Mental Health Bill [ Lords ] (Ninth sitting)

Zöe Franklin Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[The Chair]

I have a few preliminary reminders. Please switch electronic devices to silent. No food or drink, except the water provided, is permitted during the sittings of this Committee. Hansard would be grateful if Members could email their speaking notes or pass them on to the Hansard colleague in the room. Members are reminded to bob and catch my eye if they wish to speak in any debate.

New Clause 1

Reporting: racial disparities relating to community treatment orders

“(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must undertake a review of racial disparities which relate to the use and administering of community treatment orders.

(2) The review under subsection (1) must include, but is not limited to—

(a) an assessment of whether certain racial or ethnic groups are disproportionately represented among individuals subject to community treatment orders compared to their representation in the general population;

(b) a review of the outcomes and effectiveness of community treatment orders across different racial groups, including health outcomes, and patient experiences.

(3) The Secretary of State must lay a report of the findings of the review before Parliament within 18 months of the day on which this Act is passed.”—(Zöe Franklin.)

This new clause seeks to gauge the Government’s view on prevalent racial disparities as they relate to the use of community treatment orders under the Act.

Brought up, and read the First time.

[Zöe Franklin (Guildford) (LD)]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss new clause 3—Addressing and reporting on racial disparities and other inequalities in the use of the Mental Health Act 1983—

“After section 120D of the Mental Health Act 1983, insert—

‘120E Mental health units and services to have a responsible person

(1) A relevant health organisation that operates a mental health unit or community mental health service for qualifying patients must appoint a responsible person for that unit or service for the purposes of addressing racial disparities and other disparities based on protected characteristics related to functions discharged under the Mental Health Act 1983.

(2) The responsible person must—

(a) be employed by the relevant health organisation, and

(b) be of an appropriate level of seniority.

(3) Where a relevant health organisation operates more than one mental health unit or service, that organisation must appoint a single responsible person in relation to all of the mental health units or services operated by that organisation.

(4) A patient is a qualifying patient if they are—

(a) liable to be detained under this Act, otherwise than by virtue of section 4 or 5(2) or (4) or section 135 or 136;

(b) subject to guardianship under this Act;

(c) a community patient.

120F Policy on racial disparities and other disparities based on protected characteristics

(1) The responsible person must publish a policy on how the unit plans to reduce racial disparities and other disparities based on protected characteristics in that unit or service.

(2) The policy published under subsection (1) must cover the following topics—

(a) the application of the guiding principles to all aspects of operation of this Act;

(b) staff knowledge and competence in connection with promoting equality and anti-discriminatory practice in relation to this Act;

(c) workforce demographics, recruitment, retention and progression;

(d) implementation of the patient and carer race equality framework (England only) and any other requirements of relevant national policies;

(e) care planning and decision-making in the use of this Act including section 56A (making treatment decisions);

(f) the availability of alternatives to detention and involuntary treatment;

(g) take-up of independent mental health advocacy;

(h) the cultural appropriateness of independent mental health advocacy;

(i) access to and use of advance choice documents;

(j) what steps will be taken to reduce racial disparities and other disparities based on protected characteristics in that unit or service.

(3) Where a responsible person is appointed in relation to all of the mental health units operated by a relevant health organisation, the responsible person must publish a single policy under subsection (1) in relation to those units or services.

(4) Before publishing a policy under subsection (1), the responsible person must—

(a) consult any persons that the responsible person considers appropriate;

(b) have regard to the following matters—

(i) the views, wishes and feelings of people from ethnic minority communities who have been detained;

(ii) the views, wishes and feelings of people with other protected characteristics who have been detained.

(5) The responsible person must keep under review any policy published under this section.

(6) The responsible person may from time to time revise any policy published under this section and, if this is done, must publish the policy as revised.

(7) If the responsible person considers that any revisions would amount to a substantial change in the policy, the responsible person must consult any persons that the responsible person considers appropriate before publishing the revised policy.

120G Training in racial disparities and other disparities based on protected characteristics

(1) The responsible person for each mental health unit or service must provide training for staff that relates to addressing racial disparities and other disparities based on protected characteristics in that unit or service.

(2) The training provided under subsection (1) must include training on the topics covered in section 120F(2).

