

Mental Health Bill [ Lords ] (Seventh sitting)

Debate between Stephen Kinnock and David Burton-Sampson

Committee stage
Thursday 19th June 2025 Public Bill Committees

[Stephen Kinnock]

I will set out the details of two important clauses relating to aftercare. Clause 46 will provide the tribunal with an important new power to recommend that plans for aftercare arrangements are undertaken for patients who are not yet ready to be discharged from hospital. Under the Mental Health Act, the tribunal can make decisions about discharge, but it does not have a role in recommending aftercare while a patient remains detained. Giving the tribunal the power to make recommendations that aftercare planning should take place will encourage earlier planning for a patient’s eventual discharge from hospital.

Those recommendations are particularly important for complex cases in which patients may require intensive support following their discharge. Early aftercare planning ensures that the necessary health and social care services are co-ordinated and in place when the patient is ready to leave the hospital. This will help to reduce the likelihood of delayed discharges or failed transitions back into the community.

Although the tribunal’s recommendations are not legally binding, they are intended to carry significant weight with aftercare providers. If recommendations are not taken forward, the tribunal retains the power to review the patient’s case. That will ensure that there is both encouragement and accountability in the aftercare planning process, enhancing patient outcomes by making sure that care is appropriately planned and delivered.

The clause will strengthen the role of tribunals in overseeing the care and treatment of patients under the Mental Health Act, ensuring that a patient’s needs are addressed holistically and in a timely manner. By encouraging earlier and more co-ordinated aftercare planning, we will reduce the risk of patients being discharged without the necessary support in place, leading to better overall patient outcomes and smoother transitions from hospital to community care.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Sir Desmond. Again, I reflect on stories that I have heard from local constituents on the issues that are being addressed in the Lampard inquiry. Does the Minister agree that these provisions will help to avoid the too early discharges that have led people either to go back into care or to get into even more difficult situations? One of my constituents ended up taking his own life because he was discharged too early from care.

[Stephen Kinnock]

My hon. Friend is absolutely right. In many ways, the best way to look at the issue of discharge is to start thinking about it almost as soon as the patient is admitted. We need to be thinking holistically about what place they are in, what the aftercare plan might look like and how it might relate to the discharge plan. The earlier we do so, the better. In so many cases, upstream intervention is important to avoid having to scramble to deal with a crisis further down the line. My hon. Friend is absolutely right to raise that point.

I turn to clause 47. Section 117 of the Mental Health Act places a duty on the NHS and local social services authorities to provide aftercare to certain patients who have been detained under the Act once they leave hospital. Aftercare services seek to reduce the risk of readmission, and they must be provided until the NHS and local social services authorities are satisfied that the person is no longer in need of such services. However, there is currently no requirement to notify the person when that ends. Clause 47 requires that the provision of aftercare lasts until the NHS and local social services authorities jointly give notice to the person in writing that they are satisfied that the person is no longer in need of such services. This will clarify when aftercare services have ended.

Decisions on entitlement to and responsibility for aftercare services are heavily contested. Deeming rules are used to deem a person to be ordinarily resident in one area, even though they are living in a different area. They ensure continuity of financial responsibility when a person is placed in a local authority area and prevent the local authority from placing someone out of area to ease its financial burdens. Currently, section 117 does not contain any deeming rules.

Clause 47 will apply existing deeming rules under social care legislation to identify which local authority is responsible for arranging aftercare for an individual patient. This change will add clarity and consistency to an often litigious system and more closely align local authority social care and NHS rules for determining ordinary residents. This aims to support organisations to work together to provide and plan for aftercare services and reduce the number of disputes that have arisen in recent years.

Finally, I thank the hon. Member for Guildford for tabling new clause 21, which seeks to place a duty on the responsible integrated care board to ensure that advice and support is offered to the family or carers of the patient being discharged. The statutory guidance on discharge from mental health in-patient settings sets out how NHS organisations should exercise duties to co-operate under sections 72 and 82 of the National Health Service Act 2006 in the discharge process. This includes providing information or support on housing, social services provision and financial support. The Mental Health Act code of practice also provides statutory guidance on the information that should be provided to patients, families and carers.

We do not believe that it is necessary to place additional duties on integrated care boards to provide information and support, as existing duties are sufficient. We will consider whether to use the revised code to bring together guidance on discharge into one place and explore how to clarify best practice on information and support to carers. I hope that what I have set out satisfies the hon. Member for Guildford and that she will not press new clause 21. I commend clauses 46 and 47 to the Committee.

Mental Health Bill [ Lords ] (First sitting)

Debate between Stephen Kinnock and David Burton-Sampson

Committee stage
Tuesday 10th June 2025 Public Bill Committees

[Stephen Kinnock]

Absolutely, and I pay tribute to my hon. Friend for her outstanding work in the all-party parliamentary group; I am looking forward to meeting with the APPG as soon as diary time can be organised.

There is absolutely no point in the Government making policy in an ivory tower in Westminster or Whitehall. Policy must be evidence-based and based on the real, lived experience of patients—we are very committed to building a patient-centric national health service—and practitioners. If we try to make policy without involving the voices of those people, the policy will fail; we know that from bitter experience.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Mr Vickers. I, too, have received messages from organisations in my constituency that welcome clause 3 and clause 4, which I will speak to later. On the implementation, however, they have made it very clear that it is really important to hear the voices of the individuals who will be impacted and their families. As we work with the ICBs, local authorities and commissioners to implement these new regulations, I seek an assurance that the voices of the community will be heard.

[Stephen Kinnock]

My hon. Friend is absolutely right that those voices must be heard. One example is that we must produce a code of practice to ensure that approved mental health professionals are better supported in their decision making, including when assessing whether somebody with a learning disability or an autistic person has a co-occurring mental disorder. At the heart of the process are the assessment and the definition, and the pathway that flows from that. That code of practice can be developed only on the basis of dialogue and engagement with precisely the people he has talked about.