Mental Health Bill [Lords] Debate
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Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [Lords]
Danny Chambers ExcerptsMonday 19th May 2025
(1 month ago)
Commons ChamberRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: HL Bill 93 Running list of amendments – 14 April 2025 - (14 Apr 2025)
Dr Danny Chambers (Winchester) (LD)
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.
Sarah Dyke (Glastonbury and Somerton) (LD)
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?
Dr Chambers
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.
Freddie van Mierlo (Henley and Thame) (LD)
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?
Dr Chambers
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.
Victoria Collins (Harpenden and Berkhamsted) (LD)
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?
Dr Chambers
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.
Chris Coghlan (Dorking and Horley) (LD)
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?
Dr Chambers
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.
Edward Morello (West Dorset) (LD)
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.
Dr Chambers
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.
Mental Health Bill [ Lords ] (First sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [ Lords ] (First sitting)
Danny Chambers ExcerptsTuesday 10th June 2025
(1 week, 5 days ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 10 June 2025 - (10 Jun 2025)
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship, Mr Vickers.
I thank the many hon. Members who spoke on Second Reading. It is clear that in this place, as in the other place, the Bill will proceed in a collaborative and constructive spirit, with the single motivation of getting the reforms right. On Second Reading, we heard numerous powerful accounts from hon. Members arising from their personal experience of supporting family, friends or constituents with a serious mental illness, a learning disability or neurodiversity, or drawing on their own experiences to underscore the importance of the need for reform. I was heartened to hear from so many Members who set out the positive impact of the changes that the Bill will introduce, particularly the vital changes to ensure that patients’ voices are heard and that—as we would expect in any modern mental health service—the patient is at the heart of all decision making.
In our manifesto, we committed to modernising the Mental Health Act 1983 to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout their treatment. I am proud that we included this critical Bill in our first King’s Speech, and I look forward to constructive engagement with the Committee on this important legislation.
I will also take a moment to thank the Liberal Democrat Member, the name of whose constituency escapes me, and other MPs who have shone a light on the experiences of Fiona Laskaris and other families. No one should lose a child in that way. I thank Fiona for meeting me and I commend her tireless campaign efforts. The engagement that my officials and I have had with Fiona and the hon. Member has been incredibly valuable. Unfortunately, the Bill is not the appropriate vehicle to address those concerns, but I have committed to continuing engagement with Fiona and the hon. Member to further explore those issues and how we might tackle them.
Dr Danny Chambers (Winchester) (LD)
I know that my hon. Friend the Member for Dorking and Horley (Chris Coghlan) has been pushing forward on that very emotive and difficult issue of capacity; he brought it up in his maiden speech and has been campaigning tirelessly on it. My hon. Friend said that the Minister was very constructive in his engagement on the issue, which we very much appreciate. Even though we cannot include it in the Bill, we look forward to working on it.
Stephen Kinnock
I do not know whether I will be able to answer the hon. Gentleman’s question in its entirety, because quite a lot of that is being led by my colleagues in the Ministry of Housing, Communities and Local Government—in the English devolution Bill, for example. On the part of his question relating to the Department of Health and Social Care, we came to the view following the general election last year that NHS England was an unnecessary layer of bureaucracy. We think it is important that there is a clear line of accountability from the Secretary of State to Ministers, to ICBs, to trusts and to the system per se for delivery. That line of accountability was being blurred by NHS England, which is why we have removed it from the equation.
The hon. Gentleman is right that there are a lot of moving parts, but, by definition, a reform agenda creates change and some turbulence. We believe that is the only way we will get the system to where we need it to be so that we can deliver the three big shifts in our 10-year health plan: the shifts from hospital to community, from sickness to prevention and from analogue to digital. Many of the questions he is asking will be answered in the 10-year plan. He does not have long to wait for that to be published; it is coming very soon.
I reiterate that the principle underlying all of this is about empowering, devolving and giving agency to those closest to the communities they serve, because they are best placed to deliver. That all has to fit into the Bill, but the fundamental principle underpinning the Bill is the right one: it is about devolution, and about being patient-centric. The Bill deals with a cohort of people whose needs should drive the services that we design and deliver.
Question put and agreed to.
Clause 3 accordingly ordered to stand part of the Bill.
Schedule 1 agreed to.
Clause 4
People with autism or learning disability
Dr Chambers
I beg to move amendment 1, in clause 4, page 4, line 41, at end insert—
“(iv) housing.”
This amendment ensures that housing needs are considered as part of care, education and treatment review meetings.
The Chair
With this it will be convenient to discuss the following:
Amendment 51, in clause 4, page 4, line 41, at end insert—
“(iv) accommodation and relocation, and”.
This amendment ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities.
Amendment 2, in clause 4, page 5, line 23, at end insert—
“(v) the patient,
(vi) the patient’s nominated person, and
(vii) the patient’s independent mental health advocate.”
This amendment would ensure that nominated persons and independent mental health advocates receive copy of a care, education, and treatment review meeting report for children and young people with autism or a learning disability.
Amendment 3, in clause 4, page 5, line 31, for “12” substitute “six”.
This amendment would shorten the length between care and treatment reviews from 12 months to six months.
Amendment 4, in clause 4, page 7, line 6, at end insert—
“(iii) housing, and”.
This amendment ensures that housing needs are considered as part of care and treatment review meetings.
Amendment 5, in clause 4, page 7, line 32, at end insert—
“(v) the patient,
(vi) the patient’s nominated person, and
(vii) the patient’s independent mental health advocate.”
This amendment ensures that nominated persons and independent mental health advocates receive a copy of a care and treatment review meeting report.
Amendment 6, in clause 4, page 7, line 40, for “12” substitute “six”.
This amendment would shorten the length between care and treatment reviews from 12 months to six months.
Amendment 7, in clause 4, page 8, line 12, leave out “must have regard to” and insert
“have a duty to carry out”.
This amendment ensures that integrated care boards and local authorities responsible for a patient's treatment and care have a duty to implement recommendations arising from a care and treatment review.
Dr Chambers
It is an honour to serve under your chairmanship, Mr Vickers. I will speak to amendments 1, 51 and 4 together, as they all relate to housing. Amendment 1 ensures that housing needs are considered as part of care, education and treatment reviews. Amendment 51 ensures that the impact of accommodation and relocation is considered in care and treatment reviews for patients with autism or learning disabilities. Amendment 4 ensures that housing needs are considered as part of care and treatment reviews.
Appropriate housing is critical for people’s wellbeing and cannot be viewed as separate from effective and safe care. Ensuring that housing or any temporary or crisis accommodation supports the safety and independence of people with a learning disability should be a key part of care, education and treatment reviews. We believe that it is essential for fulfilling the duties of the Bill.
Without that provision, it will be far harder for patients to leave detention and for care to be facilitated in the community. If people with learning disabilities who are detained risk being discharged into insecure or inappropriate housing, their recovery from mental ill health could be jeopardised. Patients should be viewed in their whole context, not just as a collection of conditions or symptoms. Housing is among the most fundamental social needs that should be considered.
Zöe Franklin (Guildford) (LD)
I rise to speak to amendments 2 and 5, which, in summary, would ensure that patients, named persons and independent mental health advocates would receive a copy of a care, education and treatment review meeting report for children and young people with autism or a learning disability.
