Mental Health Bill [Lords]

17:33:00

I beg to move, That the Bill be now read a Second time. I want to place on record my thanks to Baroness Merron for her leadership of the Bill’s progress in the House of Lords, and to thank Members on both sides of that House for their contribution to scrutiny of it. I particularly thank Baroness May of Maidenhead for the constructive way in which she has engaged the Government, and for commissioning Sir Simon Wessely to undertake the review of mental health that underpins so much of the Bill. At the general election, Labour stood on a manifesto commitment to modernise the Mental Health Act 1983, and I am proud to say that we are delivering on that promise in the first Session of this Parliament. In doing so, we are providing a once-in-a-generation opportunity to profoundly transform the way in which we view and support people with serious mental illnesses. The measure of a society is how it treats its most vulnerable citizens, and when it comes to the treatment of people with serious mental illnesses, we are falling well short of the humane, compassionate society that we aspire to be. Patients live 15 to 20 years less than the average, and they are often accommodated far away from their families and loved ones. The facilities in which they are housed can be completely unsuitable. During his investigation last year, Lord Darzi found nearly 20 patients in a mental health facility who were forced to share two showers and live among an infestation of rats and cockroaches. Patients are denied the basic choice and agency that is awarded to NHS patients with physical illnesses. People from ethnic minority communities, especially black African and Caribbean men, are more than three times as likely to be sectioned. Although they are very different conditions, people with a learning disability and autistic people are often lumped in with those who have mental illness, reflecting an outdated lack of medical understanding.

The Health Secretary will have been briefed by the Minister for Care about the tragic murder of Christopher Laskaris, the son of my constituent Fiona Laskaris, and the lack of a voice for parents, who know their own children extremely well, in very difficult situations like this. Have the Government considered whether they might table an amendment to make things like Christopher’s tragic murder less likely in the future?

I am extremely grateful to the right hon. Gentleman for his intervention, and I place on record my thanks to Fiona for her campaigning work in circumstances that are completely unimaginable for those who have not walked in her shoes and experienced the kind of grief that she is experiencing. I know that my hon. Friend the Member for Rother Valley (Jake Richards) has been campaigning assiduously on this issue; similarly, we have had representations from the hon. Member for Dorking and Horley (Chris Coghlan), who is in his place, and the right hon. Gentleman. We are carefully considering the arguments that have been made, and looking at what we can do in this Bill to advance things in the way that Fiona and others like her would like to see. We will continue that engagement throughout the passage of the Bill, and see if there is a workable way in which we can improve it to ensure that others do not have to go through the unimaginable heartbreak that Fiona is living with every day.

My right hon. Friend is touching on ways to strengthen this Bill even further. He will know that the Joint Committee on Human Rights has just this morning published our report on the Bill. We have praised it for all that it will do to address a number of inequalities, but we have picked out one or two areas where it could go even further. I know that he will not yet have had a chance to look at our report, but will he arrange for a meeting with members of the Committee and the relevant Minister to discuss our findings?

I wish I could correct my hon. Friend and say that I have already read in detail the feedback from the Joint Committee on Human Rights, but he is right: I have not yet had a chance to do that. However, I can assure him that I and my hon. Friend the Minister for Care will look at the Committee’s report. We would be very happy to meet members of the Committee to discuss in further detail their findings and recommendations. We want to ensure that the Bill is as strong as it can be, given the length of time that has passed since the Mental Health Act was reformed. Indeed, the Mental Health Act is as old as I am. [Interruption.] Thank you for those interventions. I assure Members heaping compliments across the Chamber that it will not affect investment decisions in their constituencies, but I am none the less very grateful. There is a serious point here: whereas attitudes to mental health have come on in leaps and bounds in the past four decades, the law has been frozen in time. As a result, the current legislation fails to give patients adequate dignity, voice and agency in their care, despite the fact that patients have consistently told us that being treated humanely, and making decisions about their own care, plays a vital role in their recovery. When patients are detained and treated without any say over what is happening to them, it can have serious consequences for their ongoing health. To quote one of the many patients who bravely shared their experiences with Sir Simon Wessely’s independent review: “Being sectioned was one of the most traumatic experiences of my life. Sadly, as a result of being sectioned I developed PTSD”— post-traumatic stress disorder— “as the direct result of the way I was treated”. Sir Simon’s review was published seven years ago. It shone a light on a group of people who had been hidden, ignored and forgotten. In the time that has passed since, the case for change has only snowballed. The Bill now takes forward Sir Simon’s recommendations. The review stressed that legislation alone would not fix the system; culture and resources matter too. This was echoed in Lord Darzi’s investigation into the NHS, which uncovered some hard truths: a dramatic rise in the use of restrictive interventions on children; and 345,000 patients waiting more than a year for their first appointment with mental health services—more than the entire population of Leicester—of whom 109,000 were under the age of 18. This Bill does not solve every problem in our mental health services, but it marks a vital step in our plans to improve the quality of care, combat long-standing inequalities, and bring about a stronger focus on prevention and early intervention in mental health.

Does my right hon. Friend agree that while we are seeing record levels of mental health problems in our young people, investment in community services for people with mental health problems must be a priority?

I wholeheartedly agree with my hon. Friend. As he has heard many times from this Dispatch Box, we want to see a shift in the centre of gravity in the NHS out of hospitals and into the community as one of the three key shifts that will underpin our 10-year plan for health, which we will be publishing in the not-too-distant future. The Mental Health Act is designed to keep patients and the public safe, but it is clear to anyone who has seen how patients are treated that it does so in an outdated and blunt way that is unfit for the modern age. It is too easy for someone under the Act to lose all sense of agency, rights and respect. It is sometimes necessary to detain and treat patients, but there is no reason why patients experiencing serious mental illness should be denied the choice and agency they would rightly expect in physical care. Not only should the health service treat all its patients with dignity and respect anyway, but giving people a say over their own care means that their treatment is more likely to be successful. In the foreword to his independent review, Sir Simon Wessely said: “I often heard from those who told me, looking back, that they realise that compulsory treatment was necessary, even life-saving, but then went on to say ‘why did it need to be given in the way it was?’” Another patient in the 2018 review said: “I felt a lot of things were done to me rather than with me”. We need to get this right. We need to give these patients a voice.

I commend the Secretary of State for bringing this Bill before the House. On all occasions when I have inquired of him, he has been keen to share ideas and thoughts on legislation in relation to Northern Ireland. On mental ill health, deprivation and poverty, the figures for Northern Ireland are some of the highest in the United Kingdom, which worries me as the MP with responsibility for my constituents back home in Strangford. I know he will, but will the Secretary of State share all the ideas in the Bill with Mike Nesbitt—the Health Minister back home—so that Northern Ireland can also benefit?

I am happy to reaffirm that we have a really strong working relationship with Minister Mike Nesbitt and the Northern Ireland Executive, and we are keen to share insight wherever we can. The hon. Gentleman makes a very important point, which refers back to the remarks I made about the limitations of the legislation. Reform of the statute book is important in terms of how the law treats people. But as well as reforming the model of care, clinical pathways and looking at new treatments, innovations and technologies, we also need to focus on prevention, attacking the social determinants of ill health, including mental ill health, of which poverty is a key driver of stress, anxiety, depression and worse. That is why the Government will keep such a focus not just in our 10-year plan for health, but more broadly across public policy. The current legislation has left many people with a learning disability and many autistic people in mental health hospitals, when they could receive much better care elsewhere. Around four in 10 people with a learning disability or autism could be cared for in the community. The Bill aims to improve the care and treatment people receive when detained, while keeping patients and the public safe. Through the Bill, we are: strengthening and clarifying the criteria for detention and community treatment orders to better support clinicians in their decision-making; introducing increased scrutiny and oversight for compulsory detention and treatment; and providing patients with a clear road to recovery by introducing statutory care and treatment plans for all patients detained under the Act, except if under a very short-term section.

Does the Secretary of State agree that a proper community treatment plan for those with learning disabilities and autism is not just reliant on the actions of his Department, but a cross-Government effort and an integrated care system at a local level?

My hon. Friend is absolutely right. I am very glad that my Department is working closely with other Departments across a range of issues, in particular with my right hon. Friend the Secretary of State for Work and Pensions on the link between employment, welfare and health, and with my right hon. Friend the Secretary of State for Education on the reform of special educational needs and disabilities, and the interface between health and education services—I could go on. The point is that a wide range of factors have an impact on people’s health and wellbeing. Indeed, people’s health and wellbeing can have an impact on a wide range of aspects of their lives, which is why we have to work in a mission-driven cross-Government way.

I thank the Secretary of State for giving way; he is very kind. I was interested, when he was talking about the impacts of mental health on society at large, whether he has given consideration to the Carers Trust proposal, which would amend the Bill so that when a parent has a mental health crisis, checks and safeguards are put in place to ensure that any young carers in that family are suitably cared for?

I am grateful to the hon. Member for that intervention and for raising the very serious issue—an issue of increasing prevalence—of the impact of parental mental ill health on children and young people. We are very happy to look at the Carers Trust proposal, and to take representations on that and other issues as the Bill progresses through its Commons stages. We want to ensure that we get not just the legal basis of mental health provision in the right place, but practical care. As we think about children and young people’s mental health and wellbeing, we also need to take into account their parents’ mental health and wellbeing through that lens, too. Patients’ choices and needs will always be taken into account, thanks to the introduction of a new clinical checklist. It requires clinicians to involve patients and those close to them in decisions affecting their care, while retaining the power to treat individuals compulsorily where absolutely necessary.

Does the Secretary of State agree that that should be a case of “only when absolutely necessary”? In my previous role, I provided advocacy for the family of a young man who has been in a state hospital in Scotland for 17 years under a compulsory treatment order. His family live several hours away in north-east Scotland. That is, in my view, a horrendous infringement of his and their human rights. Will he share any learnings from the action the Government are taking, which is so welcome, on how community treatment can be placed effectively for people who are going through such horrific restrictions on their rights to family life?

My hon. Friend’s question raises two key issues with the provision of mental health services. First, we must ensure that the bar is set in the right place for compulsory treatment. Secondly, we must ensure that both compulsory and voluntary treatment in a hospital setting is within a reasonable distance of family, friends and loved ones. My hon. Friend powerfully describes the impact of such cases, where there is not just a deprivation of liberty, but an impact on an entire family. We need to do much better on both sides of the border when it comes to the appropriate placement of people in mental health settings. There will always be times when patients hit crisis points and lack the ability to express what they want. To ensure that their voice is not lost and that professionals are working with patients, the Bill introduces duties to encourage people to make an advance choice document while they are well. This document provides a record of their wishes for use by mental health professionals, should the patient later experience a crisis that renders them incapable of making their own decisions.

I was 11 years old when my mum first tried to take her own life; she was sectioned several times over the coming years, and until I was an adult. How will this new way of treating people and making that part of the community, as well as looking after the children of those impacted, be measured over time so that we know it is successful?

I am extremely grateful to my hon. Friend for sharing such personal lived experience of the issues we are debating this afternoon. I encourage her to take every opportunity to share those experiences directly with Ministers or through the passage of this Bill, which others in a similar situation will also have had, so that we can provide the best possible support for people experiencing a mental health crisis and for their loved ones, who also experience an enormous amount of pain and anxiety in supporting someone going through acute mental illness. We are also updating the outdated nearest relative provisions to allow patients to choose someone to be their nominated person, which gives that individual important powers to represent the patient’s interests when they cannot represent themselves. One patient explained: “My mother used to perform this role, but she now has Alzheimer’s and she lacks capacity. Under the current system, I cannot specify who I wish to serve as my nearest relative. The responsibility would automatically go to my oldest sister—a sister I do not get on with”. Our reforms will ensure that this statutory role is not chosen for the patient, but is rather the choice of the patient. Advocacy services are often a lifeline for those who find themselves in the vulnerable position of being detained, giving a voice to those who may otherwise feel voiceless. Patients have reported that an advocate can ensure that “their voice and opinion is valued and listened to. They came to my meetings, valued my opinion and put my views across to other people. People listened to my advocate.” We are also extending advocacy services to patients who come to hospital voluntarily and making changes to improve advocacy uptake among those who are detained, as well as working to change the culture of our health and care services so that everyone is listened to and so that patients do not have to rely on an advocacy service to get their voice heard.

I am grateful to the youthful Secretary of State for giving way. In the past few months, I have had a number of constituents describe the difficulties they have had in transitioning from care provided by child and adolescent mental health services to adult mental health services—a critical transition. They specifically faced difficulties in accessing the same medication when they turned 18 that they had previously been reliant on as young people. Can the Secretary of State describe to me how either the Bill or the change in culture for which he is advocating will improve the situation for people like my constituents?

I am grateful for that intervention. The hon. Gentleman raises what is, frankly, the depressingly familiar issue of the transition from youth and adolescent services to adult services, which applies across such a wide range of public services. It is so frustrating that we are still, in this decade of the 21st century, describing a problem that was prevalent in the ’90s and noughties. None the less, we are working to improve not just the law, but the performance in this space. Many of the changes we will be looking to make under the auspices of our 10-year plan are about better joining up of data, information and patient records, better care planning for patients and designing services around patients so that everyone—whatever their age or stage of treatment—receives joined-up services, with clinicians having a full picture of that patient’s experience. Hopefully, that will also help to deal with some of the cliff edges and bumps in the road that people can often experience when transitioning from one part of the NHS to another, whether that is from youth and adolescent services to adult services or the interface between primary and secondary care.

I welcome this piece of legislation, which I think is generally in a very good place. I have had a tragic situation in my constituency, where somebody who had been admitted to hospital in a suicidal state discharged themselves, after which, unfortunately, no follow-up care was provided, and they took their own life. It has been devastating for their family. Would the Secretary of State consider looking at how the community supports people experiencing a mental health crisis who might have discharged themselves, and how we can keep them safe in future?

I am very grateful to the hon. Lady for that intervention. The Bill deals to an extent with cases that would fall under the category she describes, in particular through reforms to community treatment orders. However, it would not necessarily cover the full extent of the sorts of people who might find themselves in that position, which is where I think we can use technology—which is not the answer to every problem in the health service, by the way. However, through better use of data, patient records and analytics, we will be better able in the future to predict risk and prevent tragedies as in the case the hon. Lady describes, which are a tragedy not just for those whose lives are cut needlessly short, but for those who live their lives with that intolerable grief and loss for the many years that follow. It is a shameful truth about our society that people with a learning disability or autism are detained, sometimes for years, with little or no therapeutic benefit. The Bill will put an end to that injustice, limiting detentions so that people with a learning disability and autistic people are no longer detained beyond 28 days unless they have a co-occurring mental health condition that would benefit from treatment in hospital. This will require the necessary community provision in place to support people with a learning disability or autism, and we are working to set out what strong community services look like and on the resources required to implement them, so that there are robust alternatives to hospital care. To help to plug the flow of inappropriate admissions to hospital, the Bill places a duty on integrated care boards to improve monitoring and support for people with a learning disability or autism who may be at risk of future detention. The Bill will introduce statutory care, education and treatment reviews to ensure that patients are safe and receiving the right care and treatment when detained, and that a plan to discharge them to the community is being worked up. We will also remove prison and police cells from the definition of “places of safety”. Police cells are for criminals, not patients in desperate need of medical help. Throughout the development of these reforms, we have maintained the central purpose of the Mental Health Act—to keep individuals and the wider public safe. The vast majority of people with mental illness, including severe mental illness, present no risk to themselves or others, and, for the majority of people, treatment can be provided without compulsion. However, there are some people whose illness, when acute, can make them a risk to themselves, and sometimes to others. No one knows this better than the families of Ian Coates, Barnaby Webber and Grace O’Malley-Kumar, the victims of Valdo Calocane’s violent rampage in Nottingham, whose campaign for justice and accountability has been truly awe-inspiring, or indeed the family of Valdo Calocane, with whom I have also spent time, listening to their experience of feeling badly let down by health services. As the independent investigation into the murders found, both he and his victims were failed by the health service, and their families have been left to live with the consequences with a level of pain the rest of us can scarcely imagine. I would like to place on the record my thanks to all four families for meeting me as my team and I worked on the Bill. Thanks to the amendments that we are making to the Mental Health Act, decision makers will have to consider the risk of serious harm when making decisions to detain. That will ensure that any risks to the public and patients are considered as part of the assessment process. We will also introduce a new requirement for the responsible clinician to consult another person when deciding whether to discharge a patient, putting in place robust safeguards against the release of potentially dangerous people. Finally, as I have said, legislation alone will not fix the wider issues of increasing mental health needs and long waiting times. To do that, the Government are investing in earlier intervention to meet patients’ needs and prevent them from reaching crisis point.

Will the Secretary of State give way?

I am just coming to my conclusion, I am afraid. In the past 10 months, we have met the mental health investment standard for 2025-26; invested an extra £680 million in mental health services this year, which is a real-terms increase; funded mental health support teams in schools for almost an extra 1 million pupils; invested an extra £26 million to build new mental health crisis centres; funded NHS talking therapies for an additional 380,000 patients; and begun recruiting the 8,500 mental health professionals we promised in our manifesto. That is all part of the additional £26 billion this Labour Government are investing in health and care services—investment that was opposed by every party on the Opposition Benches; investment that is happening only because we have a Labour Government. Mental health reform is not just about changing laws; it is about changing lives. The action we are taking will provide support and care to people at their most vulnerable, modernise our mental health services to keep us all safe, and create a safety net that any of us might need one day. I commend the Bill to the House.

I call the shadow Secretary of State.

18:01:00

I thank the Secretary of State for bringing the Bill before Parliament. The last update to the Mental Health Act, in 2007, took eight years following the Richardson review, and this Bill has been a similarly long time in the making, so I welcome the speed with which he has moved on it since taking office. Although we may tussle on occasion, as I have said since the election, we on the Conservative Benches will not oppose for the sake of opposition. We will be constructive, working to improve legislation and supporting the Government where we believe they are doing the right thing, and I recognise the Secretary of State’s constructive approach to the Bill. At the outset, let me join the Secretary of State in paying tribute to the families of Calocane’s victims in Nottingham for what they have done subsequently—their campaigning, their dedication and their work, including on this legislation—and for the incredible dignity with which they have conducted themselves in unthinkable circumstances. As the Secretary of State mentioned, the Mental Health Act 1983—I will not miss the opportunity to allude to his youthfulness—governs the compulsory detention and medical treatment of people with severe mental illness for the safety and protection of themselves and those around them. He also set out that sadly, all too often, those with learning disabilities or autism have been conflated with that group. We must take this opportunity to address that, and the Bill rightly seeks to do so. In the more than 40 years that have followed the 1983 Act, healthcare, treatments and, crucially, our understanding of mental health illnesses have come on in enormous strides. It is not only important but right that our laws are updated to reflect the modern world and the knowledge that we have today. We are debating measures that impact those with the most severe mental health issues and their families, but as was highlighted in interventions on the Secretary of State, we should not forget the broader context, the challenges posed by mental health issues more broadly, or the importance of continued investment in this space. We should also recognise the many organisations that do amazing work both to educate society about mental ill health and to support people with mental health illnesses. Let me take this opportunity to pay tribute to my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who has just left the Chamber, for the work that he did on mental health as Secretary of State. I think it is fair to say that, away from the to and fro of party politics, the current Secretary of State shares my right hon. Friend’s passion and determination to address these issues. As he said, we have done much, but I believe we can and must continue to strive to do better. Keeping legislation up to date is particularly important for a measure such as the Mental Health Act, which gives the state the power to deprive people of their liberties in order to protect the safety of the individual and those around them and to carry out treatment. Those powers should only ever be used when absolutely necessary, and it is therefore right that they are reviewed and updated to ensure that they remain relevant, proportionate and appropriate. The most recent update to the Mental Health Act, in 2007 under the last Labour Government, introduced community treatment orders and independent mental health advocates and changed the detention criteria. Since then, as the Secretary of State alluded to, trends have emerged that have raised concerns. The overall number of detentions under the Act has been rising steadily. There were around 52,500 recorded detentions in England in 2023-24, including 963 of children aged 17 and under. That is a 2.5% increase on the previous year and around 14% higher than in 2016-17. In the same year, 2023-24, black people were 3.5 times more likely than white people to be detained under the Act, and seven times more likely to be placed on a community treatment order. The reasons for that are likely to be complex, and I will return to them later. That is why in 2017, just 10 years after the previous update, the then Prime Minister, Theresa May—now Baroness May—commissioned an independent review of how the Mental Health Act was used and how it could be improved. The review considered not only the trends in detentions, but wider concerns about whether some processes were out of step with what should exist in a modern mental health system, including the balance of safeguards, patient choice and patients’ agency in their own care, and the effectiveness of community treatment orders. Sir Simon Wessely published the report of his review in 2018, and I take this opportunity to put on the record again our thanks for his important work.

Hear, hear.

