PARLIAMENTARY DEBATE
Draft Mental Health Bill - 27 June 2022 (Commons/Commons Chamber)
Debate Detail
Last year, we invested £500 million to support those with mental health needs who were most affected by the pandemic and, as we set out in the NHS long-term plan, we are investing record amounts into expanding and transforming mental health services. That will reach an extra £2.3 billion each year by 2023-24. Later this year, we will also publish a new 10-year mental health plan followed by a 10-year suicide prevention plan, which, as I set out in a speech on Friday, will place a determined focus on this major source of grief and heartbreak so that fewer people will one day get the news that turns their lives upside down. But we cannot make the critical reforms that we need and that are so essential to the country’s mental health system without making sure that the law that underpins our country’s mental health system is up to date, too.
Since the 1983 Act, our understanding of and attitude towards mental health has transformed beyond recognition, and it is right that we act now to bring the Act up to date. The Mental Health Act was created so that people who have severe mental illnesses and present a risk to themselves or others can be safely detained and treated for their own protection and that of those around them, but there are a number of alarming issues with how the Act is currently used. Too many people are being detained. They are also being detained for too long, and there are inequalities among those who are detained. The previous Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), asked Professor Sir Simon Wessely to lead a review into the Act. I pay tribute to my right hon. Friend for her tireless commitment to this most important of issues and to Sir Simon for his illuminating report, which made a powerful case for reform and was rightly welcomed on both sides of the House. It made for uncomfortable but essential reading, vividly showing how currently the Act fails patients and their loved ones and deprives people of autonomy and control over their care.
The draft legislation that we have published today builds on Sir Simon’s recommendations as well as those in our White Paper, which was published in partnership with the Ministry of Justice last year. Just like Sir Simon’s report, the White Paper was welcomed by both sides of the House. It was also welcomed by leading charities including Mind, the National Autistic Society and Rethink, countless mental health professionals and, critically, the people who use mental health services and their loved ones. Today, we are showing how we will put the vision into action. The Bill is a once-in-a-generation reform, and I would like to set out briefly to the House the important themes that sit behind it.
First, the Bill rebalances the criteria for detention so that it will take place only as a last resort when all other options have been explored and considered. Under the new criteria, people will be detained only when they pose a significant risk of harm to themselves and others, and patients should be detained only if they will benefit from the treatment that is made possible by their detention.
Secondly, the Bill shows how we will give patients more control over their care and treatment. It will ensure that, in most cases, clinicians can administer compulsory treatment only if there is a strong reason to do so. In future, all patients formally detained under the Act will have a statutory right to a care and treatment plan, drawn up between the patient and their clinician, and personalised based on the patient’s needs. It will give them a clear road map to their discharge from hospital.
There are some cases when patients are not able to make decisions about their own care or feel that they could benefit from greater support. Currently, patients are not always able to choose who can represent them, as their nearest relative automatically qualifies to act on their behalf. The Bill will change that, allowing patients to choose a nominated person who they believe is best placed to look after their interests. The Bill will also increase the powers of that nominated person, so that they can be consulted about the patient’s future care.
Thirdly, the Bill will tackle the disparities in how the 1983 Act is used. Black people are four times more likely to be detained under the Act than white people, and 10 times more likely to be placed on a community treatment order. The Bill provides for greater scrutiny of decision making, including through greater use of second opinions on important decisions, and through expanded access to independent tribunals; that will help us to address the disparities in the use of the Act.
Fourthly, the Bill will enhance support for patients with severe mental health needs who come into contact with the criminal justice system. Under the 1983 Act, too often, people in prison experience delays in getting treatment in hospital. Courts are sometimes forced to divert defendants who require care and treatment, some of whom have not been convicted, to prison as a so-called place of safety. The Bill will make crucial improvements so that vulnerable offenders and those awaiting trial can access the treatment that they need. It will tackle delays and speed up access to specialist care by introducing a new statutory 28-day time limit for transfers from prison to hospital, and it will end the use of prison as a so-called place of safety, so that patients can get the care that they need in the appropriate hospital setting.
The Bill will also amend the Bail Act 1976 so that courts are no longer forced to deny a defendant bail if the judge’s sole concern about granting bail has to do with the defendant’s mental health. The Bill will allow the judge to send them to hospital instead, so that they can be in the best environment for their mental health and can receive any treatment that they need.