Patients, along with all those tasked with helping to represent their wishes, should be able to see transparently what has been judged to be safe and appropriate care for them. Being given the opportunity to understand why their care or treatment is changing or remaining the same should be a basic right for patients, yet as it stands they are often frozen out of seeing that final report. Similarly, the nominated person, whether that is a friend, a mother, a sibling, or another parent, often has care of the patient; they know the whole person better than any NHS institution, and will often have a far fuller understanding of the patient’s history.
Mental Health Bill [ Lords ] (Second sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [ Lords ] (Second sitting)
Danny Chambers ExcerptsTuesday 10th June 2025
(1 week, 5 days ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 10 June 2025 - (10 Jun 2025)
Stephen Kinnock
I see where the shadow Minister and the amendments are coming from, but there is a risk of over-embroidering the Bill if we try to load additional duties on to something that we believe is already happening. It is a very well-established duty that clinicians, integrated care boards and other public bodies are used to applying, and this already exists within the Act. I think there is an element here of “If it ain’t broke, don’t fix it.”
If there is compelling evidence that it is not working, clearly we need to intervene as a system, which is about real leadership at the ICB level. As things stand, we feel that this amendment is surplus to requirements for the reasons I have set out. I thank the hon. Members for Winchester and for Guildford for this exchange of views, and I hope that they are content to withdraw amendment 1.
Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairpersonship, Ms Furniss. I know that the hon. Member for Farnham and Bordon will have spent his lunch time anticipating the responses to his long series of questions. The tension is palpable— I hope he is excited to hear our replies.
Dr Chambers
Unfortunately, I was busy meeting Brian May and talking about farming, so I have not had a chance to work up a really good response.
The point of the Liberal Democrat amendments is to recognise that mental ill health requires holistic care and that many non-clinical factors directly influence mental health. Although the Bill’s scope is understandably narrow, very much focusing on people once they are admitted to hospital for treatment, we need to recognise that, if someone is discharged back into the situation from which they were admitted, they are very likely to have a relapse and to need treatment again. Some of those factors are non-clinical. For example, people living in poverty—those in the lowest 20% of income—are more than twice as likely to suffer mental health issues than those on an average income.
We strongly support the Bill, but we need to recognise that, on its own, it will not improve mental health or do anything to prevent people from developing mental health issues. If our amendments are not within scope or are not appropriate for the Bill, we urge the Minister to work with other Departments, such as the Ministry of Housing, Communities and Local Government, to ensure that this good piece of legislation, which we support, can be successful.
The hon. Member for Farnham and Bordon made a point this morning about local authorities. He is right that local authority reorganisation is a challenge, especially when it comes to providing accommodation for young people and for people being discharged from mental health care centres. It is also an opportunity, because the current situation is not fit for purpose. Hampshire county council is struggling to provide the care these people need. Housing, which often affects young people’s mental health, is probably the single biggest issue that comes up in my inbox and when I knock on doors.
I thank the hon. Member for Hinckley and Bosworth. As a clinician, his point about the evidence base, especially when it comes to reviews, is really important. We are discussing a Mental Health Bill that may not be changed significantly for another 40 years, so it is important that we use the best evidence. As a long-time trustee of an evidence-based medicine charity, I am passionate about this.
I thank the hon. Member for Thurrock for pointing out that clinical guidelines suggest six-month reviews. Yearly reviews are used for many medical conditions, and I would argue that a year is also an arbitrary period, rather than one based in evidence. Why six months and not a year, or why a year and not six months?
Dr Evans
The hon. Member is correct to establish the evidence base and the guidance. Broadly, we need to balance that with the logistics and the impact on the clinician, the patient and the resources. Move too far one way and it becomes a tick-box exercise or more resource-heavy; move too far the other way and the safeguards that we are trying to implement are lost or watered down.
When I look at the amendments, that is the balance I am trying to understand; if the guidelines are written with that in mind, that makes sense. The job of this House is to scrutinise the numbers and decide whether we agree that they are right, or whether we should push a bit harder—whether we should tighten the safeguards or relax them a little to allow clinicians more freedom of choice.
I guess that is the purpose of the Bill—getting the right boundary between the safety of the individual patient, support for the wider public, and making sure that clinicians have the freedom to make their judgment so that we are not stepping on expert opinion or, worse, creating bureaucratic processes. I hope the hon. Member understands that is why we are probing further on the rationale.
Dr Chambers
I completely agree with everything the hon. Member just said. Atul Gawande did a fantastic piece of work on checklists that emphasised the need for them not to become tick boxes. They are meant to involve active thinking and decision making.
I thank the Minister for reassuring us about housing. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Dr Chambers
I beg to move amendment 8, in clause 4, page 8, line 27, at end insert—
“(ba) the person is under 18 years old and satisfies the conditions in (b)(ii).”
This amendment inserts a new subsection that extends the duty on integrated care boards to establish and maintain a register for those at risk of detention to all children and young people under the age of 18.
The Chair
With this it will be convenient to discuss the following:
Amendment 47, in clause 4, page 9, line 20, at end insert—
“(6) The risk factors specified in regulations under subsection (5) must include—
(a) homelessness;
(b) addiction;
(c) domestic abuse;
(d) miscarriage and traumatic birth;
(e) experience of armed conflict; and
(f) bereavement.”
This amendment would specify risk factors for detention for people on the register of people at risk of detention under Clause 4.
Amendment 9, in clause 4, page 9, line 29, at end insert—
“(c) seek to ensure that the needs of children and young people can be met without detaining them under Part 2 of this Act.”
This amendment extends the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.
Dr Chambers
Amendments 8 and 9 would insert a new subsection to extend to all children and young people under the age of 18 the duty on integrated care boards to establish and maintain a register of those at risk of detention. Amendment 9 would extend the duty on integrated care boards and local authorities to exercise their marketing functions in a way that seeks to ensure that children and young people’s needs can be met without detaining them.
Far too many children are unable to access the mental health care they need, leaving them more vulnerable to experiencing a mental health crisis that then requires detention, which all too often ends in tragedy. Child and adolescent mental health services are in a state of near collapse, with many children unable to access the care and treatment they need until their mental ill health has reached the point of crisis. Waiting 15 months in great mental distress is far too long, especially for children. It is a huge disruption not only to their personal development but to their education. Waiting up to two years for treatment is a huge proportion of a 12-year- old’s life.
We are pleased that the Bill, as it currently stands, includes specific provisions to prevent people with learning disabilities from requiring detention under the Act. The Government should take that approach for more people, especially our young people. Early intervention, delivered through regular check-ups and cutting waiting times for treatment by community services, is critical. We should not pretend that acute mental health services and in-patient care exist in a vacuum. The pressures they face are directly impacted by the quality of community services. We need stronger steps to ensure that fewer people require detention in the first place, especially children.
We are pleased that the Government are taking steps towards having mental health support in every school, for which we have long campaigned. We would like them to go further by ensuring a dedicated professional in every school. We are alarmed that the targets for mental health are being dropped, so I press the Government for assurances that the upcoming 10-year plan will ensure that children who are referred can expect swift and efficient support and treatment, with binding duties on health bodies to deliver that.