The previous Government published a draft Mental Health Bill based on the recommendations in the report, giving others the opportunity to have their say. The draft Bill was subject to pre-legislative scrutiny by a Joint Committee of Parliament, allowing Members of both Houses to thoroughly review it and make recommendations before the final version was introduced. Given the importance of this area of policy, which can have such a profound impact on people’s lives, I believe it is right that we took the time to get this right. The work to update the Mental Health Act started under the previous Government and we had a commitment in our election manifesto to update the law in this area, and that has been carried on by the new Government. We continue to believe that this is the right thing to do, so I put on the record our in-principle support for the Government on the Bill. I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his work in this space as a shadow Minister. Not only does he have professional expertise, but he has brought it to the House’s deliberations on this legislation. I suspect that we may hear from him a little later. There are many areas of the Bill that we welcome, including the strengthening of the patient’s right to express a treatment preference, the expansion of access to independent mental health advocates, and the removal of police and prison cells as places of safety so that patients can be treated in an appropriate setting. That said, of course we will not stand back without scrutinising and seeking constructively to improve the Bill as it passes through the House. Part of our role as the Opposition is to engage constructively in the scrutiny of legislation—to ask questions, to probe further, to seek to prevent unintended consequences, and to identify potential problems and ensure that they are aired in Committee—in order to improve it for everyone’s benefit, and that is what we shall do. I know that my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) will approach the Public Bill Committee in that vein. We very much welcome efforts to improve patients’ voice and involvement in their own care, including through greater use of advance choice documents. In its current form, the Bill places a duty on NHS England and integrated care boards to make patients aware of their option to have such a document, but this could be as simple as having a poster on a noticeboard, for instance. It does not necessarily require a conversation. Introducing it as a legal right for patients who are being treated or for someone who is at risk of detention would mean that they have to be specifically told about the option, allowing them to make a deliberate decision. I suspect that in Committee we may gently press the Minister to go further in strengthening the patient’s right to have their voice heard. I have been on a number of Bill Committees, and gently hinting to the Minister areas where we might press further may make his and his officials’ lives a little easier when amendments are tabled in Committee. We were pleased that peers passed an amendment to better protect children who require a nominated person, removing the discretion where a court order regarding parental responsibility is in place. However, we believe there is more we can do to support and protect children, particularly regarding age-appropriate settings for treatment. I hope that when the Minister for Care winds up, or in Committee, he will explore in greater detail the steps the Government are taking to reduce the number of children being treated on adult mental health wards and to ensure that lessons are learned at both national and local service provider level. Thirdly, we are conscious that a number of elements of the Bill will require additional resources to be put in place. The removal of police and prison cells—sensibly—as places of safety will require sufficient alternative capacity for people to be treated when they are detained. What approach do the Government intend to take in addressing this? Increasing the frequency with which patients can apply to the mental health tribunal to have their detention reviewed and widening automatic referrals will potentially increase demand and pressure on the system. We know that the legal system is already under pressure, and the impact assessment acknowledges that there will be impacts and costs, so is the Minister confident that the system has the capacity to handle the additional demands? If not, what steps are being taken with the Ministry of Justice to address that?

The shadow Secretary of State raises an important point about resources. The updated impact assessment estimates that the cost of reform is £5.3 billion. With the Secretary of State having confirmed that mental health spending is falling as a share of NHS expenditure from 9.01% to 8.73%, does the shadow Secretary of State agree that without legislative safeguards to protect mental health funding, the Bill may not achieve the aims it sets out to achieve?

The hon. Gentleman is right to highlight both the costs and the investment that is needed, but the cost does not detract from the importance of and need for the measures set out in the legislation. He points out that as a proportion of overall health spending, mental health spending has fallen slightly in the latest figures. I hope that the Minister in his wind-up will address how the Government will ensure that this legislation, which enjoys broad support across the House, has the resources behind it to deliver the outcomes we all wish to see in practice?

Will the right hon. Member give way?

I will regret doing so, but of course I give way to the Secretary of State.

I should point out for the record that mental health spending has increased in real terms this year, thanks to the decisions the Government have taken. As a proportion of spend on health services overall, it is true to say that it has decreased by 0.07%, but that does not take into account the fact that as well as investing heavily in our elective backlog and in clearing waiting lists, we are investing in general practice, which will benefit enormously people with mental ill health.

The Secretary of State was kinder than he normally is, and I am grateful to him for acknowledging the reduction in the proportion of mental health spending—it is slight, but it is none the less a reduction. I hear what he says more broadly, but I hope that he and the Minister will reiterate their commitment to ensuring that the legislation succeeds, which we all wish for, and that the pressures it may place on parts of the system will be addressed and not simply be absorbed within the system. I suspect that the Minister will come to that in his concluding remarks. While it is the right principle to direct more mental health patients away from in-patient hospital settings and to community treatment settings where clinically appropriate—this is key, and goes to the Secretary of State’s point—we must ensure that the NHS has the capacity to provide community treatments when the Bill is on the statute book. The Government accepted that the reforms will take a number of years to implement, given the need to recruit and train more clinical and judicial staff, but what is the plan and how much will it cost? Will it be phased in over a number of years? The NHS workforce plan will nearly double the number of mental health nurses by 2031-32, but the Secretary of State has said that he intends to update the plan. It would be helpful if, during the Bill’s passage, he or the Minister could tell either the Bill Committee or this Chamber what the changes that he envisages making through this legislation will mean for the workforce. We recognise the significance of the provisions limiting the detention of patients with a learning disability or autism. Under the Bill, they can be detained for treatment only if they have a co-occurring mental health condition that requires hospital treatment and meet the criteria in the Mental Health Act 1983. Autism alone would no longer justify continued detention under the 1983 Act; in theory, this will ensure that those with autism receive the appropriate support in the right setting, as we would all wish. What steps are being taken to ensure that there are sufficient services, with sufficient capacity, to properly support people with autism and learning disabilities? Can he confirm that under this legislation, there will always be a central role for professional clinical judgments on these matters? This debate in part follows on from concerns being raised about racial disparities in the application of the Mental Health Act. Can the Secretary of State or the Minister provide more evidence to help the House better understand this issue? What research has been undertaken, or is being planned, to enable us to understand what is behind the statistics? We welcome this important opportunity to look again at how we treat and protect people with the most severe mental illnesses, and to ensure that our laws remain relevant and proportionate in the modern world, empowering people and treating them humanely. Updating the Mental Health Act is the right thing to do, and we will work constructively with the Government to improve the safety, treatment, agency and, crucially, dignity of mental health patients who are detained, and of the wider public.

18:17:00

I add my thanks to the Secretary of State and his whole ministerial team for bringing forward this crucial legislation so early in this Government, alongside other positive measures to fix our NHS. It was Labour that built the NHS and saved it in 1997, and here he is with his team, fixing our crucial NHS. I serve a community, in Bermondsey and Old Southwark, with a higher prevalence of mental health conditions and psychoses. We are fortunate to have South London and Maudsley NHS foundation trust on our doorstep. This legislation will be crucial for the service professionals working on the frontline, as well as all those who need support. My borough of Southwark has additional help, funded by Southwark’s Labour council and our integrated care board, including direct access to help through online systems, and a drop-in hub for young people—a means of support that allows them to avoid GP wait times and delays in accessing help. I am glad that this legislation adopts a similar principle of ensuring early access to help, but despite the additional support in Southwark, as the local MP, I see the impact that poor mental health has on people’s lives, which are blighted by ill health and discrimination. I am acutely aware that just 5% of people with schizophrenia are in employment, for example. This Bill offers a chance to tackle some of the issues, but it is overdue. I look forward to working with local organisations and people with direct experience, including trade unions in mental health services, carers, Blackfriars Settlement, food banks, and the drop-in clubs that support people with mental health conditions throughout Southwark, which are doing fantastic work, often on a shoe-string budget. As the constituency MP, I also see the impact on whole neighbourhoods if someone’s ill health causes them to behave erratically, and sometimes antisocially—noise and drugs are often interrelated issues. There can also be police involvement, following cuckooing by criminals who take advantage of vulnerable people. I hope that the Bill will challenge that growing phenomenon. It would be good to hear from the Minister whether communities—including landlords and neighbours, where appropriate—can trigger interventions to support people in crisis. Just two weeks ago, I joined a ride-along with the police 999 response team. Some might say that it was not the first time I had helped the police with their inquiries. On that ride-along, which was my third with the local police, I saw again the consistent and sad overlap between what they were dealing with and mental health crises. I ended my shift with those police officers at King’s College hospital, trying to seek support for one ill man. I hope that the Government will retain the extension of section 135 and 136 powers, delivered in a Lords amendment. That would ensure that there was trained and qualified support, which would reduce the time that police lose. The amendment would save thousands of hours a week of officers’ time in London alone, and police could be redirected to areas where they are more needed. Going back further, in the run-up to the introduction of the Mental Capacity Act 2005, I was working at the Disability Rights Commission, and I recall that mental health organisations were almost envious of that legislation, given the need to reform the Mental Health Act. They wondered when access to advocacy and patient-centred treatment would be delivered for people with mental health conditions. It is sad that there have been missed decades in between, but I am glad that this Bill is before us today. The advance choice documents are a step towards a return to the greater choice and control lost in recent years, as services declined under the last Government. The use of nominated persons, as outlined by the Secretary of State, also offers a great step forward, as does access to extended use of independent mental health advocates for those in hospital. That should be automatic, as Mind has advocated. It is great that the legislation is based on the Wessely independent review and the principles underpinning it. On a more personal level, and going back even further, the reason I became more aware of politics was my mum’s diagnosis of schizophrenia in the early ’80s—at roughly the time when the Secretary of State was born. Then, Rethink was still called the National Schizophrenia Fellowship. Mum has been through the mill in the decades in between. I will not suggest that she has been detained more times than I have had hot dinners—hon. Members can see by my waistline that that is not true—but the fact that the Mental Health Act has not been updated since then is appalling. When I joined the Labour party in the early ’90s, I never dreamed that I could play a part in improving legislation as an MP. I want to flag a couple of concerns, based on family experiences. Recently, Mum told us that she believed she worked at a bank. That was news to us in the family—no doubt, it was news to the bank—as she is 75 and has not had to work for some time. I can laugh about it, but it is upsetting that she is unwell; it is frustrating that the system is mad; and trying to access support for her is maddening for us as a family. Her GP denies that she is unwell and refuses to see her. The last time this happened, she was sectioned for six weeks until she was back in rude health—and believe me, she was very rude when she came out. South London and Maudsley NHS foundation trust estimates that it costs £3,000 a week to keep someone in hospital until they recover. NHS England has put a figure of £20,000 on detaining someone with schizophrenia until they are well. Those costs are avoidable if GPs act faster. Will the Bill result in better trigger points? This is not about artificial intelligence; it is about using known data in the system, so that there is access to supportive interventions that help individuals who have a mental health condition; help their family avoid the pain and suffering that they share when an individual is unwell; save a community the misery of associated antisocial behaviour or other problems; potentially save the police a fortune, as a result of their no longer having to accompany people to hospital for treatment, where that can be avoided; and, of course, save the NHS thousands in avoidable hospitalisation and in-patient treatment. GPs can be part of the solution, but too often, they pass the buck and avoid the issue, as the Gardenia surgery in Luton does, pretending that everything is okay, despite prescriptions being uncollected, which leads to the inevitability of mental ill health rising fast. I hope that the Bill will lead to better community care, as the Secretary of State has outlined, but I also hope that GPs and pharmacists will be supported in triggering outreach work from mental health trusts when someone does not collect their repeat prescription, for example. I hope that it will be confirmed clearly that this will be in the legislation, or that the Government will indicate a willingness to accept an amendment along those lines. My final, linked point is that the Bill should come with Government targets for reduced readmissions and sectioning. If the Bill is successful, people will not be discharged and readmitted in quick succession, and patients known to the system will not require routine, cyclical readmission. With the right support, the dysfunctional system can be replaced. That will have huge benefits for people’s mental health, and will mean huge savings for the NHS. There were, I think, 52,000 detentions last year. I hope that the Government will set out how that figure will fall. I really look forward to supporting the Bill’s progression. The Bill will be transformative for the people I serve in my community, and the people I love in my family. It will be transformative for millions of people across the country—people with mental health conditions, their families, carers and service professionals—and, if it is done right, it will save the NHS a fortune, too.

I call the Liberal Democrat spokesperson.

18:25:00

I thank the Secretary of State for introducing this really important Bill, and the Minister for his proactive engagement with us earlier this week. Before I entered Parliament, I was a trustee of the veterinary mental health charity Vetlife, which cares for the mental health of the veterinary profession—I have had to clarify before that it is not a mental health charity for animals with mental health issues. I became a trustee of the charity because my really close friend Sarah, at the age of just 31, when she had her whole life and career ahead of her, took her own life; I took her place as a trustee. Getting the news that I had lost her was one of the most painful experiences of my life. Many hon. Members in the Chamber will have suffered similar experiences with their friends and loved ones. I speak about Sarah because while we are in this place, we rightly often discuss mental health issues using statistics—we talk about waiting times, workforce shortages and the economic impact—but we must never forget that there are individual lives behind the numbers, and nearly every person in the country is affected in some way. That might be through their own struggles or those of a loved one, or through grief after someone they care about has lost their battle with depression. To return briefly to statistics, veterinary medicine—the profession I come from—has a suicide rate four times the national average. It is a small profession where everyone knows everyone, and everyone has lost a friend or a colleague to suicide. I share that not just for awareness, but because it reminds us that certain groups are at much higher risk—they are more vulnerable than others—and we should do much more to identify and support them.

My hon. Friend, as a veterinarian, will know that farmers also suffer with significant mental health issues. My constituents are under immense pressure following the family farm tax and the sudden closure of the sustainable farming incentive. Alongside that, they work extremely long hours, and the unpredictability of farm work means that it is more difficult for them to access mental health support and doctors’ appointments. Does he agree that we should introduce regular mental health MOT checks at key points in people’s lives—when they are most vulnerable to mental ill health—particularly for those in rural areas where there are barriers to accessing support?

My hon. Friend will not be surprised that I agree with her; she may as well have read the next bit of my speech. She is completely right. Farmers, those working in agriculture, military veterans and their families, mothers in the first year after childbirth, people living in poverty and the LGBTQ+ community are just a few of the groups that we know are at heightened risk. We already take a proactive approach when it comes to physical health; we have targeted cancer screenings for at-risk demographics. We should take the same approach to mental health. That is why the Liberal Democrats have long called for properly resourced community mental health hubs, which could reach people before they reached crisis point. We are also calling, as my hon. Friend just did, for regular mental health check-ups at key life stages—for example, when someone has just given birth or just been discharged from the Army.

My hon. Friend is outlining the treatment options for patients. New medicines are also incredibly important, and groundbreaking research is happening at the Warneford hospital in Oxfordshire, a mental health hospital that is in desperate need of investment. Treatment options and new medicines go hand in hand, so does he agree that the Government should get behind the Warneford and invest in it?

I agree with my hon. Friend and thank him for his intervention. Mental health MOTs could help to catch at-risk people early, so that we can start treating them before the problems develop further. I am sure that for all Members present mental health issues are among the top areas in our email inboxes and our correspondence. We receive emails from desperate parents of young people who are left on waiting lists for years throughout their schooling, and from adults falling between the cracks of an overstretched system. We should probably acknowledge that these are not anomalies. They are the symptoms of a system that is under immense strain. This long-awaited Mental Health Bill is a very welcome step, but it cannot be the only step, because at the heart of our approach must be the simple principle that prevention is better than cure.

I absolutely support the idea that we need to invest in prevention—I am 100% behind that—but I have also spoken to many constituents who have issues with emergency health care. One of my constituents, Ed, sadly took his own life. He went into A&E undergoing a psychotic episode and was left simply with a phone number and no assessment. Hours later, he was lost. We need to ensure that those who need emergency treatment get it on the spot, as well as investing in prevention. Does my hon. Friend agree with that principle?

I totally agree, and I will come on to the care of people once they have been discharged after an acute mental health episode, because it is a hugely emotive and problematic situation. We need a comprehensive mental health strategy that sees mental health not just as a clinical issue but, as the Secretary of State said, something that needs to run through housing, education, employment and justice. Good clinical services are vital, but we cannot medicate or refer our way out of a mental health crisis. Many mental health issues are often rooted in deeper challenges including poverty, housing, insecurity, loneliness, debt and trauma. These are not medical problems, but they put people at huge risk of developing mental health issues, and if we are serious about prevention we must tackle these root causes head-on. The Bill focuses very much on the rights and treatment of people once they are admitted to mental health units, which is essential, but what is just as important—as my hon. Friend the Member for Harpenden and Berkhamsted (Victoria Collins) has just highlighted—is what happens when they are discharged and what support they get in the community to prevent a relapse. In Winchester, we have seen a brilliant initiative between local NHS mental health teams and Citizens Advice. Teams from Citizens Advice are in a mental health unit called Melbury Lodge, and they help mental health patients with all their life admin—the bills, the correspondence—so that they are not discharged back into the community only to come home to a load of outstanding credit card bills and demands to repay their personal independence payments, for example. What is remarkable is that every pound spent on that initiative saves £14.08 in cost avoidance for the NHS through shorter in-patient stays, fewer readmissions, better engagement of services once they are discharged and a reduction in medication use. This is a win-win for staff, patients and the taxpayer, but it is a pilot project and there is no funding secured for it to continue, despite the proven cost-saving benefits. We urge the Government to look seriously at rolling out such initiatives nationwide. My hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been passionately campaigning since entering this House to ensure that families have a greater input into medical decisions when there are questions over the mental capacity of vulnerable patients, and I invite him to make an intervention now.

I thank my hon. Friend. As he knows, in my maiden speech eight months ago I pledged that Fiona Laskaris would succeed in changing the law that had prevented her from saving her autistic son, Christopher, from murder. Fiona is here today. Despite pleading for years, she was never able to obtain a mental capacity assessment for her son. As we heard from the Secretary of State, the Government are now seriously looking at an amendment that would both honour Christopher’s legacy and save lives. Does my hon. Friend support that amendment?

I thank my hon. Friend for that moving intervention and offer my condolences to those in the Gallery. We appreciate that the Secretary of State is seriously considering an amendment that might help save lives. Early intervention cannot just be a slogan; it has to be the foundation of a functional system. Last week, I sat around a campfire with the amazing team at the Winchester youth counselling services. That charity has a nature therapy programme in which 11 to 16-year-olds can go camping, have walk-and-talk therapies and do bushcraft and outdoor cooking. While we were toasting our marshmallows, the team were talking about the free, confidential mental health support that they offer, providing services such as one-to-one counselling and a weekly wellbeing walk-in session. By immersing young people in nature, this programme helps to reduce stress and anxiety and fosters emotional wellbeing and resilience. Crucially, the services are accessible without the need for a doctor’s referral or diagnosis. Young people can self-refer, ensuring that support is available promptly when it is needed most. This is why Liberal Democrats have been calling for mental health hubs for young people in every community. We support the Government’s campaign for a mental health professional in every primary and secondary school—not just an occasional visit or a pilot scheme, but a permanent funded presence.

Just to follow up on my hon. Friend’s point about the importance of mental health hubs, in West Dorset the only child and adolescent mental health services centre is in Dorchester, and for many people in my constituency, especially young people, that means at least a 30-mile round trip to access services. In rural Britain, we are lucky if transport links exist, and those that do are often limited. That makes accessing services nearly impossible, which is what makes hubs so important.

I totally recognise the importance of that intervention. We also need a system that is much easier to navigate. A psychiatrist came to see me in my office in Winchester and told me that his son had been referred to CAMHS. He said that despite the fact that he and his wife worked in the medical profession, they had really struggled to access the help that they needed. He said: “If we can’t navigate the system, what chance does anyone else have?” That is one reason that Liberal Democrats are calling for a mental health commissioner: someone to champion families, cut through bureaucracy and help people to get the support they need before things get worse. The system needs to be simplified, both for the parents and families who are trying to access the service and to allow the system itself to function. For years, Liberal Democrats have campaigned for mental health to be treated equally with physical health, and we welcome the commitment to parity in the King’s Speech, but it must be backed by action. The Darzi report showed that mental health accounts for around 20% of the NHS case burden—as the Secretary of State acknowledged—yet it receives just under 10% of the funding. For this reason, we want to ensure that the mental health investment standard is maintained and strengthened, and not quietly scrapped or watered down. The Secretary of State also highlighted the scale of this challenge. Around 1 million people are on waiting lists for mental health services, but importantly, 340,000 children are on mental health waiting lists and some of them are waiting an average of 15 months for care, which is a huge chunk of their educational time and personal development. This is not a crisis that is waiting to happen; it is a crisis that is already here. In this economic crisis, some people ask how can we afford to invest in mental health, but the real question is how can we afford not to do so, because we already pay the price in lost productivity, emergency call-outs, A&E admissions and—most tragically of all—lives cut short. We must spend to save. The hon. Member for Bermondsey and Old Southwark (Neil Coyle) spoke about spending time with police. I have done the same thing—a fascinating and informative exercise. I encourage everyone to go on patrol with their police. In Winchester, the police say they spend up to 40% of their time responding to mental health-related incidents. We know that patients turn up to A&E in mental health crisis, many already on a mental health waiting list. I heard that the average amount of time someone spends in a mental health crisis in Winchester’s A&E, often needing individual supervision, is 18 hours. That is not sustainable, because we are using the most expensive part of our health system to do the work that should be happening earlier, which would be more cost effective for the taxpayer and provide better outcomes for patients. Finally, I pay tribute to all those on the frontline: the nurses, counsellors, psychiatrists, doctors, therapists, support staff and charities who prop up a system that should be supporting them. We very much look forward to working constructively with the Government to improve the Bill, and we support it. We will keep pushing until we live in a country where mental health gets the same attention and care as physical health.