(3) Subject to subsection (4), training must be provided—

(a) in the case of a person who is a member of staff when this section comes into force, as soon as reasonably practicable after this section comes into force, or

(b) in the case of a person who becomes a member of staff after this section comes into force, as soon as reasonably practicable after they become a member of staff.

(4) Subsection (3) does not apply if the responsible person considers that any training provided to the person before this section came into force or before the person became a member of staff—

(a) was given sufficiently recently, and

(b) is of an equivalent standard to the training provided under this section.

(5) Refresher training must be provided at regular intervals whilst a person is a member of staff.

(6) In subsection (5) “refresher training” means training that updates or supplements the training provided under subsection (1).

120H Annual report by the Secretary of State

(1) As soon as reasonably practicable after the end of each calendar year, the Secretary of State must conduct a review in consultation with relevant bodies with commissioning functions on the use of treatment and detention measures contained in the Mental Health Act 1983 broken down by race and other demographic information.

(2) Having conducted a review under subsection (1), the Secretary of State must publish a report on the progress made in reducing inequalities in treatment outcomes and the use of detention measures in the use of this Act on people who have protected characteristics under the Equality Act 2010.’”

This new clause requires mental health units and services to appoint a responsible person tasked with addressing racial disparities related to functions discharged under the Mental Health Act 1983.

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Mr Vickers. New clause 1 seeks to ensure that racial disparities in the use of community treatment orders are properly understood, monitored and addressed. We have known for many years that black individuals are disproportionately subjected to coercive powers under the Mental Health Act 1983, including detention, restraint and community treatment orders, yet progress has been painfully slow.

The new clause would require the Secretary of State to undertake a review within 12 months of the Bill passing and to publish the findings within 18 months. It would look specifically at whether certain racial or ethnic groups are over-represented among those who are subject to community treatment orders, and whether there are disparities in outcomes—including treatment effectiveness and patient experience—across racial groups. The aim is not just to collect data, but for meaningful scrutiny of how coercive community powers are applied and whether they are serving all groups equally.

The 2018 independent review of the Mental Health Act found that black individuals were more than eight times more likely to be placed under a CTO than white individuals. That is not a minor discrepancy, but a structural injustice. The review also raised concerns that CTOs were not necessarily used because they are clinically effective, but because they are seen as a way to manage risk, particularly where racialised assumptions come into play. We must ask, are CTOs truly supporting recovery, or are they disproportionately used to control and surveil? Are they fostering trust or fear in mental health services?

The new clause would give Parliament the information we need to answer those questions. It would set a timeline for transparency and create a foundation for future policy reform that is rooted in fairness and equality. In the absence of this new clause, we risk continuing a system where racial injustice is baked into mental health practice, without sufficient oversight or accountability. If this Government are serious about tackling racial inequality in mental health, they will have no objection to this basic measure of review and reporting.

We have discussed specific disparities in previous clauses, but new clause 3 aims to ensure that systematic and sustained action is embedded in the way that mental health services are run. The disproportionate detention and coercive treatment of black and minority ethnic people under the Mental Health Act has been evidenced for decades, yet progress on addressing these inequalities has been too slow and too inconsistent across the country.

New clause 3 takes a structural approach. It would require each mental health provider to appoint a dedicated senior lead to take responsibility for reducing inequalities within their services—not in name only, but through published plans covering staff diversity, culturally appropriate advocacy care planning and the use of advance choice documents. It would also ensure that frontline staff receive ongoing training that equips them to recognise and respond to disparities and uphold anti-discriminatory practice, with regular refreshes to ensure that this learning stays live. Importantly, it would place a duty on the Secretary of State to publish an annual report breaking down how the Bill is used across racial and other demographic groups, and what progress is being made to close those gaps.

This is not about creating more paperwork; it is about requiring leadership, transparency and accountability at every level, from clinical teams through to Government. If this Bill is to earn the title of a reform, it must act decisively on the most pertinent inequalities in the system. I urge the Committee to support the new clauses.

[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.

[Zöe Franklin]

I thank the Minister for outlining the PCREF and the focus that it will have in addressing these issues. I was particularly interested in the explanation of the iterative approach that it will allow. I also thank the hon. Member for Southend West and Leigh for his insights into the issue. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 2

Mental Health Crisis Breathing Space

“(1) Any person detained under sections 3, 37, 41 or 47 of the Mental Health Act 1983 must be offered support from the mental health crisis breathing space debt respite scheme.”—(Dr Chambers.)