Alongside this Bill, what requirements and resources will ICBs have for preventing mental health crises? As part of that, will the Department make specific changes to CAMHS?
Dr Evans
The hon. Gentleman makes a pertinent point about the pressure on CAMHS. In Leicestershire, about 45% of CAMHS referrals are for things like autism and ADHD, and the problem is that it takes a lot of services away from those who have eating disorders or depression, or who self-harm. Does he believe there is scope to reorganise services to make sure they are appropriate where there needs to be treatment? A child suffering with severe anxiety and self-harming tendencies should not be on a pathway with someone who has autism, for example. Has he given any thought to how this Bill might be a way of opening that door?
Dr Chambers
On the surface, what the shadow Minister says seems logical and makes sense. I am not a mental health clinician, so I want to be really careful about pushing in one direction. Whether someone has an eating disorder or is waiting for a diagnosis of something like ADHD, the waiting times are too long. We must better structure a system that ensures that everyone gets healthcare when they need it, rather than prioritising what we perceive as most important.
One of the most heartbreaking things that I hear from parents in Winchester, who are worried sick, is that young teenagers with an eating disorder have been told that they have to hit a lower BMI to reach the threshold to qualify for treatment. That is essentially saying that someone has to be sicker for longer. No one would ever say, “We’ll wait until your cancer reaches stage 4 before we start treatment,” but that is happening with eating disorders. The treatment will end up being longer, more complicated, more costly for the taxpayer and maybe less successful.
A question often comes up—the hon. Member for Farnham and Bordon alluded to this—about the pressures on local authorities to deliver mental health care. Actually, the question is “How we can afford not to deliver it?” People with mental health disorders are ending up in A&E or prison and costing police time. It costs £52,000 a year to keep someone in prison, yet apparently we cannot afford to give them the community interventions that might stop them going there in the first place.
David Burton-Sampson (Southend West and Leigh) (Lab)
The Labour Government are working on a range of early interventions for young people in the area of mental health and to stop them spiralling into crime, such as the Young Futures hubs and introducing mental health support in every single school. The hon. Gentleman makes a valid point, but it sits outside the Bill, and there is plenty that the Government are doing. Regrettably, there will always be a need, at certain times, for a young person to be under a section 2 notice and to be brought into care for a period of time, for their own safety. That is unavoidable and will be the right thing for that individual, but there is so much work being done outside this Bill to help young people and others with their mental health.
Dr Chambers
We support all efforts to keep young people happy and healthy in their communities. I visited Winchester Youth Counselling recently, where pupils can self-refer to talk through their issues. That does not involve any clinical personnel. It is hugely impactful and cost-effective and is part of the community. We support those community hubs.
Amendment 47 would specify risk factors for detention for people on the register of people at risk of detention under clause 4, including homelessness, addiction, domestic abuse, miscarriage and traumatic birth, experience of armed conflict, and bereavement. For anyone, including people with learning disabilities, life events can have a profound impact on mental ill health and can drive mental disorders. Well over a third of women with mental health problems have been a victim of domestic violence, and 50% of rough sleepers have mental health problems. The disastrous impact that bereavement can have on anxiety and depression, which are key factors in suicide, has been well documented.
It seems obvious, frustratingly, that public services do not currently reflect that key fact. There are no registers of bereaved children to ensure that they get the right support in the community and in school. There are no registers of veterans, despite their far higher risk of mental ill health and suicide. Women who have suffered a miscarriage do not receive an automatic referral, including to mental health services. The Government need to ensure that people can get mental health assessment and support at key points in their life, including the most traumatic moments.
Dr Chambers
I do not know the best place for it to be held. That is an important point. For a lot of the issues that Members are bringing up, we are not expecting there to be answers today. However, we want to ensure that they are all being considered, given that the subject might not return to Parliament for another 40 years.
Jen Craft (Thurrock) (Lab)
I have a question about the list of risk factors that has been provided. Is there not a concern that it might be too prescriptive or restrictive, and that putting it in primary legislation prevents local authorities or ICBs from widening it, from having registers and risk factors that might be appropriate to their areas, and from focusing on what the appropriate level of care is that they are best placed to meet?
Dr Chambers
That is a very insightful point. The list could be longer and is not meant to be exclusive. I am not sure of the answer to the hon. Lady’s question but, taking a step back, we know that the single most common cause of death in women 12 months after giving birth is suicide, and there is no proactive automatic care. If a person is addicted to alcohol, they are admitted to hospital for treatment for their physical symptoms. When they are physically well enough to go home and they are discharged, there is no automatic enrolment or follow-up in mental health care. I would not want to bring in a system, as the hon. Lady says, that ends up being too prescriptive. However, at the moment, we have one that is not prescriptive enough. I could list a handful of demographics of people who desperately need that proactive care.
Sojan Joseph (Ashford) (Lab)
The purpose of this part of the legislation is for ICBs to keep a register of anyone who is diagnosed with autism or a learning disability. Patients who are already under a clinical team already have a risk assessment, which covers all the areas that the hon. Gentleman is specifying. As a result of the amendment, would we not be duplicating information about risks that already exists for most patients with their clinical teams?
Dr Chambers
The point of having an at-risk list is that ideally there is proactive contact with people—perhaps in quite a soft way, and perhaps through community hubs, as we have discussed—before they demonstrate a severe mental health crisis. I assume that the people the hon. Gentleman is talking about have already been admitted to hospital and have received treatment, and that they are being followed up after they have been discharged. That is not a proactive list; it is a reactive register. Am I correct? I apologise if I have misunderstood his question.
Sojan Joseph
Anyone who is under the care of a clinical team for their mental health has a risk assessment. That is basic paperwork, which is completed by the clinicians. That risk assessment covers everything that is specified in the amendment. The purpose of this part of the legislation is for ICBs to have a register. However, ICBs will not be providing direct care; that will be provided by the clinicians. Those patients who are under any clinical team have a risk assessment that covers all the points in the amendment. My point is that the amendment would duplicate some of that paperwork.
Dr Chambers
I will not argue with an esteemed Member who has the hon. Gentleman’s background in mental health. I take his point as it stands.
Gregory Stafford
I have been listening carefully to the hon. Member’s argument. I do not disagree with anything in it; I just fail to see how the amendment fits with the clause that we are discussing, which I think may be the point that the hon. Member for Ashford is making.
As far as I can tell, clause 4 is about producing a register of people who have a learning disability or autism, who are at risk of being detained for a mental health episode and for whom those risk factors are active, for example because they have been sectioned before or have presented at A&E. Those are specific incidences. What the hon. Member for Winchester is talking about is more wide-ranging; it is not about touchpoints in the same sense. I can see how he could potentially say, “Well, domestic abuse has led to a mental health episode and therefore to a presentation at A&E or in the system.” However, if we put in societal factors, for want of a better phrase, we could end up putting most people on the list, because most people will have experienced a bereavement. I get what the hon. Member is trying to do, but I fail to see how the amendment matches the overall purpose of clause 4.
Dr Chambers
I thank the hon. Member for his intervention. In my maiden speech, I focused primarily on mental health and on the fact that there are so many demographics of people who we know are at significantly higher risk of suicide and mental ill health than the general population. Whether the issue is more appropriately addressed in the Bill or outside it, but using the Bill as a mechanism to highlight it and to cause the proactive engagement of other relevant Departments and other pieces of legislation, I am determined that we are not going to discuss the biggest piece of mental health legislation in 40 years and not even have a discussion about how we proactively engage with groups of people who we know are at very high risk of mental health issues.