18:40:00

One of the reasons I stood for Parliament was to work hard to create a society that values disabled people, that treats us with dignity and respect, and that ensures there is nothing about us without us. It is right that this Government will fix the broken system to ensure that we give mental health the same attention as physical health. I am pleased to see the four key principles from the independent review of the Mental Health Act at the heart of the Bill: choice and autonomy, least restriction, the principle of therapeutic benefit and, most importantly, treating people as individuals. After 14 years of a Conservative Government, over 2,000 autistic people and people with a learning disability are in mental health hospitals in England. Some 92% of those people are detained under the Mental Health Act 1983, and the average length of stay for in-patients is almost five years. This is a human rights scandal, as the Joint Committee on Human Rights concluded in 2019. The current situation is simply wrong. Autism and learning disabilities are not mental health conditions, and yet under the current Mental Health Act, autistic people and people with a learning disability can be detained in mental health hospitals indefinitely. In my 15-year career working with autistic people and those with learning disabilities, along with autism organisations up and down the country, including the National Autistic Society and the Autism Alliance, I have seen the tragedy of autistic people cycling through the mental health system because of those measures and the failure of public services to provide adequate social care on discharge from hospital orders. As an MP, I know from my constituency that too many people are still being detained who could be supported to live well in our communities by organisations such as Greave House Farm Trust and Action for Autism Barnsley which are on my doorstep. The most significant change in the Bill is the removal of autism and learning disability from the definition of mental disorder under section 3 of the existing Act. This vital change means that autistic people and people with a learning disability cannot be detained for treatment unless they have a co-occurring mental health condition that requires in-patient mental health care. The Government have said that “the proposed changes to the detention criteria for people with a learning disability and autistic people will only be switched on when systems are able to demonstrate a sufficient level of community support”. It is crucial for that to happen quickly, through the Government working closely with autistic people and those with a learning disability, as well with as advocacy groups, to publish a plan to build sufficient support in our communities up and down the country. My book on the treatment of autistic people in the criminal justice system demonstrated that ensuring that there is an appropriate level of services in the community is essential in preventing the needs of autistic people and people with a learning disability from becoming too complex, leading to admission to mental health hospitals. It also demonstrated the need to support safe discharge out of hospital. Critical to reducing the numbers of those currently detained in hospital under the current law are care, education and treatment reviews for adults and children who are autistic or have a learning disability, which will help speed up discharges, prevent admission and ensure that the person is being given appropriate care. I am delighted that the Bill will make those reviews statutory in in-patient settings. The responsible commissioner, clinician, integrated care board and local authority must have regard to the recommendations arising from them. As chair of the all-party parliamentary group on autism, I am aware that recommendations are often not followed in an expeditious manner. Therefore, there is an opportunity to strengthen the duty on responsible parties to follow recommendations from those reviews. The Health Secretary has been moving mountains to work on our 10-year plan. I therefore hope that the Bill’s 10-year implementation period for the changes to detention criteria will align with his important work. He is also doing an incredible job to move to a prevention-led health system, and that provides an opportunity for an integrated approach to community support, including working with the Ministry of Housing, Communities and Local Government to ensure there is adequate housing in every integrated care system. The exclusion and marginalisation of autistic people and those with learning disabilities through their institutionalisation in hospital perpetuates their exclusion from our society. I am proud that our Government are tackling these issues so early on in this Parliament, alongside their commitment to the mental health investment standard, the recruitment of 8,500 mental health workers, and work to deliver a long-term plan for the reform of adult social care. Society is an order of equality and non-discrimination. It is all the richer where autistic people and people with learning disabilities are included within it to fulfil their potential. I commend this Bill to the House.

18:47:00

I rise to speak in support of the Bill. To begin with, I need to make a couple of declarations. I have a family member who is a consultant psychiatrist. I am now a non-practising general adult psychiatrist with an endorsement and years in psychiatry, and I previously worked as a consultant psychiatrist. I took part in the 2018 Wessely review as a panel member on the tribunal working group, and I was on the pre-legislative scrutiny Committee in the last Parliament. In a declaration of a more personal nature, this is an area that I feel passionately about. It is a great privilege to speak to this important piece of legislation and reforms going forward. The United Kingdom reforms its mental health legislation every 20 years or so. I did not want to correct the Secretary of State, but the first Mental Health Act was in 1959—I hope that was substantially before he was born, with reference to his earlier comments. The legislation has gone through various iterations from the original Lunacy Act and similar legislation in the 19th century. In the UK, we have always been at the forefront of reform to the law and to provisions and powers in this area. It is important in this Second Reading debate to focus on what the Mental Health Act is and what it does. Members have talked more broadly about the challenges of delivering mental health care currently, but it is important to reflect that the Mental Health Act is very specific and precise. It is about the regulation of detention—sometimes for assessment, sometimes for treatment—of people with mental disorder, and has a range of powers on aftercare and guardianship. It is focused on detention and assessment, or treatment, of people with mental disorder. We need that because there are times when people with severe mental illness become so unwell that they are unable to recognise their illness. Their illness puts their health at risk—predominantly through self-neglect or non-treatment. It puts their safety at risk, again through self-neglect, as well as through suicide. And, less commonly but critically, it puts them at risk of causing harm to others. The legal framework allows us to regulate compulsory treatment in that regard. It is absolutely critical that we have those powers so that, when people are so unwell that they do not recognise it and they lose agency, we can, as a compassionate society, take them into hospital and treat them, with a view to getting them back to themselves. I have used the 1983 Act countless times, applying it both to assessments and, as a section 12-approved doctor, to treatments, and I have used it as a responsible clinician. I suspect that I am one of the few Members of this House—certainly in this debate—who has had those roles and responsibilities. In terms of framing, it is important to reflect that one of the key changes in the 1983 Act, which is such an important piece of legislation, was that it was about restricting powers and ensuring that there were strong procedures for reviewing detentions. As a former health professional in this area, I am certain that all professionals working in it are mindful of the scope of powers that the Act provides. When applying restrictions, people do not use these powers in anger or without a great degree of thought and contemplation. The most intrusive intervention available to us in the health service is to detain and treat people in hospital or in secure hospital settings. Those powers are not taken lightly. A lot of concern was expressed at the start of the debate—and I am sure it will continue—about the way in which people have been treated in hospital. There have been some very high-profile scandals in which things have not worked well, to say the least, and care and treatment have been atrocious and abusive. However, people working in health and care in the UK are doing so because they want to see the best outcomes for their patients. Sometimes, they are limited in that because of the resources available. They do not use the Mental Health Act with a view to harming people, but with a view to helping them. Being detained under the Mental Health Act is not a prime facie harm; it is a treatment and a good thing. If someone needs to be detained and treated in hospital, they need to be detained and treated in hospital. If I became so unwell that I needed to be detained under the Act, I would want to be detained. Thankfully, I am not in that position today—[Interruption.] At least I believe that I am not, although the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), might have a different view on that. [Laughter.] Should I get to the point where I am so unwell that I cannot consider my own care, I would want the powers of the Mental Health Act to be used quickly, particularly if I were posing a risk to myself, my family and others, so that I can get better and back to living my life. I pay tribute to Baroness May of Maidenhead, who kicked this off, and to Professor Sir Simon Wessely—a good friend—Stephen Gilbert, Sir Mark Hedley and Rabbi Baroness Neuberger for their work in the 2018 review. There is a lot of good work in the Bill, from the greater focus on advance care planning and the more frequent detention reviews, which I recognise may bring a workforce burden, to the provisions on nominated persons. I will not go into the detail in this Second Reading speech, but I will focus on a few general points on which I think a bit more work needs to be undertaken. In some ways—I will have to message Sir Simon after this to ask his forgiveness—the Bill is a missed opportunity in that we have are not moving towards fusion law. For the benefit of those who are not all over the detail, at the moment the UK has two pieces of legislation regulating how to treat people in the absence of consent. The Mental Capacity Act 2005 came about from case law in the ’80s and ’90s and was codified in 2005. That Act broadly regulates physical health treatments for people who lack the capacity to consent—we have focused quite a lot on capacity in the recent debates on the Terminally Ill Adults (End of Life) Bill. The principles of the 2005 Act are autonomy and the functional capacity and best interests tests for people who lack capacity, meaning that we test someone’s capacity, and only if they lack capacity can we intervene in their best interests, sometimes by using deprivations of liberty. The Mental Health Act arose from a very different pathway. In its first days, it was more about the regulation of asylums. The Act is about status and risk. The gatekeeper conditions for the current Mental Health Act are that a patient has a mental disorder of a nature and a degree that requires assessment in hospital because of the risk to their health and to the safety of others. Capacity does not feature whatsoever. We have two pieces of legislation. One applies to the most severe mental disorders and deals with status and risk, and the other deals with autonomy and best interests. I strongly believe that the two need to be merged. We should use capacity and best interest frameworks to regulate treatment of mental disorder in the absence of consent—there are ways of doing that. I like the fact that we are starting to incorporate a bit more in the Bill.

Does the hon. Member not think that the deprivation of liberty safeguards, which, unlike the Mental Health Act, help to hold those who lack capacity in an environment that is not secure or locked, such as a hospital, are useful, and that bringing the two provisions together is unnecessary?

The hon. Member is of course very knowledgeable given his background as a mental health nurse. I would like to see in the Bill a provision setting out that, in order to detain someone for the purposes of health or safety, they must lack decision-making capacity for the detention to be authorised. For the prevention of harm to others, there are reasons to overcome autonomy in decision-making capacity, but I would like to see an additional component specifying that if the detention for assessment and treatment in hospital is purely based on health and safety and not on risk of harm to others, the patient must also lack capacity. Otherwise, people who have full and intact decision-making capacity can nevertheless come into the scope of the powers. The liberty protection safeguards are a bit of a mess, quite frankly, and the DoLS were clearly a substantial mess. It is interesting that the legislative scrutiny of the Bill points out that it is a missed opportunity not to tidy up some of the interface between the Mental Health Act and the Mental Capacity Act—a point that I will come to a little later in my speech. In terms of parity of esteem, bringing forward fusion law and gelling the Acts closer together needs to be the direction of travel. I hope that we do not have to waste another 20 years until we get the opportunity something like that. There is something else that we need to reflect on. It comes to my other points about the focus in the Bill, but I will reiterate it. The core focus of the Bill is on reducing detentions of people from black and minority ethnic groups, who are over-represented in detention. One of the key focuses in fixing that must be on socioeconomic deprivation—where we see socioeconomic deprivation, we see severe mental disorder following—but I worry that the Bill is a missed opportunity and will not do what is required to deal with those disparities. There are three problems with the Bill, and two things that I wish to flag. I am sensitive to the concerns that have been raised about people with autistic spectrum disorders and learning disabilities, and the advocacy regarding such people being in hospital. Being in a general adult ward is a challenging environment as it is, and it is particularly challenging for someone with an ASD or a learning disability. People can get stuck in hospital not really going anywhere. That concern applies to most disorders—I do not think it is unique, given the lack of community support services. I disagree, however, with the focus on ASD and LD above all other conditions. If we want to talk about non-progressive conditions, I do not understand why a brain injury, or Korsakoff’s dementia for example, are not within the scope of this measure. I do not understand why, rather than using the Bill to take people out of section 3 of the Mental Health Act, something like a bolstered treatability test is not used, which is what was in the Act before it was modified in 2007.

I am grateful to the hon. Gentleman, who has brought his wealth of experience to this place. Would he concede that the focus on learning disability and autism is perhaps because those disorders have very specific features? Being in an unfamiliar, over-sensory stimulating or noisy environment, with a break from routine, has an adverse effect on some people precisely because of the nature of their disability, and perhaps more so than for some of the other conditions he has mentioned. Indeed, it seemed something of a weird anomaly that learning disability and autism were classed as mental illness for the sake of the Mental Health Act. I am sure the hon. Gentleman will agree they very much are not.

I thank the hon. Lady for her intervention. Sensory over-stimulation can be a particular issue for those with autistic spectrum disorders. I have been concerned when I have looked after patients, and I have thought carefully about the challenges, particularly in general adult wards, of catering to the needs of people with autistic spectrum disorders or a learning disability. I would argue that that would apply broadly to anyone in a general adult hospital, irrespective of diagnosis—everyone has particular needs and sensitivities and we need to be mindful of that. I suspect this is something that the hon. Lady and I will disagree on, but I would consider an autistic spectrum disorder and a learning disability to be a mental disorder. It certainly is under the ICD-10 classification of mental and behavioural disorders. One problem with how this issue is framed in the Bill is, for example, where Rett disorder, which is also a pervasive developmental disorder, would come into it. Does it come under the term “autistic”? Where does a not otherwise specified pervasive developmental disorder come into it? I am not sure whether how the terms in the Bill will operate in real life has been thought through. I do not understand why we are not pushing for such a provision for every disorder and condition that people have when they come into hospital. That is why we are not focused on something like a treatability test, or otherwise. This has a specific real-life fall-out. If people need to be in hospital after 28 days and there is a deprivation of liberty, that is going to happen. It will not stop happening; with the best will in the world, and even with this Bill, it will keep on happening. People will either be detained under liberty protection safeguards, or they will end up being detained with anxiety related to their ASD or learning disability, which would place them within scope of the Mental Health Act. A further challenge and disparity in the Bill is that it does not affect forensic provisions. People could be keener to pursue a criminal prosecution of people with ASD or an LD because that would enable a longer stay in detention than 28 days. That is why in the pre-legislative scrutiny we suggested that there should be an option to get a pre-authorisation for detention beyond 28 days by going to a tribunal, which we thought might deal with some of the concerns raised. Personally, I like the idea of pre-authorisation in general beyond 28 days, and it is something that Professor Richardson spoke about in her review back in the late ’90s. The Government recognise that there are challenges with this area, which is why these changes are in the schedules. There is a recognition that, frankly, this is not workable, and we will see as the Bill progresses that there are broader concerns about how it operates. Another area of concern is nominated persons and parental responsibility. The Bill changes “nearest relative” to a “nominated person”, which means that people can choose who performs that important role under the 1983 Act. The nearest relative or nominated person can discharge someone from the powers of the Act, which would inevitably mean that they would be discharged from hospital—there are powers to bar people, but it is quite a high threshold. This measure is important because it will allow someone under the age of 18 to choose someone who is not their parent to have that important statutory power. We raised this issue in the pre-legislative scrutiny Committee. We could have a situation in which a 16-year-old with competence who is detained under the 1983 Act in hospital chooses their mate, or somebody else—not their parent or someone with parental responsibility—to have the power to discharge them from measures under the Act, which would inevitably mean them leaving hospital. The parent, who in such situations is often responsible in some way for the after care, would lose that power. I am concerned, as were the Lords, about the impact of that measure on the Children Act 1989. I think there is a serious problem in changing this area of law—we do not have this in physical health—and introducing the ability to give a statutory power to a non-parent. I know the Minister will look into that in the Bill Committee, but I think the Government will have to row back on that. They could easily amend the Bill to say that if someone is under the age of 16, the nominated person must have parental responsibility unless there is a good reason for them not to have it. Sixteen and 17-year-olds are a bit different, especially when people start getting close to 18 and there are other children’s rights, but I cannot see why we should legislate to let someone under 16 choose someone who does not have parental responsibility to have that important power. The third problem is that the Bill is silent on deprivations of liberty in A&E, which are ongoing. It has been a while since I worked in A&E, but there has always been the challenge of what to do with someone who turns up to A&E if the doctor thinks that they will probably need detaining under the Mental Health Act because they are suicidal or very unwell, and wants to keep them there while the assessment takes place. We can get through it using the Mental Capacity Act 2005, but it is messy. It would be a lot clearer for everybody if we said, for example, that section 5(2) of the 1983 Act, which allows for temporary detention, could apply to an A&E setting. There is a bunch of technical stuff about the interaction between deprivation of liberty and the Mental Capacity Act, but I suspect you will start giving me the evil eye, Madam Deputy Speaker, and telling me to move on if I start—[Interruption.] Madam Deputy Speaker says no, but I suspect that Members across the House might start doing that, so I will move on. Let me flag two things in the Bill. It allows for a discharge from hospital under supervised conditional discharge to a deprivation of liberty. That is in response to the case of Secretary of State for Justice v. MM, which involves a problem with how the law currently operates. As far as I know, in mental health law we have never had a situation where deprivations of liberty in the community were authorised under the Mental Health Act—someone had to be in a registered hospital. That is a big Rubicon to cross. I see why the Government need to tidy up this area of law, but I am not convinced that we have realised what a big Rubicon this is to cross. The operation of the Mental Health Act has always meant that someone was detained in hospital, but when they are in the community they are in the community. Someone might have certain restrictions placed on them by a community treatment order, or otherwise, but they are not deprived of their liberty in their home or in some other community setting that is not a registered medical hospital. I think that measure needs a bit more reflection. I believe that the majority of those who will undergo compulsory treatment under detention, certainly for a long period of time, under this legislation will be people with psychosis, such as schizophrenic forms of psychosis, schizophrenia and bipolar affective disorder, but lot of the debate and focus has been on non-psychotic illnesses. That is not to say that those illnesses are less important—they are certainly not less important, especially for those who experience them—but I am concerned that people with schizophrenia always get a raw deal. They are often marginalised by society and in terms of the amount of advocacy they have. In fact, a lot of the evidence that we reviewed in the pre-legislative scrutiny Committee focused on non-psychotic disorders, perhaps because sadly people often turn their backs on people with psychotic illnesses. Sometimes those people find themselves in a situation where their illness is so debilitating that they cannot advocate for themselves, so there tends to be a bias towards disorders such as dementia, ASD and LD, where there is someone to advocate, such as CAMHS or families who might push a little bit more. I am not saying that any condition is more important—I really want to stress that—but as parliamentarians, we do not necessarily understand that the bulk of the conditions that the Bill focuses on concern psychosis. Finally, I have spoken a lot about how psychosis can lead to people being detained in hospital and about the impact of that. Psychosis is a pretty terrible disease but it does not need to be: lots of people get better and it is one of the most treatable diseases. The Bill will help people to get better and we cannot lose sight of that.

19:11:00

I welcome today’s Second Reading of the Bill. I would like to focus on one aspect of the legislation: the removal of autism and learning disability from the definition of mental disorder under section 3 of the Mental Health Act 1983. I recently visited a wonderful local charity, the Challenging Behaviour Foundation. It is the only UK charity specifically focused on the needs of children, young people and adults with severe learning disabilities whose behaviour may be described as challenging, and their families. On that visit, I was shocked to learn that under the Mental Health Act, autistic people and people with a learning disability can be detained in mental health hospitals indefinitely, just because they are autistic or have a learning disability. I thank the hon. Member for Runnymede and Weybridge (Dr Spencer) for sharing his extensive professional experience, but I disagree with him on one point: in my view, autism and learning disability are not mental health conditions, and I do not believe that they should be treated as such in law, which is a view shared by a lot of people in the sector who I have spoken to in advance of the debate. This issue is currently affecting a lot of people. As my hon. Friend the Member for Penistone and Stocksbridge (Dr Tidball) said, over 2,000 autistic people and people with a learning disability are in mental health hospitals in England today, the vast majority of whom are there under the Mental Health Act. Importantly, around 225 of them are under the age of 18, so this is affecting a lot of our young people. Mental health hospitals are often inappropriate for autistic people and people with a learning disability. Once detained, they can get stuck in those settings for many years, which can be deeply overwhelming and damaging and lead to lifelong trauma. As my hon. Friend the Member for Penistone and Stocksbridge mentioned, the average length of stay for current in-patients is nearly five years, and we have to ask ourselves why that is. The latest available data shows that the key reasons for delayed discharge are a lack of suitable housing and a lack of social care. Charities like CBF continue to hear worrying stories of abuse, over-medication, unnecessary restraint and seclusion in these settings. Back in 2011, “Panorama” uncovered abuse at Winterbourne View hospital, bringing attention to the fact that many people with a learning disability and autistic people were being detained in hospitals, when they could and should be living in the community. Since then, there have been numerous policy interventions and action plans from the previous Government. However, sadly they have not resulted in the changes promised and all national targets to reduce in-patient numbers have been missed; in fact, the numbers have increased. Legislative change is clearly needed, and I welcome the change to detention criteria in the Bill that will mean that autistic people and people with a learning disability cannot be detained for treatment unless they have a co-occurring mental health condition that requires in-patient mental health care. However, on page 72 of the impact assessment, the Government say that the proposed changes “will only be switched on when systems are able to demonstrate sufficient level of community support”. Ensuring appropriate provision of services in the community is crucial to supporting autistic people and those with a learning disability, so that they can be discharged from hospital, and so that we can prevent needs from escalating, and prevent admission to mental health hospitals. However, if there is no comprehensive, fully resourced plan to build capacity in the community and enable this change to be “switched on”, this vital reform could be delayed for far too long. I urge the Government to publish a comprehensive plan to ensure that the change to detention criteria can be commenced, and to ensure accountability for this process. Ideally, commencement would be in 2027, in line with modelling in the impact assessment. I also ask that those changes be co-produced with the people who will be affected by them. The previous Government’s “Building the Right Support Service Model” could act as the starting point, but I draw the Minister’s attention to the challenging behaviour national strategy group, co-ordinated by CBF, which has developed a co-produced, lifelong action plan that sets out not only the changes that need to be made to get community support right, but resources and best practice. I encourage the Minister to meet families to better understand the impact of inappropriate detention on people with a learning disability or autism and their families. I would be happy to help co-ordinate that through CBF.