Finally, the Bill will improve the way that people with a learning disability and autistic people are treated under the 1983 Act. One of my priorities in my role is personalised care. The current blanket approach cannot be allowed to continue; it means that too many autistic people and people with a learning disability are admitted into institutional settings when they would be better served by being in the community. The Bill will change this. It limits the scope for detaining people with learning disabilities and autistic people for treatment unless they have a mental illness that justifies a longer stay or they are admitted through the criminal justice system. It also gives commissioners of local authorities and integrated care boards new duties to make sure that the right community support is available instead.
I look forward to working with hon. Members in all parts of the House as we take these plans forward. This momentous Bill deals with one of the most serious and sombre responsibilities of any Government: their responsibility for the power to deprive people of their liberty. Mental ill health can impact any of us at any time. It is essential that we all have confidence that the system will treat us and our loved ones with dignity and compassion. That is what the Bill will deliver. I commend the statement to the House.
This overhaul of the Mental Health Act 1983 is long awaited. We welcome the draft Bill, and the fact that the Government have accepted the majority of the recommendations from Sir Simon Wessely’s independent review of the Act. It was interesting to hear, in the statement, of the Government’s focus on keeping people in crisis out of A&E, and of their plans to reduce the use of general ambulance call-outs for those experiencing a mental health crisis. In 2020, there were over 470,000 calls to 999 because someone was in a mental health crisis, which took up an estimated 66,000 hours of call time. In my email inbox, I have numerous examples from across the country of children being stuck in A&E for over 24 hours waiting for a mental health bed. One child waited over three days. When I work shifts in A&E, I see more and more people coming into hospital in crisis. The increased frequency is deeply concerning. Conditions are getting worse and illnesses are going untreated. We would not allow that in cancer treatment, so why is it allowed in mental health treatment?
Deprivation of liberty and the use of coercion can cause lasting trauma and distress. That is especially true for children and young people who find themselves in these most difficult situations and whose voices are often not heard when decisions are made. We are pleased that patients will have greater autonomy over their treatment in a mental health crisis, and we are glad that the Government have been working with organisations to listen to the experiences of those with learning disabilities or autism, but will the Secretary of State explain what safeguards will be put in place for people with learning disabilities or autism should the worst happen and they find themselves in prison? This is not a straightforward issue. Many people with learning disabilities or autism also live with serious mental illnesses, and we have to make sure that they have their rights protected and have dignity in their treatment.
In our communities, we witness the harsh reality of the health inequalities that so desperately need to be addressed. As the Secretary of State said, black people are over four times more likely to be detained under the Mental Health Act.
Mental health staffing levels are absolutely crucial to ensuring that mental health services are fit for purpose. More than a year and a half ago, I asked the Secretary of State’s predecessor about the future of mental health staffing. The proposals that have been set out today go well beyond what has been committed to in the long-term plan. Labour has a plan: to recruit an extra 8,500 mental health staff to treat 1 million additional patients a year by the end of our first term in office. Will the Secretary of State outline when we will get the workforce settlement? What reassurance can he give on filling training places?
For too long, the Government have had their head in the sand when it comes to mental health. They have failed on eradicating dormitories from mental health facilities, failed on cracking down on the use of restraint, and failed on getting on top of waiting times. We cannot have this kicked into the long grass and, if it gets lost in the political quagmire of Conservative in-fighting, should the Government call an early general election, people will suffer. We cannot have the Government fail on mental health legislation any longer. This is a once-in-a-generation opportunity; we simply must get this right for everyone who depends on these vital services.
I think the hon. Lady agrees with me, as does everyone in this House, that the 1983 Act is outdated. Society has learned since then, rightly, that people’s mental and emotional wellbeing is as important as their physical wellbeing. That was recognised in the Health and Care Act 2022, which came before Parliament recently, and this draft Bill does a lot to change the situation as well.
The hon. Lady talked, rightly, about the importance of mental health services. The NHS is putting record funding into NHS services. Some 1.25 million people were seen through the NHS talking therapies service, despite the pressures of the pandemic, and an additional £500 million of resources was put into mental health services because of the pandemic.
On the workforce, today in the NHS, we have around 129,000 health professionals focused on mental health. That is the highest number ever, and the number has gone up by some 20,000 since March 2016. As for the NHS’s strategic workforce plan—the 15-year plan on which it is currently working—having the correct provision for mental health will, of course, be a very important part of that.
