Aphra Brandreth MP: speeches

Speeches

• 26 Jun 2025 · Topical Questions · Hansard source

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  My constituent Paul cycles more than 1,000 km a month all across the country, but he tells me that Cheshire’s roads are among the worst. Poor roads are dangerous for all road users, so does the Minister agree that national guidance for pothole repair policy must properly reflect the needs of cyclists alongside motorists? We must urgently improve road conditions for everyone.

• 24 Jun 2025 · Mental Health Bill [ Lords ] (Ninth sitting) · Hansard source

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  My hon. Friend is absolutely right. We have seen examples where regulators have not intervened quickly or robustly enough, and where systemic issues went unnoticed or unaddressed for far too long. We need to strengthen the remit and ensure that the CQC is properly equipped and held to the high standards that we expect of it. I am an economist by background, so evaluation is something I think about a great deal. Reform, however well intentioned, must be followed by evidence, scrutiny and a willingness to learn and improve. The new clause ensures that we do not just set change in motion, but that we stop to ask whether it is working, whether the right things are being done, and if not, how we can improve. The review required by the new clause would look not only backwards at whether the regulator has effectively carried out its existing duties under the Act, but, crucially, forwards, assessing whether it is ready to meet the responsibilities placed on it by the new reforms. I particularly welcome the requirement for the review to be published and laid before Parliament. Transparency is essential. It would allow Parliament to scrutinise but also gives patients, families, professionals and the public confidence that those questions are being asked seriously and answered publicly. Ultimately, the new clause is about improving outcomes. When regulation works well it safeguards dignity, prevents harm, identifies and spreads good practice, develops trust and helps us build a system where the principles of this Bill—choice, autonomy, less restriction and greater therapeutic benefit—are not just written in statute, but visible in practice. That is especially important in mental health care, where so often the people subject to the Act are among the most vulnerable. Those in in-patient settings, particularly those who are detained, are often not in a position to advocate for themselves. They rely on a system that is vigilant, takes its safeguarding responsibilities seriously and puts patients’ rights first. I hope that all members of this Committee will support the new clause. It is collaborative in its intent, constructive in its purpose and essential to delivering the meaningful reform that we all want to see. It reinforces the importance of accountability, transparency and listening to those most affected by this legislation. We owe it to those individuals and their families to make sure that we not only change the law, but also the culture and oversight that surrounds it. This review would help us do exactly that.

• 24 Jun 2025 · Mental Health Bill [ Lords ] (Ninth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in strong support of new clause 13, tabled by the shadow Minister. The new clause would place a duty on the Secretary of State to review the functions and effectiveness of the regulatory authority, which is currently the Care Quality Commission, within one year of the passage of the Bill. The new clause is a timely, necessary and constructive addition to the Bill. As colleagues will know, the Care Quality Commission plays a dual role in relation to the Mental Health Act. First, as the regulator of services, it ensures that providers meet fundamental standards of care and safety. Secondly, through its specific responsibilities in visiting and speaking to those detained under the Act, it ensures that people’s rights are protected and that the law is used appropriately and humanely. That is no small task. It is a balance that requires the CQC to be not only reactive but proactive, and not only independent but responsive to the lived experiences of patients—especially to the voices of the most vulnerable. That is why the new clause matters. As we bring forward significant reforms to the Mental Health Act through the Bill, and rightly modernise and improve safeguards and place greater emphasis on autonomy, dignity and therapeutic benefit, we must also ensure that our system of oversight and regulation is fit for purpose. I welcome the direction that the Bill sets. Its four core principles are rightly placed at the heart of the legislation: choice and autonomy, least restriction, therapeutic benefit, and seeing the person as an individual. Those principles must shape the way that care is delivered on the ground. That means they must also shape the way that care is monitored, inspected and held to account. A review of the regulator’s role is not about criticism for its own sake; it is about ensuring that the regulatory framework supports and reinforces the ambitions of the Bill and that it can respond to emerging challenges, shine a light where services are falling short and, crucially, act to protect patient rights.

