Asked by
To ask His Majesty’s Government what reforms they are proposing
to the Mental Health Act 1983.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
The Government published their draft mental health Bill on 27
June 2022, which contains our intended reforms to the Mental
Health Act 1983. I am grateful to the joint pre-legislative
scrutiny committee on the Bill for its report, which was
published last week, on 19 January. The Government will now
review the committee’s recommendations. We will respond in the
coming months and introduce a revised Bill when parliamentary
time allows.
(Con)
I thank my noble friend the Minister for his comments on the
Joint Committee’s report. I had the privilege of chairing its
inquiry and I am grateful for the contributions of Members of
both Houses. The Government must of course spend time considering
with care our recommendations, but as a committee we feel
strongly that a Bill should be introduced to Parliament as soon
as is practicable to bring about the really important reforms to
the mental health system that people so dearly deserve. Will my
noble friend give an assurance that the Government will introduce
a formal Bill to Parliament in the current Session?
(Con)
First, I thank my noble friend and all noble Lords who took part
in the pre-legislative scrutiny committee. I think all noble
Lords agree that what we are trying to do with the mental health
Bill is a very good thing. We would like to bring it forward as
soon as we can. From my side, I know that we are ready to go, but
we are working with the parliamentary authorities to make sure
that we can get the legislative time. We want to do it as soon as
possible.
(Lab)
My Lords, due to the current mental health legislation, autistic
people are being detained in hospitals not because they have a
separate mental health issue but because they are autistic.
Autism is not a mental health condition, but more than 2,000
autistic people are currently locked up. This is a stain on
Britain’s reputation for defending human rights and a challenge
for us to define the liberty and freedom of some of our most
vulnerable citizens. So will the Minister ask his noble friend
sitting on the Bench with him, the Government Chief Whip, for a
debate in government time on this matter, so that the voices of
some of these people, some of whom have been locked up for
decades, can at last be heard?
(Con)
I have some personal experience in this space, so I understand
exactly what the noble Lord is saying. I think we all agree on
its importance. We have a commitment to decrease the number of
in-patients with learning disabilities and autism by 50%. It is
something that every ICB must have a lead on, so that they can
really tackle it, and I personally would be happy to meet the
people the noble Lord mentioned to understand further.
(Con)
My Lords, this process began four years ago, with the then Prime
Minister announcing the initial reason for the review, which was
the disproportionate way that the Mental Health Act is applied to
many black and minority ethnic communities. Beyond the review and
the White Paper, the Joint Committee recommends the abolition of
community treatment orders, which are disproportionately applied:
if you are black you are 11 times more likely to be under a
community treatment order. Most of the recommendations of the
Wessely review were to be enacted by changes within NHS England.
Can my noble friend the Minister assure us that he will hold its
feet to the fire to change the culture, practices and training of
many of our mental health professionals, because those
communities are being disproportionately affected by the way the
Act operates?
(Con)
Yes, I too saw the statistics on the number of black people who
are detained. Clearly that is not right and is something that we
need to get on top of. I know that the NHS has set up a patient
and carer race equality framework to try to tackle this, but
clearly we need to act on it. Again, it is the responsibility of
every ICB to ensure to tackle this as well.
(LD)
My Lords, a key reason why people with learning disabilities and
autism are wrongly detained under the Mental Health Act is that
mental health professionals are not trained to recognise autism
and learning disabilities. Without waiting for legal reform, will
the Government work with the professional bodies now to train and
retrain psychiatrists and psychologists in learning disabilities
and autism so that we can stop the scandal of these people being
locked away wrongly for years and years?
(Con)
Yes, and understanding starts in schools. Again, I am very aware
of that, and of the fact that training in schools is vital. We
have increased the proportion of schools with trained mental
health assessors from 25% last year; it will shortly be about
35%. The target is 50% next year. It is not 100%—we need to do
more—but it is rapid progress.
of Hudnall (Lab)
My Lords, like other noble Lords who have spoken, I was a member
of the scrutiny Joint Committee. I should say in parentheses that
I entirely support the legislation being brought forward, but one
of the things that came through very strongly from all the
evidence we took was quite serious anxiety about resourcing for
the kinds of reforms that are required. That is about not just
money but, to go to the point made by the noble Baroness, Lady
Barker, the recruitment of appropriate people to deliver the
services that are needed, and the retention and training of those
people. Can the Minister tell the House whether the Government
will review the resource allocation for the proposed changes to
the Mental Health Act, to ensure that these workforce issues are
addressed?
(Con)
The noble Baroness is correct; these things do need resources. We
have committed to £2.3 billion of extra spending next year and an
increase of 27,000 in the number of mental health nurses; I am
glad to say we are well on the way, with a 7,000 increase over
the last year. This all comes back to workforce planning—I am
sure I will be asked that question later. And, yes, we will
publish our plan soon.
(CB)
My Lords, can the Minister comment on why it is 50 years since we
have had a revision, and say whether in fact the Government are
delaying this legislation because of the resources that will be
required, as has just been referred to?
(Con)
No, I hope that all noble Lords will see that there is no sense
of delay on this side—and we are not waiting for the legislation
to introduce a lot of these measures. It is very important, and
we are ready to push on as soon as parliamentary time allows.
(Lab)
My Lords, declaring my interests in the register, particularly as
a trustee of the Centre for Mental Health and a member of the
Joint Committee, perhaps I might press the Minister on one of our
key recommendations: to establish a statutory mental health
commissioner to oversee the implementation of the draft Bill,
which we fully support, and to have a laser focus to ensure
consistency across the country in the services required,
underpinned by investment in community services. Unless those are
forthcoming in a timely way, the Bill’s intentions will be
undermined. Will the Minister confirm today that he will accept
the recommendation for a mental health commissioner?
(Con)
I hope noble Lords accept that the report came out only last week
and we need a little time to consider it. What I can say is that
we are all focused laser-like on making sure that change is
happening in this space. If the best way to do that is by
appointing a mental health commissioner, that will have my
support. At the same time, I am very aware that ICBs are
responsible for this, and I want to give them the space to make
sure they can properly manage mental health and other health
services in their area.
(Con)
Some years ago I visited a health centre with a lot of autistic
patients who were quite young. One of them came up to me and
said, “What is your favourite film?” I replied immediately,
“Chariots of Fire”—whereupon he took me through every detail of
“Chariots of Fire”, which revealed that in one respect he had a
problem but in other respects he had great ability. Does the
Minister accept that there is much to be hoped for in young
people who have this difficulty?
(Con)
I agree 100%. As I say, I have some personal experience. In many
ways, these children or young people have incredible skills and
are gifted in many directions, and the economy we live in, with
IT and everything, gives more and more opportunity for these
people to thrive.
(Lab)
I congratulate the Joint Committee on its excellent work and
refer to a report in the Times yesterday that the Government have
written to universities to ask them to limit the number of
medical school places they offer or risk fines. Can the Minister
shed any light on what I regard as a baffling move? Can he
explain to the House how the Government will address the concerns
of the Joint Committee about getting the right workforce in place
if they are planning to reduce the number of doctors in
training?
(Con)
Again, I agree that workforce is key to this. I am not aware of
the report; I will look it up. I am somewhat surprised, because I
know that we all accept that we need to invest in this space to
recruit doctors, nurses and mental health professionals.