This new clause ensures that MHCBS, a debt respite scheme, is offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.

Brought up, and read the First time.

[Dr Danny Chambers (Winchester) (LD)]

I beg to move, That the clause be read a Second time.

The new clause relates to the mental health crisis breathing space debt respite scheme, and would allow it to be

“offered and available to patients detained under sections 3, 37, 41 and 47 of the Mental Health Act 1983.”

The mental health crisis breathing space mechanism is another vital tool that can protect people in a mental health crisis from the impacts of problem debt, by pausing enforcement action, contacting creditors and freezing interest and charges on any debts.

However, the number of people benefitting from an MHCBS are significantly below its potential, largely because both patients and healthcare professionals do not know about it. Ensuring that everyone detained under the longer provisions of the Act would automatically be offered access to the scheme would ensure that many more people could benefit from it. We have discussed in previous sittings the impact of debt on mental health, and the work of Winchester Citizens Advice. I am really pleased to say that this week, I presented them with a huge award for best social enterprise at the Hampshire business awards, so my congratulations go to them.

--- Later in debate ---

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

The new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing in regard to any guidance published by the Secretary of State.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I thank the hon. Lady for giving way so early in her speech. I mentioned my concern about this provision on Second Reading: a rough road is not the same as a broken bridge. We are dealing here with the most severe mental health issues. The new clause talks about wellbeing, which affects everyone. Trying to report that and fit it into this criteria risks diluting the very aim of the Bill in trying to deal with the most severe mental health issues. I would be grateful for clarification on the difference between mental wellbeing, which affects everyone, and mental health issues, which not everyone has.

[Zöe Franklin]

When it comes to enabling the Mental Health Act to function, having an understanding on the ground of the picture across our communities regarding mental health wellbeing is very important. That is why we tabled the new clause, which would allow us to get community care right. That would then feed into the crisis care that we are discussing in this Committee.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for Winchester for tabling the new clause. Like him, we are committed to preventing mental ill health and promoting good mental health. Achieving our vision for mental health requires a spectrum of interventions across the whole of society and across the life course, from prevention and early intervention through to treatment and specialised care for those with a severe mental illness in community and in-patient settings. We are committed to the shifts from treatment to prevention, hospital to community and analogue to digital, and our forthcoming NHS 10-year health plan will affirm those commitments.

With our commitment to neighbourhood health, we are encouraging stronger partnership working between local government, mental health services and the voluntary and community sector. As part of our shift to community, we have already launched six pilot neighbourhood mental health centres to deliver a 24/7 service, with open access to anyone who requires mental health support. Through the shift to prevention, we are putting more emphasis on early intervention and recovery to support people to live well and thrive, ensuring that we improve the conditions for creating good mental health.

Alongside that, I remind the Committee of the existing prevention concordat for better mental health: a voluntary agreement signed by local authorities and integrated care boards. Signing the concordat involves a commitment to take evidence-based, preventive and promotional action to support the mental health and wellbeing of their populations. The new clause would be duplicative of that existing programme, and could introduce an unnecessary resource burden on local authorities and commissioning bodies.

We are committed to moving to a meaningful partnership between central and local government, and to letting local leaders lead within their communities. For those reasons, I hope that the hon. Member for Guildford feels able to withdraw the motion.

[Zöe Franklin]

I thank the Minister for his comments. In particular, I was interested to hear about the mental health centre pilot schemes. I look forward to their further roll-out. They will be crucial in addressing the issues that we sought to address in the new clause. I was also very pleased to hear about the focus on a meaningful partnership between local government, national Government and mental health providers. On that basis, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 7

Funding and reporting

“(1) For each financial year until all sections of this Act have come into force, of the total health service expenditure by the bodies (taken together) in subsection (2), the proportion which relates to mental health spending—

(a) under the Mental Health Act 1983, and

(b) under this Act or which, in future, would be made under provision inserted into the Mental Health Act 1983 by this Act, (taken together) must not decrease.

(2) The bodies are the Department of Health and Social Care, NHS England and integrated care boards.”—(Dr Chambers.)