Dr Chambers
I will carry on, if that is okay.
Our social and health services need to see the whole person, including their social needs and the factors in their environment that threaten their wellbeing. Trying to treat a mental disorder but failing to account for that person’s lack of housing, which drove their anxiety and depression in the first place, is doomed to fail. A lack of support for a child who has lost their parents at a young age could lead to significant harmful consequences further down the line.
There are a huge range of areas that require change, but for now we would like to press the Minister on three specific issues. We understand that some of them may turn out not to be within the scope of this Bill, but it is still important that they be addressed in some capacity.
Will the Government finally implement a register of all bereaved children to ensure that they get the support they need? Will the Government ensure that all women who go through miscarriage, stillbirth or traumatic birth access mental health support quickly and effectively? Will the Government establish a veterans register to ensure that those who have served in the armed forces and who face particular challenges as a result get the tailored mental health support that they need and do not reach the point of requiring detention?
The Chair
I need to remind the hon. Member that issues that are not within the scope of the Bill are not within the scope of the debate—but we have let you get away with it this time.
Stephen Kinnock
The hon. Member makes an interesting point. I am certainly happy to discuss that with officials, just as long as everybody is clear that there are two very different things going on here, with different types of risk and therefore different agencies. But I am all in favour of joined-up government wherever we can deliver it.
I turn now to amendment 47. It is important that robust measures are in place to support people with a learning disability and autistic people who are at risk of admission. That is why the Bill will, for the first time, put dynamic support registers on a statutory footing and, via regulations, set out the factors that the Secretary of State considers increase the probability of someone being detained. That is the most appropriate approach in order to provide sufficient flexibility for updates in line with emerging best practice, evidence and clinical and commissioner understanding.
As the factors are likely to be updated regularly, returning them to Parliament at every such instance would be disproportionate and unmanageable. Additionally, although putting them in primary legislation would not prevent the Secretary of State from providing and updating a longer list in regulations, having some factors but not others in the Bill could be perceived to give them primacy—for example, having a history of in-patient admissions or presenting in A&E in crisis. That could have unintended consequences and divert support from those most at risk.
We will of course engage with expert stakeholders, who are best placed to advise on what the list of risk factors for detention should be, taking into account the existing NHS England policy on dynamic support registers. I am pleased to provide assurance to the Committee that current NHS England policy provides examples of factors such as those in the amendment—for example, having no fixed address, having drug and alcohol addiction and having had significant life events such as bereavement and abuse. For those reasons, I hope the hon. Member for Winchester will not press his amendments.
Dr Chambers
I know how much the hon. Member for Farnham and Bordon enjoys speaking in Bill Committees—we were on the Tobacco and Vapes Bill Committee together a few months ago—and I am really pleased that our amendments have given so much material for discussion. I really appreciate the input from Members on both sides of the Committee; it has been really insightful, useful and constructive.
It has been rightly pointed out that the current state of local authorities—their funding and their capacity—means that they might not be able to deliver the more holistic care we are pushing for in the amendments, but I do not think that the Mental Health Bill should be limited by the current state of local services and funding. If that is the underlying problem, that is what should be addressed, not the measures in the Bill.
Gregory Stafford
I accept that we should aim for the pinnacle and the best. What I was trying to say was that because the amendments restrict us, rather than giving us the space to, hopefully, reach the pinnacle, or to explore other options if we cannot, they could have unintended consequences if we cannot reach that pinnacle.
Anna Dixon
The hon. Gentleman may want to take these points together. We drew attention to proposed new section 125. Subsection (1) relates to integrated care boards, while subsection (2) relates to local authorities. They do exactly what he wants: strengthen the requirements on ICBs and local authorities to better meet the needs of people with autism or learning disabilities in order to avoid detention. The very essence of the Bill therefore provides the duties that the Minister reassured us on in response to my earlier point. The expectation is that commissioners will meet needs as identified in these dynamic registers.
Dr Chambers
I thank both hon. Members for their input and their valid points. We appreciate the Minister addressing these concerns. We will not press amendment 9 or 47, but we would like to vote on amendment 8.
Question put, That the amendment be made.
Stephen Kinnock
I think the short answer to my hon. Friend’s question is yes. The written ministerial statement will be an update on the work done over the preceding 12 months, but it absolutely will also be a forward plan, so it will set out the next actions that the Government will take, what the broader, long-term change delivery process will be, the institutions that will need to change and how they will change.
A number of colleagues have also asked the question, “What does good look like?” In many ways, it is absolutely right that we, as a Government, are being held to account on the content of the Bill, but there will be a really important accountability moment 12 months after it gets Royal Assent, which will be that written ministerial statement. I fully expect every colleague in this room to read that in great detail and hold the Government to account, both on what has been achieved over the preceding 12 months and, importantly, on what the forward plan looks like.
I think that covers most of what I wanted to say, although one additional point I would make is that the amendments could have the unintended consequence of requiring Government and local areas to set out unfunded or speculative plans ahead of any funding settlements, which would affect their credibility. It is more effective to set out plans when they are ready, when we have a clear line of sight on funding and deliverability.
We also need time to engage with expert stakeholders to inform implementation planning. We know that sufficient community services cannot be achieved without wider system reforms beyond health, and details contained in any plan must also consider the context of the 10-year health plan and the independent commission into adult social care, chaired by Baroness Casey. For that reason, I thank hon. Members for their contributions and invite them to withdraw amendment 20 and not to press amendments 24, 10, 22, 21 and new clause 11.
Dr Chambers
I thank everyone for all their insights into our amendments; they were very useful and constructive. I will address a couple of them briefly.
First, I thank the hon. Member for Ashford; we totally agree that we want to be moving mental health care—any care, actually, but mental health care specifically—back into the community and have more community care. We are not advocating for more hospital care. There is a specific point to amendment 20: my hon. Friend the Member for St Neots and Mid Cambridgeshire, who is in the Public Gallery, had a tragic case of a constituent, which resulted from there not being enough available safe places for someone in crisis to be cared for.
A lot of our amendments have rightly been criticised for possibly being outside the scope of the Bill, because this Bill is for when people are in a mental health crisis, and a lot of our amendments are about how we can improve community care. To me, amendment 20 appears to be very in scope, because it addresses a failure of someone who was admitted for mental health care.
I thought that the insightful comments on most of our amendments from the hon. Member for Solihull West and Shirley, given his legal and medical background, were very useful, and we will take those on board. The only one that I would disagree with, and I think he might feel the same, is on amendment 20 specifically. His main criticisms of that were that it might result in variability across the nation, that there are currently staff shortages and that there could be implementation delays. I do not see any of those three reasons to be strong enough to not want to maintain crisis accommodation.
I thank the Minister for his comments and his serious consideration of all our amendments. We will press amendment 20 to a vote, but will not press any of our other amendments.
Question put, That the amendment be made.