19:16:00

Eight months ago, in my maiden speech to Parliament, I said that Fiona Laskaris would succeed in changing the law that prevented her from saving her autistic son, Christopher, from murder. I am here today to honour that commitment. We are on the cusp of changing the law. We have got this far thanks to the National Autistic Society; MPs from across the Chamber working together to overcome injustice, including the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), the hon. Member for Rother Valley (Jake Richards), the right hon. Member for Leeds South (Hilary Benn) and my right hon. Friend the Member for Kingston and Surbiton (Ed Davey); steadfast support from my party, the Liberal Democrats, and support from the Prime Minister and the Government, in a way that represents Parliament at its best; and Elisa Menendez and Romilly Weeks from ITV, who ran the story. Above all, we got this far because of the courage and determination of Fiona Laskaris to save others from the fate that befell her son, Christopher. Fiona and Cara, Christopher’s sister, are in the Gallery. Christopher was not unlike many autistic children. He was a sensitive, intelligent, loving and compassionate boy, who once asked his mum to stop on the way to school to rescue a lamb that was stuck in a fence. I first met Fiona when I was eight. I stayed in my bedroom and ignored her, perhaps because I was angry that she was buying my home off my dad; my mum had died when I was a few months old, and I was a sensitive boy. Well, they moved in; Christopher grew up in my old bedroom, and he loved the house as much as I did, but as a young man living alone in Leeds, he struggled. Despite Fiona pleading for help for years, she was never able to attain for him the mental capacity assessment that he needed to determine his support requirements. Horrifically, he was exploited and murdered by a man who had just been released from jail. Christopher was 24. We are working with the Government on an amendment to the Bill to ensure that the views of family members are considered when determining an adult’s requirements for a mental capacity assessment. Christopher’s story is not unique. King’s College London found that in 2022 alone, there were 95 preventable deaths of people with autism and learning disabilities in cases in which the Mental Capacity Act 2005 had not been correctly followed. It can be hard to grasp the scale of the special educational needs and disabilities crisis in this country, but tens of thousands of SEND children are out of school, including 1,800 in Surrey alone. We are losing autistic children, including my constituent Jennifer Chalkley, to avoidable suicide, and, at worst, we are abandoning autistic people in their 20s to murderers; we are failing a generation. How we answer their call for justice will serve as a measure of who we are, and I believe the answer is less a matter of money than of leadership. We know from Nobel laureate James Heckman that early intervention is exponentially more effective and economical in today’s brutalised system, which has cost the lives of Christopher, Jennifer and too many others. Although this amendment is only a small part of the answer, it can save lives. If one grieving mother can change the law, perhaps we can change the other things, too. If we succeed, it will be above all because of the voices of broken but unbeaten parents, like Fiona, demanding change. Although Christopher had a difficult life, he had the most precious thing that any man can have: a loving and devoted mum. It is up to us to ensure that Fiona is a witness that in our country, it is possible for the vulnerable to be heard, for injustice to be overcome, and to find, beyond grief, hope.

That was a very moving speech.

19:20:00

I commend the hon. Member for Dorking and Horley (Chris Coghlan) on a powerful and vital contribution to this debate. In fact, I commend everyone who has spoken so far, often from personal experience and expertise. This is unfinished business, and this Bill is long overdue. I have been reflecting on my first placement as a pre-registration student nurse. I went straight into a mental health ward. I am not a mental health nurse; that was not the route I took, but not because anything I saw there particularly turned me off it. However, it was a remarkable experience. When I walked into the unit for the first time, I was shown a burned pool table; it had been burned down the day before. The staff apologised and we moved on. The staff were full of compassion, but also frustration, and one of the things that they were frustrated with was the Mental Health Act 1983. This is some time ago; we are talking about 1996. In one of my very first teaching sessions on that unit, I was told about all the things that needed to be changed in the Act, so it is slightly surprising that I have wound up in this place, with the opportunity to change and challenge those elements. The points made to me then were particularly about the challenges for different communities, and the way that people from different ethnicities and cultures were assessed for mental ill health. The Bill will help to adjust that, and hopefully we can mitigate those problems, and move beyond and progress from the 1983 Act. Some things were not even properly on people’s radar then; for example, there was less understanding of neurodiversity, autism and learning disabilities, and the inappropriate way that they were covered by the Act. Many Members have talked about the large number of people who are autistic or have learning disabilities who are incarcerated. That has been described as an offence against human rights, and I believe that to be true, but I also believe that it will be challenging to overcome. In 2019, the long-term plan for the NHS was brought forward by Baroness May, and several Members of this House had a key part in driving forward that change. It said that we should challenge the detention of people who are autistic in mental health locations that people are left in for a very long time. We heard from my hon. Friend the Member for Penistone and Stocksbridge (Dr Tidball) that the average length of stay of someone who is autistic or has learning disabilities and is detained under the 1983 Act is 4.7 years. That is a lot longer than many people with psychotic illnesses would need to be detained. That long-term plan for the NHS had great intentions, and made suggestions for overcoming the issue and liberating people from detention. It was not just the pandemic that came soon afterwards that kiboshed them: it is really hard to drive change in the system when the Mental Health Act protects clinicians and senior people in the NHS in not driving forward that change that is needed. To drive it forward, we need a change to the Act, and that is what we have in front of us. I commend everyone who has worked hard on the Bill to ensure that patients’ voices are heard. In my constituency of Sittingbourne and Sheppey, we have big mental health challenges. We have the highest suicide rate in Kent and, I think, the 37th highest suicide rate of any local authority area in the country. That means that 37 other Members in this House have even bigger challenges when it comes to suicide and mental health provision. I am sure that what many of those places and Members have in common is the challenge of economic deprivation and inequality, which—let us face it—is the biggest driver of poor mental health outcomes. That was mentioned admirably by the hon. Member for Runnymede and Weybridge (Dr Spencer), who talked at length about the complexities of the 1983 Act. I commend him for his insight on the challenges of changing that. We have to change things across the board—in housing, access to employment and transport, things that are way beyond the bounds of the Bill. We should use this Bill to drive that forward. We should look around our communities and see the creative approaches that we can use. On Saturday, I had a lovely day out in the sunshine at Curly’s farm on the Isle of Sheppey in my constituency. It is an active farm, set up by two fathers to support their son, who has profound learning disabilities and autism. It brings in children with learning disabilities, autism, mental health challenges and behavioural challenges generally. It is something like the Challenging Behaviours Foundation, which my hon. Friend the Member for Rochester and Strood (Lauren Edwards) talked about, and which is also very active in my constituency; I was glad to host an event for it. The farm really shows us that when we get people out of institutional settings and outdoors into different environments, they can thrive in a way that they do not in school, or in healthcare settings. It is transformational to the lives of the children and young people who go there, who often go on to work in agriculture. I am sure that many other hon. Members see that.

My hon. Friend is absolutely right to say that patients with challenging behaviours should not be detained in a mental health ward for many, many years. They should be in a different setting. Does he agree that we do not have enough support or accommodation for patients? We need to invest more in community settings for some of these patients with challenging behaviours.

My hon. Friend has jumped ahead of me on that—not surprisingly, given his background as a mental health nurse. That is absolutely true. We do need to invest more, but we need to think beyond the NHS. Although this is the Mental Health Bill and it has “health” in its name, this issue is much bigger than the services that the NHS can provide. There is a weakness in this Bill. The concern I have, which several other Members have mentioned, is that it does not tie us down to a tight timeline for this transformation. The Bill provides a get-out. That is done to ensure that services in the community are properly set up, but I worry that that the timeline will slip and slip. The time to move is now. People have been languishing for too long in settings that do not offer them a therapeutic way forward, and in places that are frankly inhumane and breach what we would all consider to be our human rights. The Minister is here and listening, and I recommend that he thinks about how we can get an active plan, so that we do not let this issue slip, but actively ensure support for services in the community, invest in them where needed, and foster them.

I very much support what my hon. Friend is saying about making sure that there is an active plan. One of my concerns is that implementation of this Bill will be delayed until community support is ready. Does he agree that it would be welcome if the Minister offered a reflection on what good looks like in this space, and what ready looks like, so that we know what we are aiming for?

I absolutely agree. We should flip this around from a delay until we are absolutely ready to an active process of deciding what good looks like. Two weeks ago in my constituency, I ran a mental health conference. That was largely because, as I was going around as a new MP talking to every different organisation I could, mental health was right at the top of nearly all their worry lists, whether it was the food bank, the schools, the police, the prisons, or organisations in my community that had set themselves up to support people with mental health. I have a MenTalk in Sittingbourne and a MenTalk in Sheppey; they work in different ways, but that shows the level of pressure that exists locally. All of those organisations brought out mental health as their biggest worry, even if it was not their primary purpose. Just bringing people together and getting them to talk together—people who perhaps had not talked to each other until that point—really made a difference. You could see it in the room on that day. I am sure I am way behind the curve compared with a lot of other Members who have been doing this sort of stuff already, but for me, it really showed that we have got to be active in pushing this forwards. What we have learned from 2019 and the long-term plan for the NHS is that it is the implementation that matters. It is not the words in the strategy; it is getting an implementation plan really tight and fast on the ground. Given that the impact assessment talks about 2027 as a key point, I would like to see a commitment in the Bill to produce a workable plan by 2027 at the latest—one that can give us the road map we need for the future. That has been called for by organisations such as Mencap and the National Autistic Society, so I really commend it to the Minister.

19:31:00

Despite having worked in healthcare for most of my career and serving on the Health and Social Care Select Committee, having listened to the speeches thus far this evening, I feel in awe of the experience of hon. Members on both sides of the House, especially the hon. Member for Sittingbourne and Sheppey (Kevin McKenna) and my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I also commend the hon. Member for Dorking and Horley (Chris Coghlan), who I know is supported by my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), for his extraordinarily powerful speech. This Bill is essentially about the duty of care not only to those who have mental health issues, but to the public, including the family, friends, carers, public servants and everyone else who interacts with those individuals. The duty of care also exists to protect those individuals from themselves. As many Members have said, our hope and ambition should be that as few people as possible find themselves in a crisis situation. I therefore entirely endorse and support the comments about ensuring that we have proper and well-funded mental health services, both in the community and in the acute setting.

The hon. Member mentions support for the person needing help—to help themselves, and also to help society. Does he agree that more and more people are getting into situations where they do not feel that they are being helped, and that they just feel incarcerated and restricted?

I agree with the hon. Gentleman that more can be done to help people in crisis. What I would say, however—I think my hon. Friend the Member for Runnymede and Weybridge also made this point—is that there are people who are at such a point that, unfortunately, they need to be incarcerated in order to be able to help themselves. Hopefully, they spend their time incarcerated not just away from society but being treated effectively and appropriately. That brings me to the point that this is a balancing act and a difficult situation. I think all of us of all parties are clear that the current Act is no longer fit for purpose, especially when we think about forensic mental health. As such, I am glad that the Government are taking forward this legislation, which was started under the previous Government. The cross-party consensus we have heard this evening reflects the fact that this piece of legislation has come from both of the major parties. I am likely to be on the Bill Committee after the Whitsun recess, so I will not test the patience of the House by going through every single bit of the Bill I have some interest in or concerns about, but I will briefly raise three important areas, which I am pleased were raised by Members in the other place. A number of Opposition amendments were tabled in the other place which would have strengthened the Bill, and I hope they will be made in Committee in this place. The first area is reducing unnecessary police involvement. The noble Lord Kamall and Baroness May tabled some amendments that in my view represent a very significant and much-needed shift in how detentions and removals under the Mental Health Act can be managed. Under the current framework, the power to detain individuals and move them to a place of safety—particularly under sections 135 and 136—is largely restricted and falls under the responsibility of police officers. Although those provisions are designed to protect the public, they can often result in the criminalisation of people in acute mental health crisis, even when there is no threat of violence or risk to others. The amendments tabled in the other place would have allowed authorised and qualified health professionals such as paramedics, approved mental health professionals or specialised nurses to carry out those detentions and to move individuals under sections 2, 3 and 5 of the Act. That would relieve police officers of responsibilities that fall outside their core expertise while reducing the stigma and trauma associated with police-led interventions. It would streamline the process, ensuring that individuals were supported by professionals trained specifically in mental health care and would maintain police involvement only where there was a clear and present risk to safety. That would significantly change and strengthen the system, placing mental health crises more firmly within the domain of health rather than law enforcement.

Sections 135 and 136 of the current Mental Health Act give the police the power to break into someone’s property or detain somebody in a public place where there is the possibility of the involvement of weapons. Does the hon. Member think that health professionals would be able to manage those kinds of situations? Would the police not be the best people to deal with those situations?

I am sorry if I was not clear for the hon. Gentleman. I thought I had made it very clear that I was talking about situations in which there was no risk to other professionals. Clearly, in the situations he describes, the police are entirely the right people to be involved. The second area that I want to touch on is that of strengthening safeguards for vulnerable children. What I would like to see introduced is an essential safeguard for children and young people within the mental health care system. As my hon. Friend the Member for Runnymede and Weybridge mentioned, the current legislation allows for a nominated person to be appointed to represent the child’s interests. In my view, though, it does not provide adequate protection against the risk that that person could be coercive, abusive or in other ways inappropriate, particularly in cases involving looked-after children or those with complex family dynamics. As such, I would like to see amendments made that address that gap by establishing clear criteria for who can be appointed as a child’s nominated person. For looked-after children, the local authority would automatically become the nominated individual, ensuring oversight by a public body accountable for the child’s welfare. For other children, only individuals with legal parental responsibility—such as a guardian or someone named in a court order—should be appointed. Such measures would ensure that no vulnerable child would be exposed to undue influence during what may be one of the most difficult or disorienting times in their life. They would align mental health law with broader child protection standards and reinforce the principle that safeguarding must be at the heart of any mental health intervention involving children. Finally, I want to see amendments made that would introduce more patient voice and accountability. I accept that in its current form, the Bill makes steps in the right direction, but I would like to see an amendment made mirroring the one that was tabled in the other place by the noble Lords Howe and Kamall. Such an amendment would introduce the valuable and forward-looking provision of a mandatory debrief session within 30 days of discharge from detention under part 2 of the Mental Health Act. That session would be led by an independent mental health advocate, and would provide patients with the opportunity to reflect on their experience, raise any concerns about their treatment, and offer feedback in a safe, supportive and non-judgmental setting. That would be more than just a procedural addition; it represents a shift in culture, which I think we would all agree with, towards embedding patient voice and accountability in the mental health care system. It recognises the importance of empowering individuals after detention, supporting their recovery and learning from their lived experience to improve future services. Mental health charities and third sector organisations have strongly endorsed the proposal, so I hope the Minister will give some indication in his wind-up that he would support a similar amendment. Taken together, these reforms prioritise professional clinical opinion, safeguard children from inappropriate influence during periods of acute vulnerability and elevate the patient voice in the post-care process. In doing so, they align the Mental Health Act closer to modern standards of care, international best practice and evolving public expectations. These amendments are essential to strengthening the Bill, ensuring that our mental health system becomes not only more effective, but more compassionate, responsive and just.

19:40:00

The Mental Health Bill is a long overdue update to the Mental Health Act 1983, and I hope it will be the start of a much wider overhaul of a mental health system that is often not fit for purpose and has historically been treated as secondary to the physical health system. It is a system where too often patient voices are ignored, injustices are common and the use of detention is relied upon in the place of person-centred community care. Too frequently, those in acute mental health crisis cannot access the right support. They are refused help in the community, forced to rely on accident and emergency, and detained against their will as their mental health deteriorates. Incidence of detention is three times higher in the most deprived areas. Black British people are detained at 3.5 times the rate of white people, and those with learning disabilities and/or autism are at a unique and increased risk from detention and the impact that it can have on their lives. I will initially focus on that latter group. I declare an interest as the chair of the all-party parliamentary group on learning disability. Under the 1983 Act, as we have heard, learning disability or autism in themselves can be a reason for detention. The hon. Member for Runnymede and Weybridge (Dr Spencer) said that we will disagree on this, and I am afraid that we will, because I do not think that learning disability or autism are necessarily conditions of the mind. A number of these conditions are genetic and also affect the physical health of a person.

I am sure the hon. Member will want to come in on this.

I appreciate the hon. Member giving way. There is a logical inconsistency, which is that people with autism and learning disability are looked after under mental health services for autism and learning disability. If the argument is, “Well, those conditions should not be within the scope of Mental Health Act”, one could make an argument that they should not be within scope of mental health services full stop.

I thank the hon. Member for his intervention. I would welcome the opportunity to discuss this issue in more detail with him, although we will probably continue to disagree. People with learning disabilities and autism can suffer from mental health conditions as much as the rest of the population, but they have a unique set of challenges. I point out as a note to policymakers in general that they should not conflate learning disability and autism as one and the same thing. That is vital. At the end of January 2025, 2,065 in-patients in locked mental health facilities were autistic or living with a learning disability. As one of my hon. Friends said earlier, the average length of stay for these patients is nearly five years. For those with a learning disability or autism, a locked mental health ward can be a living hell. For someone with sensory issues, a reliance on routine, a need for a specialist diet or equipment or myriad other needs, being in a busy, over-stimulating environment—often with strip lighting and minimal privacy—often means they are set up to fail from the very beginning.

My hon. Friend is making an important speech, and I know that her experience in this issue is almost second to none. She is making a point about how those with learning disabilities being confined in the way she suggests could add to their mental health issues. Supporting them in the community would alleviate a lot of those mental health issues. In the long term, that is better for them and for the community.