• 23 Jun 2025 · Middle East · Hansard source

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  The Foreign Secretary has said that Iran must not be allowed to have a nuclear weapon. Does he therefore support the recent targeted strikes by the United States and Israel on Iranian nuclear facilities: yes or no? If not, can he explain how exactly that inaction would have curtailed Iran’s nuclear ambitions?

• 19 Jun 2025 · Business of the House · Hansard source

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  A constituent of mine, Yvonne, has led a brilliant community blister pack recycling initiative in Tattenhall. Through her efforts, the project has picked up pace and is now expanding to other villages including Tarporley, Farndon and Malpas. Hopefully it will get to Chester in the near future. Blister packs made of plastic and aluminium contain valuable materials but are not routinely recycled. The project highlights what local action can achieve and where national systems fall short. Will the Leader of the House make time for a debate on improving recycling for hard-to-recycle items?

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

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  The hon. Lady has just made my exact point: that it is who they deem appropriate. That is the point I am trying to make. It is for the individual—of course, with support of people looking after them—to decide whether it is appropriate for them and to be offered it.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to speak in support of amendment 46, tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, which seeks to strengthen clause 45, an already welcome and progressive clause, by creating a statutory right for all eligible patients to create advance choice documents if they so wish. Let me begin by saying that I think everyone on the Committee recognises the importance of advance choice documents. They are an excellent initiative, and I am glad that the Bill introduces a framework to support their use. I hope we can all agree that they represent a constructive and compassionate shift in how we think about mental health care—one that puts the patient’s voice at the centre. ACDs are fundamentally about empowerment. They allow individuals, while they are well and have full capacity, to record their wishes, preferences and concerns regarding their treatment, so that during future periods of unwellness, when they may lack capacity, their past self can still be heard and respected. As Bipolar UK has rightly put it: “The idea behind an ACD is that you use your past to plan your future.” That simple principle holds immense power. Individuals with lived experience of severe mental illness like bipolar disorder are often experts in their own care. They know what works, what does not and what signs to look out for. An ACD allows that hard-earned knowledge to be recorded, shared and used to guide clinical decisions. By identifying early warning signs and outlining preferred treatments, ACDs can enable families, friends and professionals to intervene earlier, potentially avoiding a crisis or reducing the severity of an episode. This is not just about better care; it is about safer care and, crucially, more timely care. The research is persuasive. Studies suggest that ACDs can reduce rates of compulsory detention under the Mental Health Act by up to 25%. That is not a small statistic; it is a significant reduction in trauma for patients, in the use of force and in resource pressures on services. It is hard to think of a better example of a policy that both improves outcomes and reduces system strain. ACDs can also play a vital role in reducing inequalities, especially among racial minority groups, who, as we have all said, are statistically more likely to be detained under the Act. Ensuring that those patients can express their wishes in advance gives them greater agency and helps to address long-standing disparities in the system. ACDs are not just a useful administrative tool; they are, as Earl Howe put it in the House of Lords, “are a major component part of one of the Bill’s key strands, which is to give mental health patients better control over their own care—which, of itself, carries a therapeutic value.” —[ Official Report, House of Lords, 27 January 2025; Vol. 843, c. 79.] I absolutely agree, which brings me to amendment 46. The clause as drafted places duties on NHS England and integrated care boards to consider making information about ACDs available, and to help those people whom they consider “appropriate” to create one. That is a start, but it falls short of what is needed. The shadow Minister’s amendment would take us further and create a statutory right for eligible patients to create an advance choice document. It would define clearly who is eligible—for example, those previously detained under the Act, those diagnosed with a condition that may require future detention and qualifying informal patients—and would put a clear duty on NHS bodies to inform these patients of their right and to help them to exercise it. This is not about placing a burden on services; it is about ensuring that everyone who stands to benefit from an ACD knows that they can make one and is supported to do so if they wish. I appreciate that the Government have tabled amendments 32 and 33 to clause 45, and I welcome the intention behind them. Amendment 32 requires that NHS England and integrated care boards must bring the availability of this information and help to the attention of such people “as it considers appropriate.” Amendment 33 expands on how that might be delivered, including through conversations with qualified individuals and by having specific regard to the benefits of ACDs in the 12 months following discharge from hospital. Although these are improvements, I must respectfully say that they stop short of what is needed. They continue to frame the duty in terms of who the board considers appropriate, yet the very point of ACDs is that we should not be gatekeeping access. We should not be making assumptions about who would or would not benefit from having one. Every eligible patient should be offered the choice, not just those whom the system deems suitable. We are dealing here with people’s autonomy and right to shape their future care, and if we start from a place of selective provision, we immediately disempower many of the very individuals we claim to support.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Seventh sitting) · Hansard source