Mental Health Bill [ Lords ] (Fifth sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [ Lords ] (Fifth sitting)
Danny Chambers ExcerptsTuesday 17th June 2025
(5 days, 2 hours ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 17 June 2025 - (17 Jun 2025)
Dr Danny Chambers (Winchester) (LD)
It is an honour to serve under your chairship, Sir Desmond. I thank the Minister and the hon. Member for Hinckley and Bosworth for their comments on Liberal Democrat new clause 4.
This is another good example of how, although we are aware that it has laudable aims, the Bill will fail without the supporting infrastructure. As everyone will be aware, community mental health services are among the issues that generate the most emails and correspondence—certainly in Winchester, where young people especially are struggling to access mental health care. In that context, we are alarmed that mental health spending has fallen as a share of overall health spending in the last financial year. That has been coupled with the decision to drop a number of mental health targets, including targets for the number of people receiving mental health interventions such as talking therapy, and the target to ensure that 75% of people with a severe mental health illness receive an annual physical check. Priority has not been given to the services necessary to deliver better mental health care.
For the Bill to make a meaningful difference, the Government must ensure that community mental health care services receive the investment that they need to fulfil their obligations under the Bill—I know that that is a bit of a circular argument—and reduce the overwhelming pressure on in-patient services.
There is also the impact on schools, police services and families. When I went out with the police in Winchester not long ago, they told me that between 40% and 50% of their time is spent dealing with people who have a mental health issue in some capacity. The lack of community mental health care is not just a resource burden on the health service; a lot of our other services are also affected.
Dr Evans
The hon. Member rightly talks about resources and about the cuts as a proportion—although small, it is a cut in NHS spending. The last Conservative Government brought in the mental health investment standard to try to ensure parity between physical health and mental health in investment so that, regardless of how big the pot was, mental health was prioritised. Does the hon. Member agree that there is a concern that that could be slipping under this Government? Does he agree that that needs to be addressed in the context of the community provision that we are discussing?
Dr Chambers
I broadly agree. We were really heartened that in the King’s Speech, the Government said that mental health needs to be treated as seriously as physical health. There are many reasons to join a political party but, given my long history of working in mental health charities, one major reason for joining the Lib Dems was that they had been saying that for years. I was pleased to hear that in the King’s Speech too, but we have to ensure that the percentage of spend on mental health does not slip in proportion to other very important resources.
Anna Dixon (Shipley) (Lab)
I think we are all agreed that, in order to implement the changes to the Bill, we need investment in mental health services, particularly community mental health services, but does the hon. Gentleman recognise that the Labour Government have kept the mental health investment standard, ensuring that there is sufficient and increasing investment in mental health in this country?
Dr Chambers
I hope that that is the case. I know that is the aim, but I suppose we will see in four, five or six years’ time what the mental health resources are. No one aims to underfund these services, but the demand on them changes and they need to be resilient. Darzi said that in April 2024 there were 1 million people on mental health waiting lists, and we know that some children wait 15 months, so we must not just maintain the current investment standard, but try to catch up on the huge backlog, which will not change unless we reform the system or invest in more staff and resources.
David Burton-Sampson (Southend West and Leigh) (Lab)
The hon. Gentleman makes a good point—mental health services are in a very bad place—but does he agree that the Government have already announced investment in mental health specialists in all schools, and in mental health crisis centres? I have no doubt that once the 10-year plan for the NHS comes out, there will be an even clearer path for how we tackle mental health issues.
Dr Chambers
I am really looking forward to the 10-year plan and reading about how it will improve mental health. We shared Labour’s manifesto commitments to mental health practitioners in each school and mental health hubs, so we certainly support that.
The hon. Member for Hinckley and Bosworth made some very good points and said that this proposal should possibly not be in primary legislation. I accept that integrated care boards do not have control over how every part of the service is delivered, so I am happy not to press the new clause to a vote, but I think the second part, which says that integrated care boards should have a duty to assess and report on the resource needed to meet the demands on services every two years, is important.
Gregory Stafford
I rise to speak to clauses 22 and 23 and to Liberal Democrat new clause 4.
As my hon. Friend the Member for Hinckley and Bosworth said, the Opposition support clauses 22 and 23 generally. Clause 22 addresses the concern that community clinicians—essentially, those responsible for overseeing a patient’s care outside hospital—have historically had limited formal input into decisions about community treatment orders, even though they are central to the patient’s ongoing care. It ensures that community clinicians not only are consulted but, in some cases, must provide written agreement before key decisions are made. It aims to improve continuity of care, ensure decisions reflect the realities of community-based treatment, and reduce inappropriate and poorly co-ordinated use of CTOs.
The benefits of the clause are obvious, but they are worth restating. Clearly, it improves the continuity of care and ensures that clinicians with direct knowledge of the patient’s community care are involved in those key decisions. It enhances safeguards, adding an additional layer of professional oversight before coercive measures are imposed or suggested. It promotes collaboration by encouraging joint decision making between the hospital-based and community-based clinicians, and it reduces the risk of inappropriate CTOs by ensuring they are used only when genuinely appropriate and supported by those delivering care.
However, I ask the Minister to touch on three points. First, requiring a written agreement or consultation could delay urgent decisions if not managed efficiently, so will he explain how, under the clause, any potential delay—a disagreement or just administrative inertia—can be removed to ensure treatment is not delayed?
That moves me on to the administrative burden. Clearly, the clause adds a level of complexity and requires more documentation and co-ordination. Although I understand that that is a necessary outcome, I would again be grateful for the Minister’s thoughts on how to ensure effective and speedy implementation.
As my hon. Friend the Member for Hinckley and Bosworth said, the ambiguity in the roles of the two clinicians may create confusion or disputes over responsibilities if they are not clearly defined or agreed. My reading of the clause is that there is no such clear definition; will the Minister look to provide one through other agencies, or will he put something into the clause in Committee or later in the Bill’s proceedings?
Clause 23, on the conditions of community treatment orders, addresses the concerns that the threshold for imposing conditions on community treatment orders has been too low, allowing conditions that may be clinically unnecessary or overly restrictive. By removing the “appropriate” test, the clause will tighten the legal standard to ensure that only necessary conditions are imposed.
Additionally, the clause will empower tribunals to play a more active role in scrutinising CTO conditions by allowing them to recommend that clinicians review specific conditions, even if the patient is not discharged. This reflects the Bill’s broader aim of enhancing patient rights and removing unnecessary restrictions.
The clause is a welcome addition. It will ensure that CTO conditions are imposed only when strictly necessary, meaning that there are stronger safeguards, and it will enhance the role of tribunals in protecting patient rights without requiring full discharge. It will reduce clinical overreach by preventing the use of overly broad or vague conditions that may not be clinically justified.
However, as with the previous clause, I have some questions. First, the tribunal power is limited in that it can only recommend, not require, the reconsideration of conditions. Is that the intention, or will the Minister strengthen the clause at some point to ensure that the tribunal can require a reconsideration of conditions? If he will not, what issues does he see arising from there not being a reconsideration?
Secondly, as I mentioned in my intervention on my hon. Friend the Member for Hinckley and Bosworth, I have a concern about the potential ambiguity in the shift from “appropriate” to “necessary” leading to uncertainty or dispute over interpretation. As we touched on in relation to other clauses, clinicians will need additional guidance or training to apply the revised standard consistently. Where will that revised training and guidance be located, and what is the timeframe for its implementation? We need to ensure that all clinicians are fully trained and ready to use this new power.