I will come to that point a little later, but that confinement is detrimental to their mental health. It can sometimes be hard to pick apart a co-existing or co-occurring mental health condition from the behaviour exhibited within that environment. This is part of the reason that it is all but impossible for some detained individuals, in the circumstances they are in, to demonstrate the behaviour change they need to prove they have become sufficiently well to be released. My attention was drawn last year to the case of a young woman called Bethany, who was detained for the best part of half a decade under the Mental Health Act. She is an autistic young woman whose parents believed that her entering a secure unit was the best choice. However, she ended up being locked up for days, weeks and then months on end in a room with only a mattress on the floor. She was unable to see her family or her support network, and her parents were absolutely devastated at being unable to get her out of that environment and seeing her continually deteriorate. It is hard to imagine the anguish of people seeing someone that they love go through this. When this happens to someone or their family, how on earth can they ever again trust the system that put them there? Learning disabled people and autistic people who have been through that have their confidence in accessing support taken away. In turn, that can create a vicious cycle. I strongly welcome the moves that this Bill makes towards removing learning disability and autism as a reason alone for detention. However, similar to my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna), I note that the Government have said that these changes to detention criteria will only be switched on when systems can demonstrate a sufficient level of community support. That is a source of real concern. As the NHS Confederation has warned, the “success of the reforms will be dependent on the wider infrastructure to support” the Bill. As others have said, there is no clarity on what a sufficient level of support means in practice. We do not know where we are heading or when we will have got there. The most successful support for learning disabled and autistic people to live independently in their communities is integrated care that encompasses health, housing, occupation and much more besides. I would welcome the Minister’s assurances on how that will be delivered in the timescales set out and how we get from where we are now to where good is. The continual detention of people in this way should shame us all, and an end to that cannot come fast enough. I sound a note of caution—I think this is fairly similar to that of the hon. Member for Runnymede and Weybridge—that the legislation continues to allow for the co-occurrence of mental health conditions to be a reason to detain someone with a learning disability and autism. That in and of itself could lead to this continual cycle where people are detained for longer than is necessary for their treatment while in an environment that is entirely counterproductive to them becoming well. We also need those with a specialism in learning disability and autism to be present in assessing whether an individual also has a co-occurring mental health condition. Finally, I put a plea in to the Minister that there is a real need for those who live with a learning disability or autism to be properly consulted. A number of disabled people’s charities that are run by people with a learning disability, such as the “Bring People Home from Hospital” campaign, which is operating under the auspices of Inclusion London, do not feel that they have had sufficient opportunity to input. A very minor point is that some relevant documents related to this legislation have not been printed in easy read. If they have, it has taken a while for them to arrive. People who have a lived experience of these conditions are unable to contribute in a meaningful way. More broadly, I welcome the legislation’s attempt to make progress in putting patient voice at the heart of care, particularly through advance choice documents, but there is scope to go further. The Royal College of Psychiatrists is advocating for a statutory right to an advance choice document, which the pre-legislative scrutiny Committee also recommended. That would ensure that all patients who would benefit from one would get one, with the aim of reducing detentions and involuntary treatment. While I recognise the importance of this step and this legislation alongside the Government’s investment in mental health crisis centres, a pledge to recruit 8,500 mental health staff and the Secretary of State’s commitment to the mental health investment standard, there is a desperate need to transform community mental health services to put patient voice and experience at its heart and avoid the need for detention orders in the first place. As a member of the Health and Social Care Committee, I have had the privilege of hearing from some extraordinarily courageous individuals who shared their experience of living with a serious mental illness. It is in that same spirit that I will share my own experience now. I hope that it offers an insight into the limitations of our current system. I was diagnosed with obsessive compulsive disorder as a teenager, and with bipolar disorder in my 20s. In two and half decades with these conditions I have received good care, but sadly that is the exception and not the rule. I have never been asked what it is that I want from treatment, what it is that I want for my life, and how I can be helped to get there. I have received care that is patronising, reductive, inconsistent and non-existent. During mental health crises I have had to tread a fine line between proving that I am ill, and sometimes extremely ill, and proving that I am not so ill that I need to lose my liberty, because I know that more often than not, treatment is based not on therapeutic care but on risk management. Like thousands of others, I have had to create my own care package and my own route to treatment, because I made the decision that I deserved to live, and I deserved to live well—and also that my children deserved their mum. However, I am very aware that my ability to do this is based on a number of privileges, in no small part a very supportive family, which so many do not have. While I welcome the Bill for its advances in reducing the amount of detention and increasing the agency of those who are detained, I must call for a significant overhaul of community mental health services to prevent crises from occurring in the first place. We know that we can and must do better. I ask all Members to note that when we discuss people’s serious mental illnesses, we often talk as though they were “others”, which they are not. Let me say this: “There is someone standing here among you, a Member of Parliament, who has a serious mental illness. It does not prevent me from doing my job or from living my life; in some ways, it makes me better at it.” While the Bill continues its passage through Parliament, can we please bear in mind that we are talking about individuals, and individuals who will be affected by it, and that what we seek to do—and what I hope we will accomplish—is give people who live with serious mental illnesses the ability and the right to live the best lives that they possibly can, with all the support that we can make available?

The hon. Lady’s family must be very proud.

19:52:00

I wish to draw the House’s attention to the appalling case of a young man who was very badly failed by mental health services and, indeed, tragically lost his life as a result. Today I am representing his family, my constituents Graeme, Sam and Kaitlyn, who have been campaigning to ensure that no other family has to go through the distress that they have endured and continue to endure. Declan Morrison was 26 years old when he died. He had complex needs, and required some of the most specialist care and support throughout his life. He had autism, associated severe learning disabilities, bipolar disorder and attention deficit hyperactivity disorder. He was non-verbal and required 24-hour residential care, which he had needed and received since he was 11 years old. Declan’s behaviour could be challenging, and at times he would injure himself—and sometimes, latterly, staff members caring for him. That is why it is so important that he was supported by those who knew him well, and who were able to understand his behaviour and therefore provide, as best they could, for his needs. His family were unable to provide him with the care he needed in their home, and had to put their trust in the system and specialist carers to make sure that he was looked after. Sadly, their trust was broken, with the most devastating consequences. Declan was moved into his final residential home in May 2021 after the previous placement had become unable to meet his needs, although in a subsequent independent safeguarding adult review following his death, that decision was called into question. For a brief period, Declan seemed to settle into his new placement, but quite quickly staff at the care home raised concerns that they could not safely care for him owing to his behaviour, which had become particularly challenging. However, attempts to find an alternative single-space home for him, which he needed, failed. There was nothing available, not a single appropriate placement, so he remained in that placement for a further 10 months, with his mental and physical health worsening. I will not describe here what life was like for Declan and his family at this time, because it is too distressing.

My hon. Friend is making an important point about lack of provision. Does he agree that the 10-year timescale for ensuring that that provision is available is critical? If the Government could speed that up, it would be extremely helpful in instances such as this.

I entirely agree, and I will come on to make that very point. Needless to say, events took a very dark and ultimately heartbreaking turn. In March 2022, a serious incident occurred: Declan became very distressed, and assaulted some staff members. Police were called, and a number of officers assisted staff to restrain Declan. As a last resort, he was detained under section 136 of the Mental Health Act and taken to the section 136 suite at Fulbourn hospital. Some may not be aware that under the law, patients who are placed in a section 136 suite should be there for no more than 24 hours, or 36 hours in extreme circumstances. Declan was there for 10 days—10 days in an emergency suite that was entirely unsuitable for a person with his severe needs; 10 days while more than 100 places were contacted; 10 days during which not one bed in suitable accommodation could be found locally, regionally or nationally for him. Finally, he simply could not cope, and he banged his head repeatedly against a wall, inflicting a catastrophic head injury on himself. He was taken to hospital and operated on, but he died some days later in April 2022, when his family made the heart-wrenching decision to turn off his life support. It is painfully relevant that we are debating the Mental Health Bill today, because clauses 3 and 4 specifically address the detention of people with autism and learning disabilities, like Declan. The Bill would limit detention for treatment under section 3 of the Act, but I must ask the Minister: would these provisions have been enough to prevent Declan’s tragedy? His case highlights the critical importance of having appropriate crisis provisions and suitable community placements available, not just in theory but in reality. The coroner’s report on Declan’s death and the independent care review found major failings in the system that was supposed to protect and care for him. He was acknowledged to have been in crisis for months. Ultimately there was, and there remains, an enormous shortage of available placements for someone with Declan’s complex needs, both in the community and within the NHS. As Declan’s father told me, in words that I hope will be heeded, the reliance on the section 136 suite to contain autistic individuals while they are in crisis is abhorrent, and must be seen as a breach of the Human Rights Act. Declan’s sister, Kaitlyn, has called for specific crisis provisions to be funded and created for individuals with autism who need a designated place of safety when experiencing a severe mental health crisis. Such provisions would need appropriately trained and experienced staff. In fact, one was created in Cambridgeshire following Declan’s death. Sadly, the funding was pulled and it closed, but it operated at 90% capacity when it was open, showing the very real and immediate need for this kind of provision to exist permanently and across the country. The Bill places new duties on integrated care boards and local authorities to provide community support for people with autism and learning disabilities, but how will the Government ensure that the duties it outlines translate into sustainable services that prevent cases like Declan’s from ever happening again? Duties without resources are merely words on paper. Although it is welcome that clause 49 removes police stations and prisons as places of safety, Declan’s case shows that even designated section 136 suites can be wholly inappropriate for individuals with complex needs. How will the Government ensure that appropriate alternatives are in place before the provisions commence? I note with deep concern that the Government anticipate that full implementation of the Bill could take up to 10 years, which is too long for vulnerable people to continue to be at risk. In the light of the coroner’s findings in Declan’s case, will the Government commit to prioritising the provisions relating to autistic people and those with learning disabilities, particularly the development of appropriate crisis services, as outlined in the Bill? On behalf of Graeme, Sam, Kaitlyn and all those people like Declan, I ask the Government whether they are satisfied that the provisions set out in the Bill will prevent tragedies like this one from ever happening again. If not, I urge them to make changes to ensure that it will. For Declan and all those with autism and learning disabilities, who deserve better from our mental health system, we must make sure that the Bill delivers the change they need—not in 10 years, but now. Their lives depend on it.

20:02:00

It is humbling to contribute to a debate with contributions like that from the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). I pay tribute to him for sharing Declan’s story in this place, and to my hon. Friend the Member for Thurrock (Jen Craft) for her very personal contribution. I warmly welcome the fact that the Government are giving this issue the prioritisation that it richly deserves. The reforms will give patients greater choice and enhanced rights, and ensure that everybody is treated with dignity and respect throughout treatment. I will make three broad points about mental health services in England and how they relate to the passage of this Bill. The first is about Cumbria’s hidden crisis. Cumbria’s suicide rate is 50% higher than that in the rest of the country. Over five people die from suicide every month in Cumbria—more than double the number of road deaths. Each one of these lives lost is a tragedy. They leave behind families, friends, co-workers, neighbours and emergency workers—a web of people in the community who try to make sense of the grief, loss and shock. Some fantastic local organisations in my constituency are working to bring that number down, including Every Life Matters, Andy’s Man Club and the West Cumbria Mental Health Partnership, but they are fighting a growing problem of depleted resources. It is in this context that we need excellent mental health services, so it was particularly welcome that, weeks after the general election last year, the Government funded a new initiative called Hope Haven, an open-access mental health hub with some accommodation attached to it. This new service is being built by brilliant local partners in my constituency as we speak, and I have high hopes for the contribution that it can make. However, the new service has come at the same time that Cumbria, Northumberland, Tyne and Wear NHS foundation trust has made the regrettable decision to close Yewdale ward, an in-patient mental health ward in Whitehaven that is the only in-patient service in the area. If it does close, patients will need to travel for over an hour to reach the nearest in-patient service, and the community has very poor public transport options. I have called for the ICB to investigate the process that has been followed to reach the decision, so that we can pause the closure. If we are to improve mental health services across our country, the reforms need to work for rural, isolated and coastal areas too. My second broad point is about the needs of people with experience of growing up in the care system and the link to mental health services. Care-experienced adults are hugely over-represented in our systems of mental health detention, assessment and treatment, so the much-needed reforms will be a particularly welcome change for this group.

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

I thank my constituency neighbour for suggesting the types of solutions that we should look at. Some areas of the country have much higher rates of suicide than others, and we know far too little about why those areas have those trends. Around half of children in care are expected to have some sort of mental health disorder, and they are estimated to be four to five times more likely than the rest of the child population to have a mental health need. Despite that, children in care are disproportionately rejected for support from CAMHS services, and this builds up unmet mental health needs for which we as a country are paying the price in social and economic costs further down the line. Just one example of that is the surge in deprivation of liberty orders that we have seen in recent years. In 2017-18, there were 103 applications; in 2024, the figure was 1,280. Deprivation of liberty order applications often leave judges in our family courts with impossible choices over the secure accommodation option for children. Young people who grow up in the care system should receive the very best that our country has to offer, with help being speedy and tailored. Although wider changes are needed to make that a reality, humanising our mental health legislation in the ways set out in this Bill will make a difference.

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

Absolutely. We need to support young carers and young people in care. One of the common challenges facing both of those populations is that services sometimes fail to look at what support can be provided to the whole family unit, so I take my hon. Friend’s point. Finally, I will say a few words about a sensitive issue that is a growing trend. Most weeks, I visit a school in my constituency, and there is a growing theme: teachers, and now parents, are raising concerns about the potential over-diagnosis or misdiagnosis of ADHD and mild autism. I raise this point for two reasons: first, because the risk is that the scale of the increase in diagnosis is so great that it may take away much-needed mental health services from those with acute and genuine need; and secondly, because we have yet to grasp the potential negative impacts of treating what may be social challenges as medical disorders. Some 400,000 children are currently awaiting an ADHD assessment, and rates of diagnosis have risen sharply in recent years. Diagnosis varies dramatically depending on where someone lives, who does the assessment and, worryingly, the socioeconomic background of the individual.

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

Yes, in a number of schools we have seen a growing number of ADHD and mild autism diagnoses that do not come with any form of treatment. That is in a system where there is an expectation that education, health and care plans will be filled and met by multiple agencies, and the families are often left battling the system, having to fight for a diagnosis to get that label and then finding that the help is not there. My argument is that those families—not all, but some of them—are battling a system that already has finite resources and now spends a huge proportion of its resources gatekeeping, when actually we should step back and look at what support the young person and their family need. In the case of ADHD, the National Institute for Health and Care Excellence guidelines set out very clearly that, before an assessment is made, it should be established whether parenting support could be put in place to help. My guess is that, in many cases at the moment, that offer of parenting support is not in place before an ADHD diagnosis is made. Diagnoses of autism have doubled in the last five years. I am not saying that that is incorrect, but I think the question needs to be asked, as part of the wider debate, whether that growing trend is a reflection of previously undiagnosed autism or, because of recent changes in the ICD-11 manual—the 11th edition of the “International Classification of Diseases”—people are being brought into that diagnosis who would previously have been supported in other ways. I close by urging the Government to consider the implications of the reform of mental health services for those in rural and remote communities. They need to acknowledge the benefits that will come from these measures for those with a care experience, but also to think deeply about the need for residential care that can meet their need for a secure setting. They should also consider ways in which we as a country can have a full and rich conversation about the growing diagnosis of ADHD and mild autism, so that we can establish the best routes of support for the children crying out for support and the parents often battling against the system, who may be building up a future need for the crisis mental health services we have been speaking about this evening.

20:12:00

Before I begin, I want to pay tribute to right hon. and hon. Members for their extremely informed, personal and moving speeches in support of the positive elements of the Bill, and for making extremely important, constructive suggestions about how to make it even better than it is. I stand today to speak in strong support of the Bill, and the urgent and long overdue reform of our mental health legislation. The Mental Health Act 1983, now 40 years old, was designed for a different era. While it has provided a legal framework for detaining and treating individuals in crisis, it no longer reflects our modern understanding of mental illness, patient rights or best clinical practice. As we have heard, the Act governs both civil patients and those involved in the criminal justice system, and it includes powers such as community treatment orders, but it is clear that the system it underpins is no longer fit for purpose. The need for reform is stark and obvious. Patients detained under the Act often have little say in their treatment or about who is involved in their care. As we have heard, racial disparities are deeply entrenched, with black or black British people 3.5 times more likely to be detained and 11 times more likely to be placed under a community treatment order. The journey towards reform began with the 2018 independent review, led by Sir Simon Wessely, which identified rising detention rates, poor patient experience and systemic disadvantages for people with learning disabilities and autism. A draft Bill followed in 2023, and I commend the Government for taking forward the proposed Bill. Each year, approximately 54,000 individuals are detained under the Mental Health Act. Alarmingly, as I have mentioned, black individuals are nearly four times more likely to be detained and 11 times more likely to be placed under a CTO. Furthermore, nearly 1,000 young people are detained annually, yet over half report that their hospital stay did not aid their recovery. These statistics are not just numbers; they are a call to action. There are serious concerns about the treatment of people with learning disabilities and autism. While the Bill rightly ends inappropriate detentions under section 3 of the Mental Health Act when there is no co-occurring mental illness, the delay in implementation due to the lack of resources raises fears of criminalisation, misdiagnoses, and exclusion from aftercare. We need a fully costed plan, with clear targets and accountability, to support this vulnerable group. Mind, the leading mental health charity, has identified a further three critical areas in which the Bill must go further. The first is tackling racial disparities. The disproportionate detention of black individuals under the current Act is a glaring injustice. The Bill must include measures to reduce this disparity, such as limits on the use of community treatment orders, and the introduction of a “responsible person” to oversee treatment decisions. Additionally, a statutory duty to monitor and report on progress against these inequalities is essential. I therefore support the creation of a dedicated role to monitor and act on racial disparities in detention and treatment. Secondly, the principle of least restriction is central to the Bill, yet it remains aspirational; there are no enforceable rights. Patients should have a statutory right to assessments and treatment, the ability to appeal treatment decisions, and expanded access to advocacy services. These rights are about not just legal protection, but respecting the dignity and autonomy of individuals facing mental health challenges. Thirdly, young people detained under the Mental Health Act often find themselves without adequate support or a voice in decisions about their care. The Bill must include a transparent decision-making test, tailored for children and young people, to ensure that their best interests are at the forefront of all treatment decisions. There should also be safeguards and the standardisation of advance choice documents. The Government say that the implementation timelines could be up to a decade, but I urge them to implement each element of the Bill as soon as is practically possible. This Bill is very welcome, and this is a pivotal moment in the history of mental health care in our country. It is a huge step forward, but it could go further. To truly transform mental health care, we must ensure that the legislation is not only progressive in its intentions, but robust in its protections. We have the opportunity to create a system that upholds the rights, dignity and humanity of every individual. Let us therefore not pass up this chance to make all the necessary changes. Let us amend this Bill to reflect the values of equality, autonomy and respect, and take this once-in-a-generation opportunity to build a fit-for-purpose mental health system that is fairer, more compassionate and more effective. I urge the Government to take this opportunity to address the gaps, take heed of the recommendations and concerns, and make the Bill right and proper.

Order. I want to retain the tone of this debate, but to get everybody in, we will have a speaking limit of seven minutes, which is still quite a long time.

20:19:00

It is a pleasure to be called to speak in this Second Reading debate. Prior to being elected to this House, I worked for 22 years in NHS mental health services, and I am the chair of the all-party parliamentary group on mental health. This is an issue I care about deeply. It has been widely accepted that the Mental Health Act is outdated, and the need to modernise it has been talked about for some time. I pay tribute to Baroness May who, when she was Prime Minister, commissioned Professor Sir Simon Wessely to undertake an independent review of the Act, and I commend this Labour Government for introducing the Bill without delay. As Members will be aware, last week was Mental Health Awareness Week. The discussions I took part in showed how far we have come in removing much of the stigma around mental ill health, but I fear that a lot of stigma remains when it comes to discussing severe mental ill health, such as cases of schizophrenia. I therefore welcome the importance that the Government have attached to the Bill, and to updating the law so that it is fit for the 21st century. I hope that, through our deliberations, we can play our part in ensuring that severe mental ill health is treated with the respect and understanding it deserves. The Mental Health Act provides the legal framework for the detention of people when their mental ill health means that they are at risk to themselves or others, so that they can receive appropriate treatment. The Bill looks to modernise that legal framework. I welcome clause 1, which adopts the four principles of treatment proposed in Sir Simon Wessely’s independent review. By adopting those principles, the legislation will give patients greater choice, enhanced rights and support, and ensure that being treated with dignity and respect is an integral part of their treatment. This reform is long overdue. We talk a great deal about wanting to deliver personalised care in our health service. That should be the guiding principle in every part of the service, especially for the most vulnerable. Adopting the principles is about redressing the balance of power away from the system, so that the patient has more autonomy, and more say over their treatment. That will help to ensure that those in society with the most severe mental health conditions get better, more personalised care. I also welcome the statutory role that clauses 24 to 28 will give a nominated person, who will have a greater say over the patient’s treatment and care. Replacing the old hierarchical list of relatives with a person who has been selected by the patient, albeit that there will be certain safeguards in place, is an update to the legislation to reflect today’s world. Clause 3 deals with the application of the Mental Health Act to autistic people and those who have a learning disability. The clause modifies the definition of mental disorder by introducing new definitions of autism, learning disability and psychiatric disorder. As a result, people with a learning disability or those who are autistic can no longer be detained or made subject to a community treatment order unless they have a co-occurring psychiatric disorder. This is a welcome and long overdue change. Under the Mental Health Act, autistic people and those with a learning disability have experienced inappropriate care, over-medication and extended periods of detention. As we look to modernise the Act, it is wholly appropriate to ensure that they cannot be detained unless they have a co-occurring psychiatric disorder. However, concern has been expressed in parts of the learning disability and autism sectors that the change may have unintended consequences. For example, it may lead to an increase in alternative routes to detention. In particular, concern has been raised that people with high-risk behaviours who require treatment in appropriate and safe hospital environments may end up having to be dealt with by the criminal justice system if they cannot be detained under the Mental Health Act. These concerns were debated when the Bill was considered in the other place, but I would be grateful if the Minister could say whether the Government have given any further consideration to those points. I would also be grateful if he could give an assurance that he and his officials will engage with the learning disability and autism sectors as the Bill continues through this House. In the other place, the Conservatives were successful in amending the Bill to allow the extension of police powers of detention under sections 135 and 136 to other specified healthcare professionals. The amendment provoked serious concern from representatives of healthcare professionals, and I understand it is not supported by the police either. The “right care, right person” model, put in place in 2023, has already reduced the time the police have to deal with mental health patients. Will the Government look into overturning that amendment? I would also be grateful if he said how the Government will build on the Bill to ensure wider reform of, and investment in, mental health, and how we can ensure that the aims of the Bill are accompanied by high-quality mental health services, especially community services for people experiencing poor mental health. In preparation for today’s debate, on Thursday, as chair of the APPG on mental health, I was pleased to organise for a small group of Members a visit to the mental health centre at the St Charles hospital in Kensington. During our visit, we were able to spend time in the mental health crisis assessment service. This excellent facility is open 24 hours a day, seven days a week, for anyone in the area who is experiencing a mental health crisis. I recommend that such facilities be instituted across the country, especially in my constituency. In Ashford, there are no mental health emergency facilities. Over 2,600 people whose primary issue was recorded as mental ill health presented themselves at the A&E department at the William Harvey hospital in 2024. Such facilities would help to prevent that. I press for more support to be put in place, alongside the Bill.