This new clause would require that mental health spending as a proportion of health service expenditure must not decrease in the implementation period of the Act.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

We are aware from the Darzi report that mental health cases account for about 20% of the NHS burden, and currently receive about 10% of the funding. Our mental health services urgently need investment. Children at risk of self-harm, anorexia and suicide often wait months to be seen. I keep thinking about a few people I spoke to in Winchester who have teenage daughters with anorexia. They have been told that their daughters have to reach a lower BMI before they hit the threshold for treatment. That is horrific for the individuals, and we know that their anorexia will be more difficult to treat, will require more intensive, longer treatment, and will cost the NHS more in resources and finances.

Many people cannot access the care in the community that they need. In a context in which suicide and mental ill health is on the rise, it is therefore disappointing to us that the Government have removed key NHS targets on mental health, such as physical health checks for those with mental disorders. Supporting those with mental health conditions is a fundamental pillar of the Government’s welfare reforms and economic agenda, but we know there were about 1 million people waiting in 2024 for mental health services. That is why we need to ensure that the spend on mental health care does not decrease and that, if anything, it increases.

--- Later in debate ---

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

The new clause would introduce a dedicated veterans’ mental health oversight officer, recognising that those who serve or have served in the UK or Commonwealth armed forces face distinct mental health challenges that are not always adequately met by the current system. Far too many veterans experience post-traumatic stress disorder, depression, anxiety or substance misuse that, sadly, is linked to their service. Yet they are often treated within a system that does not fully take account of those experiences, and they are sometimes detained under the Mental Health Act without the benefit of trauma-informed, veteran-specific pathways of care.

New clause 9 seeks to change that. It would create an independent officer, tasked with monitoring the use of the Mental Health Act in relation to veterans, advocating for tailored assessment and care linked to veterans’ service history, promoting alternatives to detention where appropriate, particularly through veteran-specific services, and reporting annually to Parliament on outcomes including rates of detention, recidivism and systemic barriers. It is not just about oversight; it is about respect and responsibility.

[Gregory Stafford (Farnham and Bordon) (Con)]

I am very sympathetic to the hon. Member’s concerns, but how does she see the new clause fitting in with the already established armed forces covenant, which protects and promotes healthcare for veterans across the country?

[Zöe Franklin]

I see them as absolutely sympathetic to each other and working in concert. We want to ensure that veterans have specific, tailored mental health care, as is outlined in the Bill. That is why the new clause would ensure that veterans’ unique needs are not just recognised but actively addressed. It is a practical and overdue step to improve care, safeguard rights and deliver the joined-up service that veterans deserve. After all, they give so much to our nation through their service.

I hope that the Minister will support the new clause, but if he does not, I hope that he will outline for the Committee how the Government will ensure that the aims of the new clause will be addressed through the Bill and its accompanying documents as they stand.

[Stephen Kinnock]

I am grateful to the hon. Member for Guildford for bringing the issue before the Committee. While most veterans lead healthy and successful lives following their service in the armed forces, we know that some may need mental health support. This Government are proud of the courage and dedication of our armed forces, and we are committed to ensuring that those who serve and served in the armed forces receive the best possible care.

All service personnel have access to mental health support throughout their career. The Defence Medical Services provide a responsive, flexible, accessible and comprehensive treatment service and, for leavers from the armed forces, NHS mental health services are available that are specially designed to support the unique needs of veterans. That includes veterans in mental health in-patient settings under the Mental Health Act and those within the criminal justice system. In England, these services are Op Courage and Op Nova, and in Wales there is Veterans NHS Wales. These bespoke services link with wider NHS mental health services to advocate for and support veterans to receive care tailored to their needs.

We are committed to giving veterans and armed forces personnel fair access to mental health care services and special consideration where appropriate. That is reflected in the core principles of the armed forces covenant, to which public bodies such as the NHS are legally bound to give regard. It is our firm view that a wealth of measures are already in place that respond to the unique needs and experiences of those who serve and have served in our armed forces. For that reason, I ask the hon. Member for Guildford to withdraw new clause 9.