I will briefly touch on new clause 4, tabled by the Liberal Democrats, because although I understand that the hon. Member for Winchester may not press it, somebody else might. It would place a general duty on integrated care boards to ensure that services in the community have the necessary level of resource to meet demand such that the provisions of the Bill function as intended, and to assess and report on this every two years. As my hon. Friend the Member for Hinckley and Bosworth mentioned, the Opposition generally support the overall aims of the new clause, but as ever, there are some issues with the detail, so I have five questions for the hon. Member for Winchester if he responds, or for the Minister to answer in his summing up.
First, if we imposed a statutory duty on ICBs to ensure sufficient resources for the CTOs, what mechanisms would there be to monitor and enforce compliance? Secondly, what would be the consequences if an ICB failed to meet this duty? Would there be formal accountability or a sanction process? Thirdly, how would the duty interact with existing NHS budgetary constraints and competing priorities? Would it become a statutory obligation with no clear means of redress if unmet? Fourthly, could the duty set a precedent whereby Parliament mandates resource guarantees without providing additional central funding? Finally, what constitutes “sufficient” resources in the context of the CTOs? Who defines that standard, and it is defined locally or nationally?
David Burton-Sampson
I appreciate the hon. Member’s intervention. He makes the point that there may be situations in which the young person’s request might be inappropriate. However, on the flip side, there may be a situation in which it might be inappropriate for the person with parental responsibility to be the nominated person. They could have been involved in the situation that has led to that young person entering a mental health spiral—an abuse situation, for example, which has not been discovered by the authorities. That person would still have parental responsibility at that time. I think it is important that the young person can choose the person to support them in their ongoing care. I will be supporting clauses 24 to 28 and Government amendments 40 and 41.
Dr Chambers
Amendment 49 extends the support offered by mental health advocates to cover social and financial stresses and to family carers and other members of the household when the patient is discharged.
Other hon. Members have today discussed how social and financial struggles can play a major role in someone’s mental ill health and in blocking their recovery, and how those are often the areas where someone can most benefit from advocacy and advice. As we are all aware, patients should not be viewed as a collection of symptoms, but within their whole context, including the situation they are living in. Addressing someone’s housing insecurity, debt or family breakdown should not be viewed as a separate consideration, but as a core part of supporting them to live happily, healthily and independently. Furthermore, family carers and the wider household are absolutely critical for people’s wellbeing and recovery, and should be properly equipped to prepare for their loved one returning from hospital. They, too, may need advocacy and may be missing out on support that they can and should receive.
A good example comes from Winchester, where Winchester Citizens Advice has a member of staff—a former mental health nurse—based at Melbury Lodge in-patient mental health unit. Often, someone may be admitted for two, three or four months, and when they are discharged, they go home to all their life admin—there will be final demands for credit cards or requirements to repay personal independence payments and that type of thing. It is very overwhelming, particularly for those who already have fragile mental health, to have to sort out a whole backload of administration—especially financial and complicated administration. For two days a week, that staff member supports in-patients in sorting out all their administration from anything that needs to be done.
What is interesting is that when these patients are discharged from Melbury Lodge in Winchester, if they have had that help, they end up being hospitalised and on medication for a shorter time. They are also more likely to engage with various support and community services once they have been discharged and are much less likely to be readmitted to hospital. For every £1 spent on that initiative, £14.08 is saved in cost avoidance. That initiative run by Melbury Lodge and Winchester Citizens Advice was up for an NHS award last year. It is a proven concept and something that should be done across the entire country. It has been running for two years and has proved how much money can be saved. Unfortunately, it was a pilot project and is struggling to secure money to continue indefinitely. I urge the Government to look at how that type of initiative could be rolled out around the whole country.
Sojan Joseph
The hon. Member is making a very valid point that all patients need help with their finance and accommodation to keep them in the community and make discharge more appropriate. However, those provisions are already in place as part of the patient’s care plan. Different hospitals have different settings, such as a discharge or enablement team, or even the nurses on the ward itself can help and look into those provisions. Does the hon. Member think that that is the role for independent mental health advocates, who prioritise detention and the Mental Health Act, rather than the finance and accommodation issues, which need to be resolved by a different team?
Dr Chambers
I accept that point. It is a very sensible point. There has been a huge amount of discussion about what is in scope. Given that this is focused primarily on both current in-patients and preventing readmittance to an in-patient unit, I think it is within scope. I am aware that a lot of staff support patients, but it is not a core part of their role. It is something they squeeze in among all their other duties. When we have the expertise of someone at citizens advice, who knows how to navigate the huge complexity of various organisations and businesses that have to be dealt with, it is a lot more efficient. The figures speak for themselves.
Dr Chambers
My apologies, Sir Desmond. I thought amendment 49 was included in the debate on clause 24.
Rosie Wrighting (Kettering) (Lab)
I rise to speak to clauses 24 to 28 and the Government amendments to them. They cover an important and long overdue reform, which introduces a new statutory role: the nominated person, replacing the outdated concept of the nearest relative. I think, cross party, we all agree that this is about protecting some of the most vulnerable people in society and children.
The clauses and amendments make important changes to the current Act, which too often forces an individual to rely on someone they may not trust or even have contact with, just because of their family relationship. As the Minister said, the White Paper found that the vast majority would choose their parents, but we must have legislation that reflects the diversity of society and families. Growing up in a single parent family, it would have been inappropriate for my other parent—who is one of my nearest relatives, but who I did not live with, know or particularly trust—to be my representative or make decisions on my treatment and care. In my upbringing, the people who knew me best were not always my closest blood relatives.
The nominated person model gives individuals the right to decide who should speak for them when they are at their most vulnerable. That might seem like a small change, but it is a powerful one and aligns with the Bill’s overall goal of placing patient voices at the heart of mental healthcare. Having someone a person trusts—someone who knows them and can advocate for them—is vital. I was contacted by a constituent whose brother was sectioned and assessed at hospital as needing ongoing support in sheltered accommodation. His social worker challenged the decision and recommended private accommodation. That confusion, despite his sister continually challenging the recommendation, meant he was discharged, with nowhere to go, in the middle of the night.
It is crucial that safeguards will remain. Where an individual cannot nominate someone themselves, a person can still be appointed on their behalf, but with far clearer guidelines and recourse if concerns arise. It is not about removing protection; it is about modernising it to reflect the society we represent. Mental health legislation must reflect the value and diversity of the society it serves, and the clauses and amendments before us bring us a step closer to that.
Mental Health Bill [ Lords ] (Sixth sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [ Lords ] (Sixth sitting)
Danny Chambers ExcerptsTuesday 17th June 2025
(5 days, 2 hours ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 17 June 2025 - (17 Jun 2025)
Dr Danny Chambers (Winchester) (LD)
I beg to move amendment 49, in schedule 2, page 87, line 13, at end insert—
“(18A) In section 130B (arrangements in relation to independent mental advocates: England), after subsection (3)(d), insert—
‘(e) support the patient’s carer and family members to prepare for the patient’s discharge from hospital treatment, and
(f) support the patient to access help with social and financial stressors that might otherwise increase their likelihood of future detention.’”