20:26:00

I welcome the direction of the Mental Health Bill. It marks a long-overdue shift in how we treat some of the most vulnerable in our society, recognising that people deserve more than crisis care—they deserve dignity, choice and autonomy. It has been a real privilege to be in the Chamber for this important debate, and to hear the very moving speech by my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom), and by so many others across the Chamber who shared their constituents’ stories, and their own. The Bill rightly puts patients at its centre. It gives them more say in their treatment, improves the complaints process and introduces personalised care plans. Replacing the outdated “nearest relative” with a nominated person reflects a broader move toward a more respectful, person-centred system that listens, empowers and supports recovery. But here is the uncomfortable truth: however well-intentioned, the Bill will achieve little unless we confront the funding crisis already engulfing our mental health services. The Bill asks overstretched and underpaid staff to deliver changes that demand time and care when many are already at breaking point. My constituents across Guildford see that every single day. Jennifer came to me in despair over the care that her daughter Leah is receiving at a local mental health unit. Chronic understaffing and a lack of support mean that concerns go unanswered. Underfunding has created a cycle of inadequate care—treatment refused, early discharges to free up beds, and inevitable readmissions when Leah’s needs are left unmet. I have heard from Samantha, whose son suffered a psychotic episode that ended in tragedy—a stark reminder of what happens when crises go unsupported. I also want to mention the story of a young woman whom I will not name, but who made a series of attempts on her life until she tragically succeeded, after gaining access to a poison from overseas. I know this is not a unique story, and that multiple coroners have written to the Secretary of State for Health and his predecessors on this issue. Will the Minister agree to meet me to discuss the case and whether it may be possible to use the Mental Health Bill to prevent further similar deaths? There is also the fact that across the country people are waiting months and sometimes years for mental health care. Children and young people are falling through the cracks, as CAMHS is overwhelmed and referrals are delayed; patients are sent miles from home due to local bed shortages; and police are left to respond to mental health emergencies because there is no one else to call. Our system is not just stretched; it is at breaking point. Yet the proportion of NHS funding going to mental health care is falling—despite soaring demand, despite mental illness making up a fifth of the NHS’s burden, and despite the Government’s promises. These are not just gaps in the system; they are failures of political will.

As well as NHS funding for direct mental health services, does the hon. Lady agree that we should invest in preventive steps to help children to avoid the mental health anguish that they are suffering today?

Absolutely. I know from my own caseload of too many stories of where if young people had received preventive care and support, they would not be facing the tragic situations they and their families are now living through. This Government have scrapped key mental health targets, including goals for early intervention, therapy access and physical health checks for people with mental illnesses. I am sorry, but this signals a retreat at the very moment we need to advance. I support the vision outlined in the Bill, but its success depends entirely on the foundation on which it stands. Without adequate investment, even the very best intentions will struggle to take root. Ensuring that people can exercise their rights and that staff can support them demands more than legislation; it demands real resources and sustained commitment from this Government. We need a national effort to rebuild mental health care from the ground up, with early intervention for young people, trained professionals in schools and communities, continuity of care and a culture shift that treats mental health with the same urgency and seriousness as physical health. Failure is not an option—not for the thousands still waiting, not for the staff stretched to their limits, and not for the communities left to pick up the pieces. We can and must do better.

20:31:00

I rise to support this important Bill. I have been incredibly humbled by some of the speeches, particularly from the hon. Members for Dorking and Horley (Chris Coghlan) and for St Neots and Mid Cambridgeshire (Ian Sollom) on the Lib Dem Benches, from the hon. Member for Runnymede and Weybridge (Dr Spencer) given his experience, and of course from my hon. Friends the Members for Thurrock (Jen Craft) and for Sittingbourne and Sheppey (Kevin McKenna). This Bill is incredibly welcome. It is long overdue and deserves the urgency and seriousness it is being given. I have heard from families in my constituency who have waited months and sometimes years for help; in many cases, the waiting list for CAMHS in Southampton exceeds two years.

Recently, I met grandparents in my constituency who are caring for their grandchild, who was recently diagnosed with autism. Their grandchild is suffering from poor mental health and is unable to attend school, and the family is struggling to access support. I welcome the Government’s work so far in this area, including the pledge to have a specialist mental health professional in every school, but does my hon. Friend agree that a three-year wait for an appointment with CAMHS, as my constituents are facing, is completely unacceptable?

My hon. Friend makes an incredibly important point, and I fully agree that the wait facing many people is excruciating. I have had constituents come to me in tears because they do not know whether their children will make it to adulthood. The services are just not there, and they are subject to hugely long waits and often inadequate provision. These changes are crucial. Of course, there are some truly commendable local initiatives in Southampton that are making a real difference on the ground. I pay tribute to services such as The Lighthouse, an invaluable out-of-hours mental health support centre for adults in crisis, and No Limits, a brilliant charity that has for many years provided a wide range of health and wellbeing support schemes to children and young people across the city. These organisations exemplify the compassion and commitment of professionals and volunteers to those who need their services. Let us be clear, though: however dedicated those services and the people within them may be, they are operating under immense pressure. Demand has outpaced capacity, and that is why national action is so urgently needed to match that local effort with investment, modernisation and the workforce expansion required to ensure that no one is left behind. There are two essential pillars upon which real improvement in mental health provision has to be built: the legal framework, which the Bill rightly seeks to modernise, and, as colleagues from across the Chamber have mentioned, the funding that underpins the delivery of services. Reforming the law is a vital step, but without sustained investment in frontline mental health care we risk changing the rules without changing the reality for patients.

In my constituency we have a statistically significant suicide rate; I have mentioned several times in this place that I know seven men who have taken their own life. Does my hon. Friend agree that while funding is important, early intervention and preventive care in mental health services is also really good money, well spent?

As a former cabinet member for children’s services, I have learned through experience that early intervention will always be far better value for money than reactive services, which are obviously very necessary but often come too late. We need both compassionate, up-to-date legislation and the resources to make it meaningful in practice. The Bill will bring our mental health laws into the 21st century. As has been mentioned, the Mental Health Act is as old as the Secretary of State—I am sad to say that both he and the Act are still younger than I am—and its provisions no longer reflect our understanding of mental health or the standards of dignity and agency that we now rightly expect. These reforms will put patient voices at the centre. I am pleased that for the first time patients will have greater rights to make their wishes known and to be involved in decisions about their own care. No one could make that case more eloquently than my hon. Friend the Member for Thurrock. The Bill also rightly recognises the needs of children and young people, too many of whom are falling through the cracks. One of the major factors affecting their mental health is the pervasive presence of social media. There is growing and compelling evidence that addictive algorithms are leading to increasing anxiety, depression and low self-esteem. Add to that the impacts of cyber-bullying, social comparison and 24-hour peer pressure and it is little surprise that there is real damage to the mental wellbeing of our young people. In my constituency, we have seen two tragic, heartbreaking deaths that were very much about mental health, in which online forces led people to the terrible decision to die by suicide. We must take action both to prevent and to react to poor mental health. The Bill gives young people the right to express their views in writing and requires professionals to take those views seriously. Every child deserves support, not silence, and the Bill will take us in the right direction. As I have said, the reforms in the Bill are important, but will Ministers confirm that they will be backed up by the funding needed to deliver sustainable mental health services in England? I welcome the fact that the Government have committed an additional £680 million to mental health services this year. I urge Ministers to get that money out of Whitehall quickly and to the frontline, in Southampton and other places where it is desperately needed. I am delighted that we now have a national plan to recruit 8,500 new mental health staff, which will include placing specialist professionals in every school. When I served as cabinet member for education in Southampton, we were proud to lead the way by introducing mental health support into our local schools with a pilot initiative, which has had a clear and positive impact. I am delighted that that successful approach is being adopted on a national scale. I am also delighted that this Labour Government are developing Young Futures hubs across the country to provide the early support for which my hon. Friend the Member for Darlington (Lola McEvoy) made the case so eloquently, with the aim of keeping young people well and, importantly, out of hospital in the first place where possible. We have seen the scandal of learning disabled and autistic people being locked in hospital simply because there is nowhere else for them to go. The Bill will end that inappropriate detention and strengthen community-based support. When more people die by suicide than in traffic accidents and when patients are left in police cells simply because there is nowhere safe for them to go, radical change is the only responsible path. We must strive to achieve that change through this Mental Health Bill.

20:39:00

It has been humbling to be part of this debate and to hear powerful contributions from hon. Members who have so much knowledge, in particular the hon. Member for Runnymede and Weybridge (Dr Spencer) and the hon. Members for Dorking and Horley (Chris Coghlan) and for St Neots and Mid Cambridgeshire (Ian Sollom), who made emotive speeches. I welcome the Bill and the Government’s recognition that the current legislation is no longer fit for purpose. With over 54,000 people detained under the existing Mental Health Act, this is an opportunity to modernise a system that often fails to provide care fairly and effectively. We have heard brutal testimony of that today. Although I support the direction of the Bill, one area that needs greater attention is the impact on young people. We are seeing a clear and worrying rise in mental health issues among children and teenagers, yet the Bill does not fully guarantee them the same rights and safeguards as adults. There is still no statutory test for decision-making capacity for under-16s. Without it, many young people could miss out on key rights such as choosing a responsible nominated person or accessing the protection around informal admission. Current guidelines say that children should be placed on adult wards only in exceptional cases, but that is still happening far too often. In 2022-23, nearly 200 children were admitted to an adult psychiatric ward. These environments are not designed for them. Children who are placed there can lose access to education, peer support and age-appropriate care. This must change. It is not only adult wards that are of concern to me but the fact that many children are sent to live far away from their homes and support structures, even to other towns. We must have statutory provision to stop this happening. Turning to racial inequality, the data continues to tell a stark story. Black people are nearly four times as likely to be detained under the Mental Health Act and seven times more likely to be placed under a community treatment order. Those orders were meant to reduce hospital readmission, but they often do not achieve that aim. Instead, they feel indefinite, coercive and difficult to challenge, and many say that they erode the trust between families and healthcare providers. That is why I support either abolishing CTOs altogether or ensuring that they are subject to regular independent reviews with clear criteria. I also support the call to have a person in every trust who is responsible for race equity—someone with authority and visibility to ensure that training, policy and data are used effectively to address local disparities. We need national accountability too. That is why an annual report by the Secretary of State, broken down by protected characteristics, is vital. If we are serious about reducing inequality, we must measure, understand and act on it. Finally, on autism and learning disabilities, I support the decision to remove the ability to detain people without a co-occurring mental health condition. However, there are real concerns that, without proper support in the community, people may end up being misdiagnosed just to fit the criteria for detention, or may be left without appropriate care altogether. We need a clear, costed plan for supporting integrated care boards and local authorities to deliver the care people need in the community. That means targets, proper funding and safeguards to prevent delays and poor outcomes. We cannot afford a system where a lack of planning results in another decade of delays for this vulnerable group. The Bill is an important step forward, but it is not enough on its own. If we want meaningful change, we need investment, accountability and a stronger focus on the rights of the people who depend on mental health services every day. We are all responsible for ensuring that this legislation does more than just change the law. It must change lives.

20:43:00

It has been an absolute privilege to listen to contributions from Members with real expertise and experience. I wholeheartedly welcome the Government’s Mental Health Bill, and I am proud that this vital and, as we have heard, long-overdue Bill will modernise the woefully out-of-date Mental Health Act, which we know is linked to racial inequalities, poor care for people with learning disabilities and neurodivergence and which fails to give patients a proper voice. By modernising the Mental Health Act and making it fit for the 21st century, the Government are demonstrating that they have the ambition, compassion and determination to ensure that patients have greater choice, autonomy, rights and support, and that all patients are treated with dignity and respect throughout their treatment. There are many welcome measures in the Bill, from strengthening patient rights to reforming the use of involuntary detention and limiting the extent to which people with a learning disability can be detained, but to ensure that we tackle the crisis in—and transform the future of—mental health care as a whole, we must go further and build on these reforms. Nowhere is that need more urgent than in children’s mental health services where, alongside profound societal change, the damage to the capacity of the state made by the previous Government is most painfully visible, and where the cost of inaction is overwhelming. The relationship between unhealthy online habits among adolescents and poor mental health is well documented. The World Health Organisation reported last year that “potentially damaging social media use…has been shown to lead to depression, bullying, anxiety and poor academic performance”. But those changes have occurred at the same time as huge reductions in the availability of youth services and other early intervention, the closure of safe community spaces, which provide access to trusted role models, and stark increases in relative child poverty and homelessness. Earlier this month, I launched a constituency survey to hear directly from children and their families to better understand the state of local children’s mental health services. Some of the responses paint a bleak and harrowing picture of parents desperately trying to get their children the support they need. The initial results of the survey demonstrate that we must focus on two connected areas of reform, which I believe must be part of our wider plans to tackle the mental health crisis. First, we must begin with early intervention as a system-wide principle, not an afterthought. Under the previous Government, the mental health system often failed to intervene in a timely, consistent and adequate manner. It is widely understood that early mental health challenges can significantly impact a child’s development, yet services for young children remain insufficient and poorly co-ordinated. For children in their early years and pre-school stages, support is often fragmented or entirely lacking. To address the gap, we need a cohesive early intervention strategy that does more to integrate early years health and education. Additionally, we must go further by giving children access to mental health professionals in every primary and secondary school, making support not just accessible but familiar and trustworthy. Schools are often where issues are first identified, and they must also be where the support starts. It was brilliant to hear the announcement on Friday that that will begin to be rolled out, but it does need to be accelerated. Secondly, we must overhaul how children access specialist care and tackle the systemic barriers created by high thresholds and long waits. Early intervention works only if there is a functioning system to refer into, but that system is broken. Over the last 14 years, services have been hollowed out, waiting lists have spiralled and thresholds for access have been pushed so high that even children in a clear crisis are being turned away. I have heard countless stories of children who are self-harming, experiencing suicidal thoughts or in deep emotional distress being told they do not meet the criteria for treatment. Families are left to watch their children deteriorate, terrified, helpless and too often unheard. That is not care; that is the cost of failure. That is no reflection on the professionals delivering the care. My survey showed good levels of satisfaction, but there simply is not enough of it to meet demand. Unless we expand the service capacity and rethink how thresholds are applied, the most vulnerable children will continue to fall through the cracks, no matter how early their needs are identified. Early help must lead somewhere. That means ensuring that timely and specialist care is available for those who need it. These two reforms are not stand-alone; they are interdependent. We cannot have meaningful early intervention without timely access to specialist care, and for as long as we do not address the root causes of poor mental health—child poverty, hollowed out youth services and weak online safety—the problem will continue to get worse. The Bill, along with a wider plan to tackle the mental health crisis, presents the opportunity not only to fix what is broken but to create something better: a mental health system that is accessible, equitable and fit for the future. I am proud to support the Bill.

20:49:00

It is a real pleasure to speak in this debate, Madam Deputy Speaker. Thank you for allowing me the opportunity to make a contribution. I shall begin by saying that it is essential that we get this right. In his introduction, the Secretary of State outlined his case very well, and I welcome his policy, his strategy and his legal way forward here in Westminster. I also believe that that will set a trend for the rest of the regions of this United Kingdom of Great Britain and Northern Ireland, and particularly for Northern Ireland. I know that the Minister has direct contact every month with the Health Minister in Northern Ireland, Mike Nesbitt, and that a very constructive dialogue takes place between the Secretary of State here and the Minister back home. Hopefully, this will allow all the regions across the United Kingdom of Great Britain and Northern Ireland to ensure that we are all on the same page when it comes to mental health support and obligations. The Minister and the Labour Government have set a strategy in place that I welcome. Mental health has increasingly, and rightly, come to the forefront of our minds. We are now taking it on board and teaching our children coping mechanisms from their early school days, for example with teachers practising breathing exercises with children and helping and guiding teenagers through exam situations. Those things are happening already; we have come forward in leaps and bounds. However, this is not a sprint. This is a generational marathon, and we are struggling to make the mile markers. That is why I welcome the whole premise and thrust of the Bill. The “Mental Health in Northern Ireland Fundamental Facts 2023” report was launched around 18 months ago, and it contained some interesting stats to consider. The wide-ranging report shows that 30% of people in the most deprived areas are likely to have a probable mental illness, compared with 20% in the least deprived areas, and that poverty, particularly child poverty, is a key contributor. It also shows that 24% of children in Northern Ireland are living in poverty. Stable housing is also a key driver of wellbeing, and almost 70% of people experiencing homelessness have a diagnosed mental health condition. In my intervention on the Secretary of State earlier, I welcomed his agreement to share the Bill and its recommendations with the Health Minister in Northern Ireland, because I believe that its constructive, helpful recommendations will help us to achieve some of the aspirations and policies of the Government and the Minister here. The report also highlights the association between poor mental health outcomes and adverse childhood experiences, with 47.5% of young people aged 11 to 19 experiencing at least one adverse childhood experience. Young people in the least deprived areas are more likely to experience no ACEs compared with those in the most deprived areas. One in five adults and one in eight children in Northern Ireland have a probable mental illness, according to the report, with rates in adults similar to other regions. However, our history of conflict and some 30 years of a terrorist campaign—with terrorists murdering and the IRA trying to kill Unionists and those who objected to their way of life—have repercussions and contribute to more complex mental health difficulties in the population. This is a snapshot of any, and indeed all, of the regions in the United Kingdom. We are all facing the same difficulties and we all need a more effective solution and support for individuals and families. I have had many anxious parents whose children have been referred to child and adolescent mental health services. The waiting list in Northern Ireland has approximately 2,100 total waits for a CAMHS assessment, with 1,104—over half of that number—waiting for more than nine weeks. These are children who may be self-harming or have OCD and whose bodies are feeling the effects of obsessive hand washing when stressed. These are just some of the things that young people have to deal with. There are so many things that affect their education. This is why I welcome the aims of new section 125A, which provides for the making of arrangements for ensuring that care, education and treatment review meetings take place for children. Education, hope and a future are essential and I welcome this aim. It is all about giving hope, and I think every one of us, as an elected representative, wants to give hope to our constituents—to the parents and to the children—of a better future. That is why we welcome this positive Bill. I gently question whether the Bill goes far enough in its legal obligations for children’s reviews on education and health. I look to the Minister for his opinion on whether more should be done to ensure that children and vulnerable adults have a pathway to education and a better health programme, and therefore hope and a better future. We must not have a postcode lottery. Indeed, children and vulnerable adults in each region deserve the same rights and deserve dedication and services. I hope that while this Bill applies only in England and Wales, it will make changes for the good of the entire United Kingdom of Great Britain and Northern Ireland and will put in stone—I use that political term—a focus that all can benefit from. The Minister and the Secretary of State gave me a commitment in my intervention. I look forward to the Minister continuing his positive thoughts on how we can all gain because tonight is one of them good nights in this House.