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  I will make progress, as I know that a few Members wish to speak on this point, and we have a long day ahead. I will touch briefly on amendment 18, tabled by the hon. Member for Winchester, which suggests that ACDs should include a person’s financial circumstances. I recognise the sentiment behind the amendment. As both I and the hon. Member for Winchester have said in Committee, financial stress can be a major factor in mental health, but I gently suggest that prescribing the content of an ACD in this way is unhelpful. The point of the document is choice. The individual decides what they want to include, not us. That is the strength of the approach. It is personal and voluntary; it is theirs. Amendment 46 respects that principle. It does not tell patients what to include in their ACD; it simply gives them the right to make one, and ensures they are informed of that right and supported to act on it. ACDs can be lifesaving, and they help people to stay well, safe and in control. They are especially valuable for those who have been detained before or who are at risk of detention in the future. We know that they are already supported by a wide range of stakeholders and experts by experience. The question for us is not whether to support ACDs—I think we all do. The question is: do we want to make access to ACDs a universal right for those eligible, or do we want to continue to leave it to the discretion of the system? I believe the answer is clear: we must empower people, honour their voice and do so not only when they are well and able to speak, but when they are unwell and most vulnerable. That is what the amendment seeks to do. I urge all colleagues on the Committee to support amendment 46 and strengthen clause 45. Let us make the right to create an advance choice document a reality for everyone who needs one.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

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  I will take a few moments to reflect on clauses 46 and 47. They deal with aftercare, which is at the heart of how we help people to recover from serious mental illness and reduce the chance of their readmission. Clause 46 will give mental health tribunals the ability to make recommendations about aftercare services—a welcome shift in emphasis towards recognising that recovery is something that happens not at the point of discharge, but in the weeks, months and even years that follow. Until now, tribunals could recommend things like hospital leave or transfer, but they had no say in the vital question of what happens after discharge. Clause 46 gives them a voice in shaping that next phase. It is a step that could help to ensure that aftercare is not an afterthought, but a core part of discharge planning. The effectiveness of this change, however, depends on whether there are services to recommend. As the independent review made clear, the challenge is not just in writing aftercare into law, but in making sure that it is there in practice. Clause 47 takes a welcome step in providing greater clarity and accountability around which local authority is responsible for arranging section 117 aftercare. By clarifying the rules on ordinary residents, especially for people who received care as children, and by requiring that local authorities and NHS bodies jointly issue written notice when aftercare is ending, the clause helps to ensure that decisions are made in a timely and transparent way. That improved clarity should support smoother transitions from hospital to community, reduce disputes between services and, ultimately, help to prevent relapse and readmission. Clarity in law must be met by capacity on the ground, which is why the core question is not just what the clauses enable, but whether the system is equipped to deliver on them. I therefore ask the Minister what assessment has been made of the availability of appropriate aftercare services in the community. Can we be confident that NHS and social care teams have the resources that they need to meet the duty effectively? We know that aftercare, under section 117 of the Mental Health Act 1983, can include support with housing, employment, social engagement and culturally appropriate services, all of which can mean the difference between recovery and relapse, but they only work when they are properly joined up, tailored to the individual and delivered in a timely way. The independent review put it well: “priority should be given to making sure that good services are available to all…But we also believe that it is right that people who have been detained should have additional support to ensure a successful transition to the community.” I agree with that principle. If we want to see fewer people detained, we must do better at supporting people once they leave hospital. I support clauses 46 and 47. They are sensible, necessary reforms that will give structure and clarity to a part of the system that has often been patchy or overlooked. But if we want them to work as intended, they must be backed up by investment in community services, good local commissioning and effective partnership between health and social care. In short, these are good steps but must be followed through with real delivery on the ground if we are to achieve the lasting outcomes that we all want.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