[Zöe Franklin]

I thank the Minister for his comments—particularly about Op Courage, Op Nova and the armed forces covenant—and for his commitment to the veterans who have served this country and their courage, even when they face challenges with their mental health. The Liberal Democrats are willing to withdraw the amendment, but we will observe the passage of the Bill closely to ensure that it serves our veterans well across the UK. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 11

Costed plan to ensure community provision for individuals with learning disabilities and autism who are at risk of detention

“(1) Within 18 months of the day on which this Act is passed, the Secretary of State must publish a fully costed plan for how Integrated Care Boards and local authorities will ensure provision of adequate community services for individuals with learning disabilities and autistic people who are at risk of detention under Part 2 of the Mental Health Act 1983.

(2) As part of the development of that plan, a formal consultation process must take place to determine how the decision to enact the relevant parts of this Act will be made.

(3) The consultation must include input from relevant stakeholders, including—

(a) individuals with learning disabilities and autistic people;

(b) carers for people with learning disabilities and autistic people;

(c) healthcare professionals; and

(d) advocacy groups.”—(Dr Evans.)

This new clause requires a costed plan to ensure that ICBs and local authorities are able to provide adequate community services for individuals with learning disabilities and autistic people at risk of detention under Part 2 of the 1983 Act, informed by a consultation with a range of stakeholders.

Brought up, and read the First time.

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

--- Later in debate ---

[Dr Chambers]

I thank the Minister for his reassurances, especially on the ongoing reviews. I will withdraw the new clause, but I make the obvious point that this is about not only the health and safety of the staff and patients, but the public perception of mental health, and the stigma surrounding it if we are treating people in Victorian-era asylums. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 15

Review of impact of this Act on detention

“(1) The Secretary of State must, within a period of 12 months following the day on which this Act is passed, commission an independent review into the impact of relevant provisions on reducing the number of people detained under Part 2 of the Mental Health Act 1983.

(2) In subsection (1), ‘relevant provisions’ include—

(a) sections 4, 5 and 6,

(b) section 8,

(c) section 21, and

(d) sections 46 and 47.

(3) The Secretary of State must, within 12 months of the publication of the review in subsection (1), publish a strategy to implement the recommendations of that review.”—(Zöe Franklin.)

This new clause would require the Secretary of State to commission a review into the impact of relevant provisions in the Act in reducing the number of people detained, in particular the provisions relating to people with autism or a learning disability, on grounds for detention and for community treatment orders, medical treatment, care and treatment plans, and on after-care, and to implement any recommendations within 12 months of the publication of the review.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss the following:

New clause 18—Report on the impact of this Act on patients with eating disorders—

“(1) Within a period of 12 months following the day on which this Act is passed, the Secretary of State must publish a report on the impact of relevant provisions in this Act on patients with eating disorders.

(2) In subsection (1), ‘relevant provisions’ include—

(a) section 5 (Grounds for detention),

(b) section 11 (Making treatment decisions),

(c) section 17 (Urgent treatment to alleviate serious suffering),

(d) section 21 (Care and treatment plans), and

(e) section 47 (After-care services).”

This new clause would require the Secretary of State to report on the impact of this Bill on patients with eating disorders within 12 months of the passage of this Bill.

New clause 23—Impact assessment: children and young people in temporary foster care—

“(1) The Secretary of State must, within 18 months of the passing of this Act, publish and lay before Parliament an impact assessment on the impact of this Act on children and young people who are in temporary foster care.

(2) The impact assessment under this section must consider—

(a) whether the ordinary residence provisions result in delays or inequities in accessing treatment or after-care under this Act;

(b) the effect of transitions between placements on continuity of treatment under this Act; and

(c) any unintended consequences for children and young people in temporary foster care arising from the application of subsections (3) to (5) of section 125G of the Mental Health Act 1983.”

This new clause would require the Government to publish an impact assessment on the impact of this Act on children and young people in temporary foster care.

[Zöe Franklin]

New clause 15 calls for an independent review of whether the legislation achieves one of its core aims: reducing unnecessary detention under the Mental Health Act. People with learning disabilities and autistic people are still far too often detained in hospital settings, sometimes for months or years, despite clear evidence that community-based support would be more effective and humane. The Bill’s provisions—including those on grounds for detention, care and treatment planning and aftercare—are supposed to address that, but if we do not review their impact, there is a risk that they remain warm words without real change.

The new clause would ensure that the Government must review how well the new law is working, in particular for those most vulnerable to inappropriate detention, and then act on that evidence within a year. If we are serious about reform, which I believe the Government are given the content of the Bill, then the new clause would ensure serious scrutiny and accountability.