20:55:00

I have spoken many times in this House about mental health because I see the impact of poor mental health every day in Blackpool—in our communities, our families and, tragically, our children and young people. Today I want to focus the House’s attention on them. As a mental health advocate and former chairman of an award-winning mental health charity in Blackpool, I have witnessed a growing and urgent need to support our young people. Now as the MP for my home town, in the midst of a severe mental health crisis, desperate parents come to me every day asking for help. A mother recently contacted me about her 14-year-old daughter. In just four months, her child attempted to take her own life three times by overdose. The minimal support they had was hard fought for, and it was inconsistent and incohesive. The family are on constant high alert in case their daughter tries to take her own life again. As a new parent, I cannot comprehend how they must be feeling day to day. No family should be left in that situation, let alone have to fight for the help that should be there from the outset. Earlier this month, I sat down with young people, parents, teachers, community leaders and the police to discuss the links between bullying and mental ill health. Among the brave young people who shared their stories was Elsie. She spoke about how bullying about her appearance began in primary school and intensified in secondary school. She became anxious and depressed and eventually stopped going to school. She was moved from top to bottom sets, and her academic attainment plummeted. She told me she hated herself, but because she was seen as one of the ones that was acting up, she was punished by the adults around her—she was seen as the problem. The real problem was that no one listened, and the painful truth is that her experience is far from unique. When young people speak up about their mental health, our job is first to listen and then to act. That is why this Mental Health Bill matters. It delivers on the Government’s commitment to modernise the Mental Health Act and give people greater autonomy to ensure that everyone is treated with dignity and respect during their care. It strengthens the voice of patients, gives statutory weight to their rights to be involved in decisions about their treatment, increases scrutiny of detention and seeks to limit the use of the earlier Act to detain those with learning disabilities. The most recent NHS figures show around 135 hospital admissions of 10 to 24-year-olds in Blackpool due to self-harm in the year to March 2024—a sharp rise from about 100 the year before. That is more than double the national average. Child in-patient admissions for mental health conditions in Blackpool are also significantly higher than the national average. Children in care, care leavers, young carers and those living in poverty are especially vulnerable and too often are the ones failed most severely. This inadequacy extends to detention. We know that people living in deprived areas are more than three and a half times more likely to be detained under the Mental Health Act than those in more affluent parts of the country. That is a staggering and unacceptable disparity and the sad reality for my constituents in Blackpool South. The Bill takes a much-needed step forward, introducing a 28-day limit on detaining people with a learning disability or autism who do not have co-occurring mental health conditions. I support the reform, but it cannot come into effect until we have sufficient community services, which my community is crying out for. In that context, I welcome the plan to expand community-based support. The Government have committed to walk-in mental health hubs in every community, more accessible support workers and a specialist mental health professional in every school—all desperately needed in Blackpool. Those essential steps must be backed by funding, urgency and clear timelines, because right now our youth mental health services are stretched beyond capacity. Young people in Blackpool and across the country are too often placed on adult wards, sent far from home or left to fend for themselves until they reach crisis point.

My hon. Friend makes a powerful point. I have had a stark case in my constituency involving a young woman aged 15 with anorexia. Sadly, because we do not have the in-patient facilities in our area, she was detained and confined to a wheelchair. She did not feel that her wishes, or those of her mother, were taken into account during her stay. She was eventually placed in an in-patient ward out of county. Does he agree that one of the Bill’s strengths is that it will give my constituent a voice and a right to have her wishes heard?

I completely agree. A family member of mine was recently suffering from a mental health crisis but could not be placed in Blackpool and had to go hundreds of miles away. That is not acceptable. Patients must have a greater say and they need more support. Mental health charity Mind points out that children are being restrained, ignored and left to navigate a confusing system alone. That is not a system built on dignity or care. We must strengthen legal safeguards for children and young people. I urge the Government to introduce a statutory framework for assessing capacity in under-16s. Without one, their voices are too easily sidelined. Statutory care and treatment plans should be extended to every young person who receives mental health care. We need stronger protections for children placed in inappropriate or unsafe settings far from their families and communities. In their consideration of these reforms, will the Government clarify how they plan to implement the new model of specialised mental health services for children and young people, particularly in the light of the abolition of NHS England? What specific provisions will be included for children and young people in the updated service specifications and legislative reforms? Will the Government commit to a series of sustained reforms of the wider system, so that children and young people can access effective early support in their communities before they ever reach crisis point? The Bill cannot be seen in isolation from the wider challenges facing young people’s mental health. Reforming the Mental Health Act is crucial, but it must be matched by real-world changes to services, staff and support on the ground. Elsie’s story of unchecked bullying at school affecting her mental health and future prospects matters—as do the thousands of untold stories from children across the country. They deserve a system that listens to them, values their voices and responds with the care that they need. They deserve support that meets them wherever they are, not once they have already reached the edge. They deserve the dignity, compassion and care that the Bill aspires to deliver. Let us ensure that we do not waste this opportunity.

21:02:00

May I say how humbled I am to follow such powerful and personal contributions from many hon. Members? I welcome these long-overdue reforms of the Mental Health Act. I am extremely proud to be part of a Government who are moving so quickly to ensure that people who experience severe mental illness are given more autonomy and choice, are always treated with dignity and respect, and are given enhanced rights and support under the Bill. Mental health is a theme of so many of the conversations that I have—and of the support that I try to provide—in my Aylesbury constituency, whether with Fay, Tyler, AJ and Dhwani, the young people who joined my recent work experience programme and devised the fantastic “Breaking the Silence” campaign to improve mental health understanding for young adults; with the residents at Bearbrook Place, which is run by Connection Support and offers supported accommodation for adults facing homelessness, who told me that their mental health challenges contributed to them becoming at risk of homelessness, and that it was their ongoing mental health recovery gave them the most confidence that they could live independently again; or with the people who go along to the fantastic drop-ins provided by the Space charity in St Mary’s church, many of whom experience mental challenges as a result of unexpected life events, health struggles or social isolation. I could go on, but this evening I will focus on how the Bill should improve the experience of pregnant and new mums struggling with severe mental illness. That subject is particularly close to my heart, as I lost one of my best friends, Sophie Middlemiss, to suicide shortly after the birth of her little girl—her third child. I speak to many parents about it, including the fantastic Amy Scullard, who runs the PANDAS perinatal mental health group in Aylesbury. In this period of pregnancy and the year after birth, almost one in four people struggle with their mental health. For many people, their experience is relatively mild and they will recover, but some people, often without any prior mental health challenges and without warning, will experience extremely severe mental illness. Suicide, tragically, is the leading cause of death for women in that period from six weeks to a year after birth. I wish to highlight three aspects of the Bill that will be important for people who experience serious mental illness at that stage of their lives, and who will end up falling within the scope of the Bill. First, the fact that patients will be able to choose a “nominated person” to represent them is a vital step forward. It is crucial. I have seen at first hand how, at the point at which people are severely unwell, they are unable to make the best decisions for themselves. Formalising the ability of someone to play that role on their behalf, and with more powers to challenge the system, could make a positive difference to their care. Secondly, I am pleased that the Bill will make individualised care and treatment plans statutory. Every person is different—our attitudes to mental health have evolved a huge amount since the Mental Health Act was last updated—and ensuring that they have a personalised care plan that accounts for their particular circumstances is crucial. So too is the fact that the Bill creates a duty to inform and support patients in making advance choice documents before they become ill, from a place of good health. Thirdly, I am pleased that the Bill aims to reduce the significant racial inequalities that exist under the current Act. Those inequalities also drive significant differences in perinatal healthcare outcomes more broadly. Black people are more than three and a half times more likely to be detained under the Mental Health Act than white people, and more than seven times more likely to be placed on a community treatment order. That has to change. The Bill introduces measures that should have a positive impact for people from ethnic minorities, for example through the introduction of advance choice documents, as well as by tightening the criteria for detention and compulsory treatment. I am conscious of the time, Madam Deputy Speaker, but I wish to make a point about the implementation of the Bill. For people experiencing severe mental illness in the period after birth, mother and baby units can be a crucial part of their recovery, as well as having significant benefits for the parent-infant relationship. Too often, however, whether or not a mum can access one of those units remains a postcode lottery. I believe we must get to a point where all women who have given birth within the 12 months prior to compulsory admission are given the option of being admitted to a ward where they can remain with their baby. I am so pleased to see the Secretary of State’s commitment to the mental health investment standard, and all the funding that will be needed properly to implement the measures in the Bill. I hope that provision for that group of women at severe risk of serious mental health illnesses will be considered. I will conclude by noting that for all those who experience milder struggles with their mental health, it is clear that there is a whole lot more we need to do beyond the Bill. I know Ministers are conscious of that, and a lot of vital work is under way, including more mental health support in schools, the recruitment of additional mental health support workers, and the roll-out of family and youth hubs. Such community provision and services are essential. The Bill is for those people who struggle with the most severe mental illness and require intensive, specialist support. For them, the Bill represents a crucial step forward, and I am proud to support it.

21:08:00

I thank all Members who have spoken so far to share their professional experience, leaving me feeling very under-qualified to speak on this matter, and those who shared their deeply personal contributions. We all know the shocking statistics associated with mental health. Indeed, the cost of poor mental health is calculated at £300 billion a year in England, and the life expectancy of people with a severe mental illness is around 15 years shorter than for those without one. I wish to draw Members’ attention to men’s mental health, which is an often neglected and overlooked area. Men’s mental ill health frequently goes unrecognised or untreated, leading to severe consequences. Men face unique challenges and are often less likely to seek help. About 12.5% of men in England have a mental health disorder. Only 36% of NHS referrals for psychological therapies are for men, and many men fear judgment for discussing mental health. Men can feel pressured to appear strong, leading to shame, fear of judgment and a reluctance to take time off work for mental health reasons. To add to that list of mental health disparities, we must add racial inequalities, as has been pointed out by many hon. Members. Black people in Britain are nearly four times more likely to be sectioned than their white counterparts, and the NHS’s race watchdog has warned that discrimination is playing a part in those high figures. Racial discrimination can prevent black and minority ethnic communities from accessing the care they need. We know that black African and Caribbean communities face particular barriers to accessing specific mental health services. They are less likely to self-refer to psychological talking therapies and less likely to be referred to such services by their GPs. In addition, the racism, racial violence and hate crimes that threaten many such communities have an additional impact on the mental health of community members, often leading to more severe mental illness, compounded by social injustices, discrimination and disadvantage. I recently visited Rochford hospital, a community and mental health unit that serves my constituency, where I saw for myself the disparity; there were a significant number of young black people on the ward—a mix that certainly does not match the make-up of our local area. We know the terrible toll that poor mental health can have, which can wreak havoc on people’s lives. My constituency of Southend West and Leigh lies within Essex, a county that is unfortunately the unwelcome focus of England’s first public inquiry into mental health deaths. The Lampard inquiry is investigating 2,000 mental health deaths in Essex between 2000 and 2023, which is yet another shocking statistic. It aims to examine the failures in care in Essex and hopefully ensure that they are not repeated elsewhere. The inquiry has reported that the alleged failings are on a deeply shocking scale and the Essex partnership university NHS foundation trust has had to apologise for the harm caused to those affected. The director of the charity Inquest, Deborah Coles, which provides support on state-related deaths, told the inquiry that “many NHS trusts were more concerned about their reputation” than about the care that they provided for their patients. She pointed to an “overuse in restraint”, segregation and seclusion, once again especially with black patients. As we have heard, the Government are committed to driving down poor mental health, and the Bill is among the steps they are taking. I welcome the measures outlined in the Bill, particularly the involvement of patients in decision making throughout their care and the strengthening of their voice. For too long, patients have been ignored. Given some of the emerging themes from the Lampard inquiry, I also welcome the measures on increasing the scrutiny of detention to ensure that it is used only where necessary and only for as long as necessary, and on the importance of having a nominated person in place. The Secretary of State talked about prevention, and I welcome the other measures that the Government are bringing in, such as the first men’s health strategy, which will also focus on mental health. The most tragic figures are on the terrible toll of people who take their own lives as a result of poor mental health. Men are disproportionately affected by suicide—the statistics are horrifying. Of the 6,069 registered deaths caused by suicide in 2023, 75% were men. Suicide remains the leading cause of death for men under 54. These are not just statistics: real lives are being lost. Sadly, I have had personal experience of the trauma caused by male suicide and the devastating impact that it has on the family and friends who are left behind. In November, my close friend Sam, a bubbly, charismatic, well-liked and much-loved guy, with a whole future ahead of him, unexpectedly took his own life, two days before his 34th birthday. His loss is still felt by many, and there are so many unanswered questions. We must fix this system. I speak today in Sam’s memory, and in memory of everyone else who has been let down by the level of mental health support available. I never again want to receive a call to say that someone close to me has been lost in this way. We must do better, and I am hopeful that we are starting to head in the right direction.

21:15:00

I begin by offering my heartfelt thanks to everyone who has taken part in this debate and offered their professional and powerful personal experiences. I said in my maiden speech that we must never be afraid to learn from those around us, and I certainly have learned an awful lot today. I know from experience that poor mental health touches nearly every one of us at some point in our life, but despite that being a widespread experience, it remains deeply personal, and is too often isolating. That is why I wholeheartedly support this Government’s aim of transforming mental health care in this country and finally placing mental health on an equal footing with physical health. Achieving that will require significant investment in frontline services, a shift towards preventive care and a healthcare system that puts the individual needs of patients at its heart. I welcome the Government’s announcement of plans to recruit an additional 8,500 mental health staff, and the £26 million investment in new mental health crisis centres. However, even where there are the strongest frontline services, some individuals will always require more intensive, tailored support. We must do all that we can to help those people in their time of crisis. Reform of the Mental Health Act 1983 is long overdue. Sir Simon Wessely’s independent review in 2018 made it clear that we must give patients greater freedom of choice over their care and treatment, as well as more ownership of it, and involvement and engagement with it. The Bill does just that; it replaces outdated practices, through which patients were treated as passive recipients of care, with ones that treat them as active partners in their care. It introduces choice, autonomy and enhanced rights and support. Patients will be given a voice through personalised care and treatment plans, which will be placed on a statutory footing. The plans will include measurable objectives for treatment and recovery, with clear pathways towards discharge. They will be reviewed regularly, so that any changes in the patient’s condition or needs are promptly addressed. There is also the welcome use of advance choice documents, which will enable patients to record their treatment preferences in advance, so that their voice is heard even if they lose the capacity to make decisions during a crisis. Just as importantly, this Bill recognises the vital role of support networks, replacing the “nearest relative” rule with the right to choose a nominated person. That will ensure that no one faces the system alone. However, alongside that welcome increase in support, we must ensure stronger safeguards, because no one should be detained unless absolutely necessary. That is why I welcome the Bill’s move to raise the threshold for detention, and to more clearly define what constitutes a mental disorder; that will ensure that detention is always a last resort. Additionally, there are vital new protections for people with autism and learning disabilities, which so many of my hon. Friends have spoken about so eloquently. The provisions ending the use of police and prison cells as so-called places of safety is a positive step. The reform of section 136 will ensure that those in crisis receive appropriate care and are not treated like criminals. These reforms represent a meaningful change in how we support people at their most vulnerable, and will make a real difference to thousands of lives each year. People experiencing a health crisis deserve dignity, respect and far better treatment than the system provides for them. Society has made great progress in de-stigmatising mental health, and it is time that our laws reflected that. Through this Bill, we can move closer to a modern, compassionate healthcare service.

21:19:00

I echo the remarks of previous speakers; it has been a privilege to listen to the depth of personal and professional expertise expressed in this debate. I do not share that expertise, as I think will become abundantly obvious in a short moment. What do you get if you put a group of men in a room and ask them to talk about mental health? Half of them leave, and the other half run into the corners of the room. I do not know whether that rings true for the men in your life, Madam Deputy Speaker, but when I heard that, it reminded me of myself. I heard it from a chap called Graham in Norton in my constituency, rather than from Graham Norton. Graham has set up a men’s shed in Norton, which is a national scheme. It is a remarkable place where men can come together and talk about mental health, but they do so by engaging in other activities. For those who have not been to one, a men’s shed is just like your shed—it has all the great things your shed has—but your mates are there as well. In the men’s shed in Norton, you can make model boats, or make things using the 3D printer, and it has the most amazing workshop, which includes a fantastic pillar drill. It made me think that I need a pillar drill for my workshop, to help my mental health. I met many men there; some were bereaved, some were suffering from serious or terminal illnesses, and others were feeling lonely. They gave me plenty of tea, and we had a really good chat—a really positive and uplifting chat—and there was a great deal of mickey-taking as well, which you always find when you get a group of men together. That sort of facility is incredibly important for all the reasons we have heard about in discussions about men’s mental health. Not least among those, as we have heard a number of times this evening, is the fact that for men of my age, suicide is the most prevalent reason for death. We heard that from my hon. Friends the Members for Darlington (Lola McEvoy) and for Whitehaven and Workington (Josh MacAlister). In my constituency of Stockton North, men wait more than three months over the national average for treatment for mental health conditions—as do women; in fact, everyone does. Some form of talking therapy would really help with many conditions, which is why I want to take a moment to talk a bit about psychotherapy.

My hon. Friend mentioned men’s sheds. I was delighted to visit the Kirkcaldy men’s shed in my constituency recently to see the amazing work that the people there do. Listening to this debate, I have been struck by the positive changes that this Bill will bring, and by the contrast with Scotland. The people I speak to from almost every local service raise the issue of the mental health crisis across Fife, be they from the NHS, charities or the police. NHS Fife has asked for funding from the Scottish Government to sort out our mental health crisis and was told to not even ask. That is such a contrast with where we are in this place, and I am sure my hon. Friend agrees that action needs to be taken in Scotland and in Fife.

I absolutely agree with my hon. Friend. It will not be very long before voters in Scotland have the opportunity to contrast the Scottish Government with what a Labour Government deliver, and hopefully they will chose the latter. I mentioned psychotherapy. For a profession that has been around since the time of Freud, it is remarkably unregulated; there is no professional register, no form of legally enforceable complaint, and no way to ensure that someone found guilty of misconduct is stopped from practising. In fact, anyone can call themselves a therapist. In 2007, the previous Labour Government considered some form of regulation for therapists, and I encourage the Government to include such regulation in the Bill; it would be the ideal place for it. Since 2007, there has been a strong increase in private practice, and in legal cases arising from issues to do with psychotherapy. Of course, there are also online influencers. Professor Dame Til Wykes—an expert in this area—described them as “selling snake oil”. As my hon. Friend the Member for Southampton Itchen (Darren Paffey) mentioned, that is another reason why we need stronger safeguards and regulation of social media for children. Essentially, an unqualified psychotherapist could do harm, but the issue is more likely to be the missed opportunity to do good—perhaps a failure to diagnose a more serious condition or, frankly, a missed chance to save somebody’s life. Regulation is supported by the profession. Chloe, a professional, urged me to raise this issue with the Secretary of State; I am doing that now, as he is in his place. This is an opportunity to restore confidence in the profession, and for us all to pick up where the last Labour Government left off. As I say, half the men in a room will run out of it when mental health is mentioned. What is the answer to that? Graham gave me the answer: “Put a broken lawnmower in the middle of the floor. A big conversation will ensue, and two hours later, all the men will know each other’s names, and the names of each other’s families. They’ll have talked about how they are feeling and whether they are doing okay. You probably will not have a repaired lawnmower, but you will have lots of suggestions.” There is a good reason for that: men generally are not good speaking face to face, but they can speak shoulder to shoulder.

21:25:00

I am delighted to speak about this new Mental Health Bill. It follows up on the Mental Health Act 1983, which is as old as our Secretary of State, as we heard. What I have heard throughout the debate is that mental health affects us all in some way. It touches all of us, whether personally or through people we know really well. I welcome the greater protections under the Bill, especially for people with learning disabilities. I also welcome early intervention, the stress on out-of-hospital care and the idea of advance choice. People who have repeated psychoses know exactly what they want when they are well. When they become ill, they can become paranoid about their family and their friends, and they are not rational. That is one of the reasons why sometimes they need to be detained under the Mental Health Act. If they have an advance choice document, they can at least say what they would like while they are in a normal state of mind. That is important, and I look forward to that measure. I like the fact that police stations are being removed as a place of safety. I am concerned about how sections 135 and 136 of the Mental Health Act are being used. I notice that there are some schemes in which mental health workers go out with the police and work together with them, and that is crucial. A close relative of mine became extremely unwell, though it was not quite as awful as what happened to the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). First, they were sectioned in an A&E department, and then no bed could be found for 48 hours for this poor relative of mine. The heroic nurses and consultants had to look after someone who was acutely psychotic. That simply is not is not tolerable in our system. We need to find a place quickly for people who are mentally ill, and we have to make sure that they get the best treatment, so that they can get better quickly, while protecting the rest of the NHS. This close relative of mine was moved to a bed 140 miles away from her family. We must ensure that we get more sufficient beds and more local provision. I know that will take time, and that mental health provision is not in a good state, but I hope that with this legislation and our new Labour Government, we can change that, so that people do not have to travel out of area for mental health provision. I am impressed by the idea of crisis hubs. I have worked with the Stroud crisis team for many years as a GP, and I have always felt that, given a bit more strength and a bit more resource, they could keep a lot of people out of hospital and from being sectioned, but they need that resource. They also need close working with consultant psychiatrists.

One of my constituents waited more than eight hours in a mental health crisis for 111 to get back to them, in which time their mental health deteriorated. Previously, they accessed a dedicated local support line, which gave them prompt access to professional support. Does the hon. Member agree that prompt access to support in a crisis is vital to reducing the need for the greater degrees of intervention covered by this Bill?