I welcome the publication of the draft Mental Health Bill. While it is necessary for it to be given proper scrutiny, does my right hon. Friend join me in believing that we need to get these new provisions on the statute book as quickly as possible, to ensure that all those who are going through a mental health crisis can indeed be treated with the dignity and compassion that they deserve?
I support wholeheartedly what the Health Secretary has said today. I hope that he does not mind my saying that in one instance it does not go far enough: there are still 2,000 people with autism and learning disabilities in secure institutions, effectively incarcerated, even though they would be better off in the community. It is a human rights scandal. As part of the remedy, would he consider changing the rules on sectioning so that, after a short period, anyone who wanted to keep someone in a secure unit would have to reapply for sectioning every week or two, so pressure is put on the system to find a better solution?
In his statement, the Secretary of State outlined that patients will be able
“to choose a nominated person who they believe is best placed to look after their interests.”
Could he outline what rights that nominated person might have? I have a particular issue in my constituency: somebody has been moved from one part of the country to another, but their next of kin was not asked for permission and only found out after the event. I think that it is incredibly important not only that there is a nominated person, but that that person has outlined rights that can be enforced in these situations.
As my right hon. Friend will know, I am supporting the No Time to Wait campaign, led by my good friend James Starkie, who is trying to ensure that there is a mental health nurse in every GP surgery in the country to help with the early intervention that we know is so critical. There is a great example in Norfolk and Suffolk NHS Foundation Trust, led by Lisa Dymond. Will my right hon. Friend, in the course of his work on this draft legislation, engage with that trust to see the work that it is doing to ensure that we can provide the access that people so desperately need?
Can I ask the Secretary of State about brain injury, which he knows I am a bit obsessed with? I visited three units—in Newcastle, Birmingham and Sheffield—the week before last. The big problem is that people are being given what is called a neurorehabilitation prescription, which is very similar to what he has described, but unfortunately, the moment they leave the trauma unit, the services that they require simply are not available in vast parts of the country. There are not enough occupational therapists, speech and language therapists, physiotherapists or psychiatrists to do that work.
The most distressing thing I heard was at the Birmingham Children’s Hospital—it does not have a hydrotherapy pool, which would be useful; nor does any other children’s hospital in the UK—which saw a 70% increase in brain injuries in children during covid from parents attacking their children. How are we going to get the workforce we need in order to make a difference to those people’s lives?
I welcome the Secretary of State’s draft mental health Bill. Will he meet members of the all-party parliamentary group to discuss what the Bill will do for those with autism? Can I also parrot the call from the Chair of the Select Committee, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), about the need to review the sectioning of those in mental health provision? There are far too many people languishing, and they need our help.
I am sure the Secretary of State will share my disappointment that, in England, 24% of all children’s mental health referrals are closed before the child receives any support. In my Adjournment debate last week, I highlighted the importance of children’s mental health services and trauma support and care, so will he reassure the House and me that he will do everything in his power to make sure children receive timely mental health support?
Support for children, even before the pandemic, was rightly a priority. Funding will increase to record levels by 2023, with an additional £2.3 billion in total so that an additional 345,000 children and young people can be seen. We put in an additional £79 million during the pandemic, and we will set out in our new 10-year mental health strategy exactly how we will do more.
“unless there are exceptional circumstances”,
and makes it very clear that those exceptional circumstances do not include a shortage of staff or beds. That is welcome, but at the moment about 50% of prisoners who are assessed as needing transfer to hospital are not transferred because the beds are not available. What can the Secretary of State do to make sure that that is not an issue by the time the Bill becomes law?
Far too many people are sent to mental health and learning disability placements out of their area. In April 2021, the Government committed to end the practice, but in March 2022 some 670 people were in out-of-area placements and, most concerningly, 50 of them were more than 300 km away from their homes. When will the Government meet their target and end out-of-area placements? What discussions has the Secretary of State had with the Secretary of State for Levelling Up, Housing and Communities about the issue of commissioning?
With that being the case, can the Secretary of State tell me what discussions have taken place with the relevant Minister in the Northern Ireland Assembly? Furthermore, the Secretary of State said that £2.3 billion had previously been allocated for this. How much will come to Northern Ireland through the Barnett consequentials, taking into account the fact that Northern Ireland has the largest percentage of mental health disorders in the United Kingdom and is in need of similar radical reform and, indeed, additional funding as well?
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