I turn to new clause 18. Eating disorders are complex, often misunderstood and frequently mismanaged in the mental health system. Too many patients face delayed interventions, inappropriate detention or a lack of tailored care, particularly when their condition does not fit into a narrow clinical threshold. The Bill introduces reforms to detention criteria, treatment decisions and care planning, but we must ensure that the changes actually work for people with eating disorders.

The new clause would require the Secretary of State to publish a report within 12 months that assesses the Bill’s impact on patients with eating disorders, including whether it is has improved access to appropriate treatment, safeguarded against unnecessary detention and strengthened aftercare. This is a matter not just of policy but of real people’s lives. We owe it to this vulnerable group to ensure that the reforms deliver real change, and that they are not left behind in a system that is still too often shaped by other conditions.

Finally, on new clause 23, children and young people in temporary foster care are some of the most vulnerable in our system. They often face multiple disruptions in care, placement and support, all of which can significantly impact their mental health. The new clause asks for a focused impact assessment on how the changes in the legislation will affect them. In particular, the new clause looks at whether the ordinary residence rules delay or block access to mental health treatment, whether placement changes disrupt continuity of care, and whether the provisions in section 125G of the Mental Health Act unintentionally harm this group.

Foster children should not fall through the cracks of bureaucracy. If we are serious about improving mental health services for all, we must understand and address the unique risks that face those who are moved frequently, often with little warning or support. An impact assessment is a necessary first step to ensure that their needs are not overlooked.

I commend all the new clauses to the Committee and look forward to hearing from the Minister.

[Stephen Kinnock]

On new clause 15, we want more people cared for in the community and fewer people reaching a point of crisis and detention, but we do not think it is right to use the legislation to drive down the numbers in an arbitrary way that could interfere with clinical decision making and create a risk that people do not receive the help that they need. An evaluation of the relevant clauses should therefore focus not purely on the reduction in detentions, but on the overall improvement of experience and outcomes. Such improvement is predicated on the independent review principles of choice and control, therapeutic benefit, and the person as an individual, as well as the principle of least restriction.

The timescales suggested in new clause 15 are not feasible. Following Royal Assent, our priority will be to update the code and for staff to be trained on the new legislation and code, before commencing the first phase of the reforms. The first phase of significant reforms cannot take effect until the work on the code and the training of staff are completed. Few, if any, of the sections mentioned in new clause 15 could therefore be commenced within 12 months, and it would be premature to commission a review of their effect on detention rates within that time period.

We plan to commission an independent evaluation of the reforms, subject to funding and fundable research applications. This will be a long-term, staged exercise, given the long period over which different reforms are expected to be sequentially commenced following the initial primary legislation. We will monitor the impact of the reforms on the number of detentions and disparities in detention rates, all of which are already published under the monthly Mental Health Act statistics. We have also committed to providing Parliament with an annual update on the implementation of the reforms. As we already plan to commission an independent evaluation of the Bill, and as the timescale set out in new clause 15 would not be feasible, I ask the hon. Member for Guildford to withdraw the new clause.

On new clauses 18 and 23, we have already published an impact assessment alongside the Bill, which was scrutinised by the Regulatory Policy Committee and rated fit for purpose. We have also committed to laying an annual report on the Bill’s implementation, through the written ministerial statement. We are committed to monitoring and evaluating the reforms to understand their impact on different groups affected by the legislation.

On new clause 18, we recognise the devastating impact that an eating disorder can have on someone’s life. The earlier treatment is provided, the greater the chance of recovery. The implementation and evaluation of the reforms will be a long-term, staged exercise. It would not be possible to assess the impact of the reforms on people with eating disorders within 12 months, as not all reforms will have been implemented. We will continue to work closely with NHS England to improve access to appropriate and timely care and treatment for people with an eating disorder.

On new clause 23, we recognise that there are inequalities in mental health prevalence and outcomes for children and young people in care. We are committed to ensuring that all children are able to access the care and treatment they need. We plan to develop bespoke guidance in the revised code on the care and treatment of children and young people, to account for the specific needs of that cohort. I hope that hon. Members will not press their new clauses.