That is certainly true, but we need to be careful, because part of the issue is the resources for mental health, rather than the Mental Health Act. We must not blur the two. The current Government are putting 8,500 mental health workers into the system, and I am delighted about that. Hopefully, it will prevent the waits for mental health assessments that people are having to put up with. I want to say something about “appropriate medical treatment” and “therapeutic benefit”, to which the Bill refers. Some 8.7 million people in this country are on antidepressants, and about 25% of those people are trying to get off them. The harm that these drugs can do includes an increased risk of suicide when people are first going on to them and when they are coming off them, as we have seen in a couple of recent, tragic cases. They can also cause fairly long-term sexual dysfunction. I am asking the Medicines and Healthcare products Regulatory Agency to put proper warnings on its leaflets, and I am also asking for a special service to help people come off antidepressants, because doing so is extremely difficult and most GPs are not particularly well informed about the best ways of doing it. It has to be done extremely slowly. My hon. Friend the Member for Whitehaven and Workington (Josh MacAlister) talked about ADHD and autism, and what should be done about neurodiversity. I feel that we should be extremely careful in mental health services not to over-medicate people with so-called neurodiversity, and I look forward to speaking to my hon. Friend about that. I had to nip out of the Chamber for half an hour earlier, to talk to the head of a neurodiversity taskforce which will report in July. What I think it needs to do is bring about a much more supportive service rather than going straight for medication, which is what seems to happen when people are referred to private psychiatric clinics. At present, the level of Ritalin-like substances with which people with ADHD are treated has increased by a factor of 500%—and, interestingly, that increase has occurred in social class 1 rather than social class 5. There is something here that we need to get a grip on: we need to provide proper services for people with ADHD. I was interested by the comment from the right hon. Member for Godalming and Ash (Sir Jeremy Hunt) about families. When it comes to mental health, families are crucial, and I would like to adapt the Bill slightly to make them much more central and responsible. The concept of a family could be extended to certain other people whom a person, when well, could nominate, but families are the crux in a lot of psychiatric care. Their input must be valued, and they must be involved. This is a very good Bill, and it is about time we had it. I support all its greater protections, and I believe that it will reduce the number of compulsory detainments.

21:32:00

I thank everyone who has taken part in the debate, from the Secretary of State onwards. It has been moving and inspiring to see the House united on the need for change. It has been particularly useful for me to benefit from the professional expertise and the personal experience of so many Members who have spoken. My hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna), the hon. Member for Runnymede and Weybridge (Dr Spencer), my hon. Friends the Members for Ashford (Sojan Joseph) and for Thurrock (Jen Craft) and the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom) have all educated and moved me with their experience and knowledge. It has long been known that the Mental Health Act 1983 is not fit for purpose, and I pay tribute to all the work that has been done so far, including the excellent review undertaken by Professor Sir Simon Wessely, commissioned by the former Member of Parliament for Maidenhead when she was Prime Minister. I know that the intent of the Bill both to strengthen the voice of patients and add statutory weight to their right to be involved in the planning for their care and to inform their choices about the treatment that they receive is strongly welcomed by Members on both sides of the House. Also welcome are the steps that the Government have taken since the election to start to transform mental health services with new funding—mentioned by the Secretary of State—and the plans to recruit 8,500 new mental health workers. Before I deal with the substance of the Bill, may I ask the Minister whether, when he winds up the debate, he will be able to provide some reassurance about the future of the patient and carer race equality framework, which I believe is vital to the achievement of equality of outcome in mental health, and which I believe would be more effective as part of the Bill than simply as guidance? I know that that is the strongly held view of many of the experts by experience who have worked on PCREF. One thing I know from my time in a previous role, when I helped to develop mental health services in Lambeth over two decades, is that a disproportionate number of people from African and Caribbean-heritage communities are detained under the Mental Health Act, as has been said by others. Figures highlighted by Mind show that rates of detention for black or black British groups are over three times those for the rest of the population. Similarly, black or black British groups are more than 10 times more likely than white groups to be subject to community treatment orders. In Lambeth, working with organisations such as Black Thrive—set up by my great former colleague Dr Jacqui Dyer, among others, to radically change mental health services in south London and elsewhere—we showed that hearing people’s voices, early intervention, reducing stigma among African-Caribbean communities, and focusing on keeping people well via work and training provided by membership organisations, such as Mosaic Clubhouse, can prevent people from becoming ill and from tragically coming into the mental health system for the first time via the criminal justice system. I welcome the changes in the Bill and the commitment from the Minister in the other place to improve data on outcomes and on patients’ experience of community treatment orders. Despite the passing of the Mental Health Units (Use of Force) Act 2018—otherwise known as Seni’s law—which was brought forward by my right hon. Friend the Member for Streatham and Croydon North (Steve Reed), the use of force in mental health settings remains too frequent, and that must be addressed as well. Prevention work and intervention to address mental health needs at the earliest possible stage are critical, because if someone faces mental health problems when they are young, it can hold them back at school, damage their potential and leave them with lifelong consequences. That is why I warmly welcome the work that the Government are doing to bring vital services into schools so that they can intervene early, support pupils and help prevent conditions from becoming severe. It is really encouraging that mental health support teams should reach 100% coverage of pupils by 2029-30—the end of this Parliament. Young people in Dartford, where I ran a well-supported engagement event last month, will absolutely welcome the introduction of Young Futures hubs in communities in England to deliver support for teenagers who are at risk of being drawn into crime or facing mental health challenges by providing open-access mental health support for children and young people in communities. I have seen that approach achieve excellent results at the Well Centre, a mental health centre run for young people in Herne Hill as part of Lambeth Together’s care partnership. I very much look forward to seeing this legislation progress through the House and become law with the support of all Members. I will support it 100% as it does so.

I call the shadow Minister.

21:37:00

A rough road is not the same as a collapsed bridge. Both slow you down, but one stops you entirely. There is a simple distinction that is often missed in the public discourse: the difference between mental wellbeing and mental health. Every one of us faces challenges that affect our mental wellbeing, such as stress, burnout and grief, but fortunately not all of us experience diagnosable mental health conditions. Recognising that nuance helps us talk more openly and responsibly about what support is needed, for whom and where. At the heart of this Bill are the most vulnerable people in our society. Tonight we have debated not how Parliament serves the powerful, but how it protects the most vulnerable while upholding freedom, how it safeguards the public without surrendering to fear, and how it balances the need for control with the imperative of compassionate care. Mental incapacity may dim a person’s ability to choose, but the law must never let it extinguish their right to matter. Reform of mental health law must recognise that protecting someone from themselves or others is not carte blanche to own their life, but simply involves borrowing the reins for a time to steer the person to recovery, and handing them back when agency is restored and they are fully equipped to chart their path once more. We have heard personal testimonies in today’s debate. The hon. Member for South Derbyshire (Samantha Niblett) talked about her mother being sectioned, the hon. Member for Bermondsey and Old Southwark (Neil Coyle) talked about his mother being sectioned for schizophrenia, the hon. Member for Winchester (Dr Chambers) talked about his friend who died of suicide, and the hon. Member for Dorking and Horley (Chris Coghlan) talked about his friend who was murdered. The hon. Member for Thurrock (Jen Craft) spoke about her personal experience with OCD and bipolar, the hon. Member for Aylesbury (Laura Kyrke-Smith) talked about her post-natal depression and the suicide of a friend, the hon. Member for Southend West and Leigh (David Burton-Sampson) talked about his friend Sam who died from suicide, and the hon. Member for Stroud (Dr Opher) spoke about his close relative who was sectioned for psychosis. It shows that this discussion has got to the top of the nation and that it is at the very heart of every part of our communities. The hon. Member for Winchester talked about the problems of suicide for the professions, particularly doctors, vets and farmers. The hon. Member for Bermondsey and Old Southwark said that he has had a ride-along three times with the police. I am pleased he is getting on so well with the police, but, more importantly, he made the very valid point that that is not a role for the police. The hon. Member for Penistone and Stocksbridge (Dr Tidball) talked about autistic people and learning difficulties, using her specialist abilities from her professional aspect as chair of the APPG. My hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), whose CV is as long as the Bill itself, talked about compassionate treatment, how to use the legislation and, most importantly, the scope of the powers, in essence because of the need to be precise when using such powers. The hon. Member for Rochester and Strood (Lauren Edwards) talked about the importance of support for learning disabilities and autism. It is really important that this is about community, given that last week was Mental Health Awareness Week, for which the theme was community. The hon. Member for Dorking and Horley spoke passionately about Fiona’s campaign for Christopher’s case, and we will look closely at that amendment in Committee. The hon. Member for Sittingbourne and Sheppey (Kevin McKenna) is a nurse who also brings his professional experience to this House. He and I both came into this House to try to change the NHS, and while we chose different sides, there is clearly passion there. My hon. Friend the Member for Farnham and Bordon (Gregory Stafford) talked about his experience of improving the system and policies to improve mental health care. The hon. Member for Thurrock—a member of the Health Committee, as I was—talked passionately about OCD and bipolar, and how important it is to show that people can achieve whatever they put their mind to, no matter how high the barriers in front of them. The hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom) told a passionate and moving tale about Declan, and the tragic story, which really helped bring to life what can, unfortunately, go on in this country. The hon. Member for Whitehaven and Workington (Josh MacAlister) spoke about the higher level of suicide in his area, and the importance of making sure that that is identified. The hon. Member for Dewsbury and Batley (Iqbal Mohamed) talked about the racial discrepancies, which is really important. The key thing is evidence of why that is happening, and to make the legislation effective off the back of that. The hon. Member for Ashford (Sojan Joseph) talked, as a mental health care nurse and chair of the APPG, about personalised care, which is so important. That leads me to the hon. Member for Guildford (Zöe Franklin), who also talked about putting the patient at the centre. The hon. Member for Southampton Itchen (Darren Paffey) talked about local services such as Lighthouse and No Limits, again showing the community support, and the hon. Member for Leicester South (Shockat Adam) talked about the placement of children, at which we will be looking very closely in Committee. The hon. Member for Mid Cheshire (Andrew Cooper) pointed out the impact that social media can have on young people’s minds. The mental wellbeing of this House would not be the same without hearing the dulcet tones of the hon. Member for Strangford (Jim Shannon) from the back Bench. The hon. Member for Blackpool South (Chris Webb) talked about the mental health charities that he has seen at first hand and about how people suffer. The hon. Member for Aylesbury rightly shone a spotlight on maternal health, which often gets missed in this conversation. The hon. Member for Southend West and Leigh talked about men’s mental health—a passion of mine—and he was right to point to the men’s mental health strategy that the Government are bringing forward, and in which I encourage everyone to take part. The hon. Member for Worsley and Eccles (Michael Wheeler) rightly talked about learning from others, and we have definitely done that in this debate. The hon. Member for Stockton North (Chris McDonald) talked specifically about the men’s shed, and I look forward to seeing his campaign on Labour for lawn mowers in its next manifesto. The hon. Member for Stroud and I have both seen more than a handful of patients with mental health issues in our time, and I love his idea, which I hope will be brought forward, about having management plans already decided by the patient, so that when they are in crisis, that has already been dealt with. Last but not least, the hon. Member for Dartford (Jim Dickson) talked about the accumulative attention across this House that has led us here today, which is really important. We heard that the first mental health Act was introduced in 1959, but I am shocked—not once, but twice—to find I am the same age as the Mental Health Act 1983 and that I share the same year as the Health Secretary. In 2007, the previous Labour Government introduced community treatment orders and independent mental health advocates, all aiming to increase the support for people at risk of being detained and allowing patients who have been detained to be discharged to communities if certain conditions allowed. However, valid concerns were raised, and Members on both sides of the House have agreed that more needs to change. I am pleased that the Bill builds on the work of the previous Government, who made significant strides in addressing the long-standing disparity between physical and mental health. As has been mentioned, former Prime Minister Baroness May commissioned the independent Wessely review into the 1983 Act. I, too, pay tribute to their work in this journey. His report built on the principles of choice and autonomy, least restriction, therapeutic benefit, and people as individuals. The Conservative Government worked to create a draft Bill, which as we heard underwent significant scrutiny—we even have Members here who were part of it—recognising the need to get it right. Much of the Wessely report’s recommendations are here in front of us tonight, built around advance choice documents, improving advocacy, reform of community treatment orders, and changes around autism and learning disabilities, to name some of the 150 recommendations. On behalf of His Majesty’s official Opposition, I am pleased to stand here today and say that we support the principles behind the Bill. We will work constructively with the Government to scrutinise and improve it in Committee, and ensure that we pass good legislation that will do what is intended. The Minister understands that progress in principle must become progress in practice, so I would like to jog his memory about some of the questions asked by my right hon. Friend the Member for Melton and Syston (Edward Argar). Does the Minister believe there are enough treatment facilities, particularly in the community? Are there adequate places of safety for people being detained once police and prison cells are removed? Does the mental health tribunal system have capacity to deal with more cases? And what will happen following the abolition of NHS England, which commissions specialist mental health services? Does he believe in hitting the mental health investment standard? Will he commit to doing so going forward? To that end, will he set out a timetable for this House, the services and the public to all work towards, to be held account to? There is little greater moral burden than deciding for someone who cannot decide for themselves where care ends and control begins. Make no mistake, this is what this House is grappling with tonight and throughout the passage of the Bill. Involuntary care should never be the first instinct or answer, but a resort to prevent harm to both the individual and those around them. Compassionate care, therefore, demands precision. Without precision, we simply have sentiment. As His Majesty’s Opposition, we will endeavour to ensure that the Government’s sentiment becomes a commitment.

21:47:00

It was truly a privilege to be in the Chamber this evening to hear so many moving, powerful and thoughtful contributions. It really was Parliament at its best, and it is an honour for me to close the debate. The Bill has been a long time coming. Patients, practitioners, campaigners and charities have all long awaited the introduction of this legislation and have played a hugely important role in getting the Bill to this point. I would like to put on record my thanks on behalf of the Government and pay testament to their commitment to change. I thank Members in both this House and the other place, including our brilliant and esteemed colleague Baroness Merron, for all their work. As the Bill started in the other place, it has already been through extensive detailed scrutiny under the eyes of peers, many of whom were there when the Act was last revisited in 2007—I am sure they will enjoy me reminding them of that. It is testament to the cross-party consensus that has so far underpinned the Bill that the debates were constructive and largely led to the betterment of the Bill. I trust that this collegiate spirit will now continue in this House, and I thank the Opposition and the Liberal Democrats for the constructive spirit in their approach to this debate. Every speech we heard sought to improve processes and outcomes for patients and their loved ones, and there is broad cross-party support for the overall ambitions of the Bill. However, some specific issues and queries were raised in the course of the debate that need addressing. Many hon. Members asked about our implementation plans, rightly stating that legislation is only as good as its application. Indeed, we know that community service provision is very far from where it needs to be—an issue that we intend to address alongside the implementation of the Bill. Our first priority after Royal Assent will therefore be to draft and consult on the code of practice. It is essential that we listen both to practitioners and to those with experience of the Act when we draw up the statutory guidance.

The review of the Mental Health Act 1983 is very welcome. It started its life close to my constituency with the work of Professor Sir Simon Wessely, who drew on the experience of many residents in south-east London, particularly with regard to his work on racial inequalities. As the Minister is talking about the implementation of the Bill, I wonder whether he can reassure my constituents, who want to know that this Bill will do the job of eliminating racial inequality from mental health services, by committing to putting the patient and carer race equality framework on the face of the Bill.

We are already working to reduce inequalities under the Mental Health Act. The patient and carer race equality framework is now a contractual requirement for all providers of NHS-commissioned care. It will support trusts to improve their interaction with racialised and culturally diverse communities and improve governance, accountability and leadership on improving experience of care for those communities and drive concrete actions to reduce racial inequalities within mental health services. Given that our first priority after Royal Assent will be to draft and consult on the code of practice, it is essential that we listen both to practitioners and to those with experience of the Act when drawing up the statutory guidance that supports the Act’s application. We will therefore engage with people with lived experience, their families and carers, staff and professional groups, commissioners, providers and others to do this. The code will be laid before Parliament before final publication. Alongside the code, we will develop secondary legislation that will be laid before Parliament, subject to the parliamentary process as set out in the legislation. We have already published policy papers that set out more information on some of the delegated powers in the Bill and provide an early indication of what we intend to set out in regulations. We recognise the appetite to deliver after years of delay and the importance of parliamentary scrutiny and accountability in this crucial work. We have therefore committed to laying an annual written ministerial statement on progress, so that hon. Members will have ample opportunity to hold us to account for progress made and milestones achieved. We have covered a wide range of topics and questions this evening, and I will not be able to cover all of them in the time allocated to me. I will therefore limit my comments to two areas that have come up repeatedly, namely the implementation plan and the treatment of people with autism and learning disabilities.

I thank the Minister for giving way. He is talking, rightly, about the importance of the implementation of legislation. He will be aware that new measures came into force two months ago under the Online Safety Act 2023, which introduced legal powers to remove online content that promotes suicide. Ahead of this, I wrote to Ofcom about a platform that is actively promoting suicide and suicidal ideation, and has been linked to the deaths of almost 100 young people and adults. The Ofcom chief executive replied to say that Ofcom was opening an investigation. Does the Minister agree that it needs to get on and remove this kind of content across the UK?

Of course, we have the Online Safety Act, and there are measures within that legislation that address this issue. However, my hon. Friend is absolutely right that it is time to crack on and deal with this deeply troubling issue. I pay tribute to her excellent work, and I hope she will continue to press Ofcom to do the right thing, and to do it rapidly. We know that implementation will take time, as the pre-legislative scrutiny Committee recognised. We estimate that it will take around 10 years to fully implement all Bill’s measures, due largely to the time needed to train specialised workforce groups, including second opinion appointed doctors and tribunal judges, and the need to ensure that the right community support is available for people with a learning disability and autistic people. This timeframe necessarily spans multiple spending reviews and multiple Parliaments, so I am limited in the detail I can give today about future spend and timelines. However, we have set out in the impact assessment what we think is required in both time and funding. We expect the process of drafting and consulting on the code of practice to take at least a year. Alongside the code, we will develop secondary legislation, which will be laid before Parliament. We have already published policy papers, which contain more information on some of the delegated powers in the Bill and provide an early indication of what will be set out in regulations. We will then need time to train the existing workforce on the new Act, regulations and code, which will likely be in 2026 and 2027. Although we will commence some clauses, such as on supervised discharge, two months after Royal Assent, the first major reforms, including clauses concerning grounds for detention—excluding the changes to part 2 for people with learning disability and autistic people—and nominated persons, are expected to follow the training in mid-2027. The timelines for later phases are inevitably less defined, but we will expand the workforce and improve community support with the aim of implementing the reforms increasing the frequency of mental health tribunals from 2030-31. These timelines are indicative, and we will iterate the plans as we get more certainty on future funding and wider workforce plans. The other issue that came up a lot is the treatment of people with autism and learning disabilities. Again, implementation should be well planned to ensure that the proposed legislative changes have the intended effect. The proposed changes to the detention criteria will be commenced only when strong community services are in place so that the alternatives to hospital care are robust. Members will understand that robust implementation plans are dependent on the final legislation that is passed and on future funding, which is subject to future spending reviews. However, local systems do not need to wait for legislative changes to come into force to begin putting in place the necessary community services for people with a learning disability and autistic people. There is renewed funding in 2025-26 within ICB baselines to continue improving community support provision for people with a learning disability and autistic people. We should recognise that the Bill is the result of the independent review commissioned by the now Baroness May of Maidenhead during her premiership. Many important contributions have also come from those with lived experience of the Act and their loved ones. It takes real courage to speak openly about those experiences and to channel pain into change. As my right hon. Friend the Health Secretary said in his opening speech, the Government have demonstrated their commitment to funding mental health properly, and that commitment has been translated into real, tangible delivery: the £150 million multi-year capital investment to improve mental health urgent and emergency care pathways; 600 new or expanded crisis alternative services nationally, including crisis cafés, safe havens and crisis houses, providing an alternative to A&E or psychiatric admission; £26 million in capital investment to open new mental health crisis assessment centres, which aim to provide accessible and responsive care for individuals in mental health crisis; and 8,500 more mental health workers. We are also committed to improving early intervention and shifting care to the community to support people to live well and thrive. We have committed to improve support for young people, with Young Futures hubs, making support workers more accessible to children. We are piloting in England the 24/7 neighbourhood mental health centre model, which builds on learning from international exemplars. It is a privilege to be leading this transformational legislation through the House. I know that, because it matters so much, many people will have views on what is needed to get it right, and I look forward to further debates in that constructive and improving spirit. I commend the Bill to the House. Question put and agreed to. Bill accordingly read a Second time. Mental Health Bill [Lords] (Programme) Motion made, and Question put forthwith (Standing Order No. 83A(7)), That the following provisions shall apply to the Mental Health Bill [Lords]: Committal (1) The Bill shall be committed to a Public Bill Committee. Proceedings in Public Bill Committee (2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 26 June 2025. (3)The Public Bill Committee shall have leave to sit twice on the first day on which it meets. Consideration and Third Reading (4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced. (5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day. (6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading. Other proceedings (7) Any other proceedings on the Bill may be programmed.—(Anna Turley.) Question agreed to. Mental Health Bill [Lords] (Money) King’s recommendation signified. Motion made, and Question put forthwith (Standing Order No. 52(1)(a)), That, for the purposes of any Act resulting from the Mental Health Bill [Lords], it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.—(Anna Turley.) Question agreed to.