This amendment extends the support offered by Mental Health advocates to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.
It is an honour to serve under your chairmanship, Mrs Harris. I jumped the gun this morning, so I have already spoken in detail about the amazing initiative at Melbury Lodge with Winchester Citizens Advice. I will not bore the Committee with the details again, except to say that it is a brilliant example not only of delivering really good care for patients, but of a really good cost-effective intervention for the taxpayer. If it is not appropriate for it to be set out in secondary or primary legislation, will the Minister consider a meeting with me, Melbury Lodge and Winchester Citizens Advice to discuss how this type of initiative could be rolled out across the country?
Aphra Brandreth (Chester South and Eddisbury) (Con)
It is a pleasure to serve under your chairmanship, Mrs Harris. I rise to make some brief comments on amendment 49.
I am sympathetic to aims of the hon. Member for Winchester in tabling the amendment. A patient who is being discharged from hospital may indeed require specific, targeted support. The overall success of their treatment and continued recovery can be greatly enhanced where the right structures are in place to support them in the community. The amendment rightly draws attention to social and financial stressors that may affect an individual at the point of discharge and in the weeks and months that follow. We all recognise that there is a pressing need for a more joined-up approach between in-patient services and community provision. Without that, we risk patients falling through the cracks and suffering unnecessary and distressing re-admissions. Better discharge planning must be at the heart of our efforts.
I have some concerns, however. Although I acknowledge the good intentions behind the amendment, it risks expanding the remit of independent mental health advocates beyond what might be appropriate. There is a delicate balance, but an important distinction, between advocacy and care co-ordination. Independent mental health advocates play a vital role, and it is essential that their independence and clarity of purpose be preserved. If we are not careful, we risk blurring that boundary. In doing so, we may undermine the very effectiveness of the independent mental health advocate in fulfilling their primary function.
The role of an IMHA is to support patients in understanding and exercising their rights under the Mental Health Act. They may already be involved in supporting an individual to prepare for discharge, including by contributing to plans for ongoing care and support. The amendment would significantly increase the breadth of that role and might shift the focus away from the core purpose of advocacy.
Stephen Kinnock
I am grateful to the hon. Member for Winchester for bringing this issue before the Committee. The intention of his amendment is to extend the support offered by independent mental health advocates
“to cover social and financial stressors and support for family carers and other members of the household when the patient is discharged.”
It would amend paragraph 18 of schedule 2, which deals with amendments relating to nominated persons. It should more properly be inserted into schedule 3, which deals with independent mental health advocates.
The Bill will already extend the support that advocates can provide to help patients to be involved in decisions about their care and treatment, to be able to make a complaint and to be provided with information about other available services. Those other services could include support following discharge from statutory or voluntary organisations, which may cover social and financial issues, and help to support carers. Those organisations would be better placed to support patients with these specific needs, rather than independent mental health advocates, whose skillset is specific to supporting patients to understand their rights under the Mental Health Act and participate in decisions about their care and treatment. We will consult on guidance in the code of practice to help independent mental health advocates to understand their extended role.
In addition to policy regarding independent mental health advocacy, advance choice documents give individuals the chance to give instructions about practical aspects of their life. Examples of such aspects include domestic, financial or caring responsibilities, such as children or pets. This provision allows the individual to be looked after when unwell and aims to ease additional anxieties. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.
Dr Chambers
I appreciate the valid points that hon. Members have made. The point about running a pilot was a sensible suggestion. We have had something that could be viewed as a pilot in Winchester for two years. We know that it works well, and every £1 spent on it saves £14.08. If I have suggested this amendment in the wrong part of the Bill through my naivety and inexperience, or if mental health advocates are not the right people to deliver a solution that we know works, may I ask the Minister whether there is a more appropriate part of the Bill in which to include it or another way to implement this proven system, such as by amending a different Bill, before I decide whether to press the amendment to a vote?
Stephen Kinnock
I thank the hon. Gentleman for that question. Fundamentally, our view is that the role that he is proposing is not the right one for an independent mental health advocate. The role of an independent mental health advocate is to work with the patient around their legal rights, rather than to deal with some of the more practical issues that he is talking about here. Our sense is that there are both statutory and voluntary organisations who are better placed to carry out that work. I do not think that a pilot would work with IMHAs, because by definition that is not the right role for IMHAs.
Dr Chambers
In that case, can we have a discussion outside the Committee about how to do this?
Dr Chambers
indicated assent.
Amendment 49 negatived.
Schedule 2, as amended, agreed to.
Clauses 25 to 28 ordered to stand part of the Bill.
Clause 29
Detention periods
Question proposed, That the clause stand part of the Bill.
Stephen Kinnock
Currently, under the Mental Health Act, a person detained for treatment can be kept in hospital initially for six months before the responsible clinician must make an assessment to decide whether to continue their detention or to discharge them. The independent review raised concerns that six months is too long. It heard evidence that patients were sometimes detained longer than necessary and were only considered for discharge when a tribunal hearing was due. It found that in up to 17% of cases referred to the mental health tribunal, discharge happened in the 48 hours before the hearing. That suggests that some patients are being detained longer than is necessary.
The review recommended reducing from six months to three months the initial detention period for people admitted for treatment, so that a patient’s detention is reviewed sooner to ensure that patients are not detained when they are no longer benefiting from treatment and can be safely discharged.
Clause 29 will mean that patients detained for treatment have their detention reviewed three times—up from twice—in the first year: at three, six and twelve months from the date of detention. The new renewal periods will not apply to part III patients, except in very specific circumstances when an unrestricted patient changes status. I commend the clause to the Committee.
Dr Chambers
I do not know whether we could combine yoga with our proceedings, Mrs Harris.
The hon. Member for Hertford and Stortford spoke really well in a similar vein to what I am about to say. Our amendment 19 to clause 41 would extend the provision of opt-out advocacy services in England to informal patients under 18 years old. Young people and their families and carers often face a nightmare navigating the mental health system. We find this on every level. A psychiatrist who came into my office in Winchester said that he and his wife, who is also a medical professional, were struggling to navigate the system to get care for their own child. His words were quite profound: “If we can’t navigate the system, what hope has anyone else got?”
Even when young people have secured desperately needed in-patient care, often after many months of delay, they can face real challenges in understanding the care being implemented and its impact. Often, such young people are cared for far from home. Enabling them to benefit from mental health advocacy that ensures the pressures on the system do not lead to unfair or damaging decisions for mentally ill young people is crucial. It can help to ensure that the patient’s whole situation and entire history is always taken into account, and that treatment is always appropriate, rather than symptoms just being addressed in isolation. We should be looking to empower patients and their families and carers across the whole system, not just in relation to those who are sectioned.
Gregory Stafford
You will be delighted to know that there will be no yoga from me, Mrs Harris.
I rise to support clause 41 and schedule 3, which will expand access to independent mental health advocates to not only those detained under the Mental Health Act but informal voluntary patients. Like many Committee members, I am sure, a number of IMHAs in my constituency have approached me about this, and they welcome the expansion. I pay tribute to the amazing work that they do across Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Previously, only patients detained under specific sections of the Mental Health Act or subject to certain treatments were entitled to IMHA support.