[Zöe Franklin]

I thank the Minister for his comments; it was really helpful to hear about how he sees the timings in our new clause fitting with the ongoing work to implement the Mental Health Act and the commissioning of the independent review. I am concerned about his comment that the work will be dependent on funding. I hope that the funding for the important independent review will be ensured. However, on the basis of the Minister’s comments, I am happy not to press any of the new clauses. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 16

Transfer of patients: out of area placements

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

(2) After section 19 (transfer of patients), insert—

‘19A Transfer of patients: out of area placements

(1) The Secretary of State must reduce to zero, within five years of the passage of the Mental Health Act 2025, the number of patients transferred to a hospital outside of the area in which the patient is ordinarily resident.

(2) The Secretary of State must publish, within six months of the passage of the Mental Health Act 2025, a report to outline how the duty under this section will be met, including how provision for treatment under this Act will be increased.’”—(Dr Chambers.)

This new clause would require the transfer of patients to hospitals outside of their area to be reduced to zero within 5 years, and for the Secretary of State to produce a report on how this will be achieved.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

The new clause would require the number of patients transferred to hospitals outside their area to be reduced to zero within five years, and the Secretary of State would have to produce a report on how this would be achieved. We should not underestimate the harm and distress caused to patients and their families when they are allocated an out-of-area mental health placement. At the end of March 2024, there were 900 active out-of-area placements in England, of which 89% were deemed inappropriate.

Patients must be treated in a centre close to their home and family, and that can be achieved by increasing capacity and co-ordination between services. The new clause calls on the Secretary of State to publish guidance within six months of the Bill’s passage, setting out what processes and funding will be available for that purpose. Vulnerable people deserve to be treated near to their families and home, and the new clause would ensure that happens.

--- Later in debate ---

[Dr Chambers]

I thank the Minister for his comments. He recognises the issue and is taking steps to address it, so I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 19

Report and Guidance: Improving Outcomes for LGBT Patients

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, prepare and lay before Parliament a report on the mental health outcomes of patients who are treated under the Mental Health Act 1983 and who identify as lesbian, gay, bisexual, or transgender (LGBT).

(2) The report under subsection (1) must include an assessment of—

(a) any differences between non-LGBT patients and LGBT patients in—

(i) the extent of the use of detention measures under the Mental Health Act 1983; and

(ii) treatment outcomes following detention, and

(b) the availability and accessibility of ‘culturally competent’ mental health treatment under the 1983 Act for LGBT patients.

(3) Following publication of the report under subsection (1), the Secretary of State must publish guidance for responsible bodies and individuals working with patients under the Mental Health Act 1983, including but not limited to those working in—

(a) mental health hospitals;

(b) places of safety;

(c) crisis accommodation; and

(d) relevant community mental health services.

(4) The guidance under subsection (3) must include—

(a) provisions about updated training standards for staff regarding the specific mental health needs and experiences of LGBT individuals, including training on non-discriminatory practice and inclusive communication approaches;

(b) steps to improve safety for LGBT patients in relevant mental health settings, with particular regard to addressing discrimination and harassment; and

(c) a definition of ‘cultural competent mental health treatment’ for the purposes of subsection (2).

(5) Responsible bodies and individuals working with patients under the Mental Health Act 1983 must have regard to guidance published under subsection (3).

(6) In preparing the report under subsection (1) and the guidance under subsection (3), the Secretary of State must consult—

(a) patients with a mental disorder who identify as LGBT;

(b) the families or carers of patients with a mental disorder who identify as LGBT;

(c) relevant professional bodies;

(d) integrated care boards;

(e) local authorities;

(f) providers of mental health treatment; and

(g) such other persons as the Secretary of State considers appropriate.

(7) The Secretary of State must update the guidance under subsection (3) at regular intervals, and no less frequently than every three years.”—(Zöe Franklin.)

This new clause would require the Secretary of State to report on mental health outcomes and disparities for LGBT patients in treatment under the Mental Health Act 1983 and publish guidance covering training and safety for this specific group.

Brought up, and read the First time.

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

New clause 19 would require the Secretary of State to report on mental health outcomes for LGBT patients detained or treated under the Mental Health Act 1983, and to publish clear guidance to improve staff training, patient safety and inclusive care for that group. We all deserve appropriate support when experiencing poor mental health, and that support must be fair and respectful, no matter whether the patient identifies as lesbian, gay, bisexual or transgender. Members of the LGBT community should have confidence that they will be treated with dignity and should not face unequal or inappropriate treatment because of who they are. Unfortunately, we know that that is not always the reality.

Stonewall’s “LGBT in Britain—Health” report revealed deeply concerning findings: almost one in four LGBT individuals had heard discriminatory or negative remarks about them from healthcare staff, one in eight had experienced unequal treatment, one in 10 had been outed without their consent in healthcare settings, and one in seven had avoided treatment altogether for fear of discrimination. That is unacceptable anywhere in our health system, but it is especially alarming in mental health settings, where patients are already in distress and often detained, and may not be in a position to advocate for themselves.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the hon. Member for bringing this issue before the Committee. This Government are committed to tackling health inequalities. The NHS continues to pursue its advancing mental health equalities strategy, which sets out plans to address inequalities in access, experience and outcomes in mental health care, including for LGBTQ+ people. However, we do not think that a review within 12 months of the passage of this Bill is the right approach. First, there are known data quality issues with the recording of sexual orientation in the mental health services dataset, which, combined with small numbers, limits our ability to monitor outcomes accurately and reliably.

Secondly, we do not need a review before acting to improve patient experience under the Act. We will update the code of practice following the passage of this Bill, including the statutory guidance to the Mental Health Act, and will work with patient groups to consider what further guidance is needed to reduce disparities in use of the Act. That consideration will cover issues based on sexuality, gender, race and other protected characteristics. We are also committed to monitoring and evaluating the reforms, which will include an assessment of whether new safeguards and support mechanisms are being equitably accessed through different groups. For those reasons, I ask the hon. Member to withdraw the new clause.

[Zöe Franklin]

I thank the Minister for his comments, for the recognition that individuals in the LGBT community clearly have concerns about the way that mental health care is provided, and for the commitment to addressing those. I hope that at some point he will be able to advise on the timeline for looking to resolve the issue of the unreliability of data; it is crucial that we have accurate data in order to ensure good outcomes and improvements in mental health care. However, in the light of the Minister’s comments and commitment on the issue, we will not press the new clause, although I look forward to observing closely, as this Bill continues through the House, how it will address the current inequalities for the LGBT+ community. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 22

National strategy on mental health units

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

(2) In Part VIII (Miscellaneous Functions of Local Authorities and the Secretary of State), after section 118, insert—

‘118A National strategy on mental health units

(1) The Secretary of State must, within 12 months of the passing of the Mental Health Act 2025, publish a national strategy to set out how the Government will ensure that all relevant mental health units meet or exceed ‘good’ safety standards as assessed by the Care Quality Commission (CQC).

(2) A strategy issued under this section must address the following matters—

(a) recruitment, retention and training of mental health staff,

(b) patient-to-staff ratios, and

(c) safe staffing levels during crises and night shifts.

(3) Following publication of the strategy, a report on implementation progress must be laid before Parliament annually.

(4) For the purposes of this section, a ‘relevant mental health unit’ is a facility used for treatment under this Act.”—(Dr Chambers.)

This new clause would require the Secretary of State to publish a strategy, followed by an annual progress report, on how the Government will ensure that all mental health units used for treatment under the Mental Health Act 1983 are rated “good” or above by the CQC.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

New clause 22 is quite similar to new clause 14, on the state of in-patient facilities. It would require the Secretary of State to publish a national strategy to ensure that all mental health units meet or exceed a good rating for safety, as assessed by the Care Quality Commission. It would also mandate annual progress reports to Parliament. We all know that far too many mental health settings fall below acceptable standards. The CQC has repeatedly flagged serious failings in in-patient mental health services, including unsafe staffing levels, poor physical conditions and risks of harm to patients. These are not isolated issues but persistent and systemic problems.

The new clause calls for a proper, co-ordinated response. It would require the Government to set out how they will address staffing shortages, improve recruitment and retention, and ensure safe staffing levels, particularly at night and during crisis periods, when the risk is often highest. It is not enough to rely on reactive inspections or piecemeal initiatives; we need a national strategy backed by data, accountability and regular reporting to the House. Too many vulnerable people are currently treated in mental health units that are overstretched, understaffed and, in some cases, unsafe. The new clause would begin to change that by setting clear expectations on monitoring progress and holding the Government to account. I commend the new clause to the Committee.