The clause reflects the recommendations of the 2018 independent review of the Mental Health Act and the 2021 White Paper, and aims to enhance patient rights and reduce disparities in access to advocacy. That clearly empowers more patients by giving informal patients access to advocacy support. It improves transparency and accountability in mental health care settings. It ensures proactive outreach so that patients are not left unaware of their rights or support options, and supports informed decision making and potentially reduces coercive practices.
Clearly, there may be some resource implications for advocacy services, which the Minister may wish to touch on. Likewise, there may be some implementation challenges, which other hon. Members have raised, especially around ensuring timely and consistent notification and engagement. There could be potential delays in care co-ordination if advocacy processes are not well integrated. I would welcome the Minister’s thoughts on that.
This shift is long overdue. Too many vulnerable people, admitted voluntarily but feeling powerless, have lacked a clear, independent voice. The clause corrects that injustice by embedding advocacy deeper into the system, moving from passive availability to proactive engagement.
Schedule 3 underpins clause 41 by putting clear duties on hospital managers and advocacy providers alike to ensure that patients are automatically offered support. It is opt out, not opt in. That clarity of responsibility will reduce coercion, increase transparency and ultimately lead to fairer treatment decisions.
Schedule 3 operationalises the principles set out in clause 41 by embedding them in the structure of the Mental Health Act 1983. Like clause 41, it reflects recommendations from the 2018 independent review and the 2021 White Paper, aiming to reduce disparities in access to advocacy and ensure that all patients, regardless of detention status, are supported in understanding and exercising their rights. Like clause 41, it strengthens patient voice, reduces inequalities, improves compliance and encourages the early intervention and resolution of concerns.
Let me turn to Liberal Democrat amendment 19, which was tabled in the name of the hon. Member for Winchester. Clearly, its purpose is to extend the opt-out advocacy services in England to include informal patients under the age of 18. This ensures that children and young people who are not formally detained under the Mental Health Act, but who are receiving in-patient care, still have automatic access to an IMHA.
Currently, opt-out advocacy provisions primarily apply to patients who are formally detained. However, informal patients aged under 18, who may be in hospital with parental consent, can still experience significant restrictions and may not fully understand or exercise their rights. This amendment seeks to close the gap by ensuring that young informal patients are automatically offered advocacy support, recognising their vulnerability and limited legal autonomy.
My view is that this does strengthen patient rights. It safeguards vulnerable patients and promotes equality by aligning the rights of informal patients aged under 18 with those of detained patients. It supports informed decision making and helps young people to understand their rights and treatment options. If the hon. Member is minded to press the amendment, I hope that the Government will at least give it tacit support, even if they do not vote for it. That being said, I would welcome the Minister’s comments on why he does not feel that the amendment, or an alternative draft of the wording, if he does not like the specifics of it, should be included in the Bill. I do believe that this is important.
Government amendments 42 and 43 to schedule 3 are relatively technical but important elements of the Bill that align provision in England and Wales. I have just a few questions for the Minister. Robust rights must come with realistic resources. How will the Government ensure that advocacy services are funded and resourced properly to meet the new wider demand? Although they are technical, the Government amendments will still have an impact. What steps will be taken to monitor consistency so that a patient in Farnham, Bordon, Haslemere, Liphook or one of the villages surrounding my constituency has the same access to an advocate as a patient in Coventry, Aberafan or Swansea. We want to make sure that there is consistency.
Finally, will there be clear standards for timely engagement, especially given the risk of treatment delays if advocacy is not well integrated? If the Minister can answer those questions, I think that this will be a good step forward for patient voice and fairness in mental health, and I would support the clause and schedule 3.
Dr Chambers
I think the hon. Member for Farnham and Bordon has spent more time discussing our amendments than I have, so I would like to give him the opportunity to vote in favour of one of them.
Amendment proposed: 19, in schedule 3, page 91, line 13, after “patient” insert—
“or English qualifying informal patient under 18”— (Dr Chambers.)
This amendment extends the provision of opt-out advocacy services in England to informal inpatients under 18.
Question put, That the amendment be made.
Mental Health Bill [ Lords ] (Seventh sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Danny Chambers
Main Page: Danny Chambers (Liberal Democrat - Winchester)Department Debates - View all Danny Chambers's debates with the Department of Health and Social Care
Mental Health Bill [ Lords ] (Seventh sitting)
Danny Chambers ExcerptsThursday 19th June 2025
(3 days, 2 hours ago)
Public Bill CommitteesRead Full debate Mental Health Bill [HL] 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 19 June 2025 - (19 Jun 2025)
Jen Craft
I agree on the notion of a right; where we vary is that I think that the Bill as written, and Government amendments 32 and 33, enshrine the notion of a right without it having to be spelled out as such. Local variation includes localised populations, such as those from marginalised communities. We might consider different translations of support that is available. That will not be the case across the board—it will vary from area to area. This does not remove people’s ability to make an advance choice document; it simply gives local commissioners the ability to determine what is most appropriate for their area, how that support should look and how it will be targeted.
Without getting ahead of the Minister, I hope that he will say what guidance on best practice for local commissioners and ICBs will be set out, particularly in relation to those with learning disabilities and autism. We have spoken about easy-read documents, for example, which should probably be made available, as should advice on how commissioners can best make sure that all those who might benefit from an advance choice document are meaningfully engaged and informed of their right and ability to do so.
The Minister has agreed previously to make sure that he works with disabled people’s organisations, including those run by and for people with learning disabilities and autism, on bringing forward a code of practice on the Mental Health Bill. Input on patient experience into how best to contact and meaningfully engage people who would benefit from an advance choice document would be particularly beneficial.
Very briefly, the aim of Liberal Democrat amendment 18 is to include consideration of financial circumstances in an advance choice document. I have looked into this—in my opinion, it is outside the scope of what an advance choice document does. An advance choice document sets out how an individual would wish to be treated if they became so unwell that they were unable to make those decisions for themselves. I am not fully sure how one’s financial circumstances fit into how one would be treated relative to detention or, potentially, in a community-based setting. I understand that financial circumstances have an impact on people’s mental health—we have talked about that in debates on other clauses—but they do not necessarily have a place in this specific part of the Bill.
I encourage the Committee to support clause 45 and to adopt Government amendments 32 and 33. This is, once again, a big step forward in ensuring that those with serious mental illnesses are able to input into their care and treatment in a real and meaningful way.
Dr Danny Chambers (Winchester) (LD)
It is a pleasure to serve under your chairship, Sir Desmond. In the previous sitting of the Committee, I spoke extensively about the close link between money worries and poor mental health. That link is why I have sought, through amendment 18, to ensure that advance choice documents include a specific section on money. This would give people greater choice and control over their finances when they are in crisis. Without that provision, financial worries could be an even greater hurdle to recovery.
We have talked a lot about financial problems being a major contributor to mental health crises, and they can make it much more difficult to recover from one. I will not go through all the details again, but the numbers show how significant the problem is. Last year, nearly 21,000 people in England alone were struggling with problem debt while in hospital for their mental health, so it is not a small cohort of patients for whom this is a specific issue. Ensuring that people’s finances are taken into consideration when they are in a mental health crisis will prevent future illness, reduce waiting lists and help people to return to daily life more smoothly, including to work. If we ignore it, that will end up costing the NHS more in time and resources.