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  It is a pleasure to continue to serve under your chairship, Mrs Harris. I rise to speak in support of new clause 12, which has been tabled by the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, and to comment on clause 54, which has been grouped for this debate alongside it. Those two provisions both deal with the care and treatment of children and young people admitted to hospital for mental health reasons. In doing so, they touch on one of the most sensitive and critical responsibilities we have as legislators: safeguarding vulnerable children at a moment of profound crisis in their lives. Clause 54, as introduced in the Lords, will place a duty on the Secretary of State to review whether the current requirement to notify the Care Quality Commission should be extended. Currently, notifications are required only when a child or young person is placed in an adult ward for more than 48 hours. The clause asks whether that threshold remains appropriate, and whether other scenarios—for example, where a child is admitted for assessment or placed in an adult setting even for less than 48 hours—should also trigger notification. That is a welcome first step, and I support the clause. However, I also recognise the limitations of a clause that asks the Secretary of State only to review existing safeguards, rather than requiring that those safeguards be strengthened. That is why I also support the aims of new clause 12, which sets out a more detailed and practical framework to ensure that children are admitted to adult wards only when there are truly exceptional circumstances, and always with appropriate scrutiny and documentation. The issue has been a consistent concern across multiple reviews, including the independent review of the Mental Health Act, the Joint Committee on the Draft Mental Health Bill, and the Joint Committee on Human Rights. Each has made clear that existing protections are insufficient and that too often, vulnerable children are still being placed in inappropriate settings. That concern was echoed in evidence submitted to this Bill Committee by the Children and Young People’s Mental Health Coalition. Their written submission sets out the risks in stark terms. In 2023-24, the CQC was notified of 120 instances in which a child or young person was placed on an adult ward. We also know that between December 2023 and November 2024, 319 children were sent out of area to receive treatment, often far from their families, schools and local support networks—that is nearly one child every single day. Those are not just numbers; they are children and teenagers, many already facing significant trauma, mental health challenges or adverse life experiences. They are often the most vulnerable young people in our society. How they are treated in the days and weeks following a mental health crisis may have lifelong consequences for their wellbeing, development and future. The Mental Health Act and the code of practice are already clear: children should not be admitted to adult wards except in emergency situations, and even then, only if it is in their best interests. But as the Committee heard in written evidence, that standard is not always met in practice. Young people have reported feeling terrified on adult wards, with an expectation that they behave like adults in environments that were never designed for their needs. That is why new clause 12 is so important: it would give legal weight to existing guidance by requiring that any such admission was explicitly justified in writing, with clear reasons why no other options were available or suitable. The new clause would also ensure that steps were taken to protect the young person during their time on the ward and, crucially, to transfer them to a more appropriate setting as soon as possible. It would also require immediate notification to the regulator when a child was placed on an adult ward or was out of area for more than 24 hours. Those are simple procedural safeguards, but they really matter. Requiring decisions to be explained and recorded helps ensure they are properly thought through, and provides transparency, oversight and a route to accountability. I appreciate that the Government are seeking to address the issue through updates to the Mental Health Act code of practice. I welcome that intention and I recognise the role that the code can play in setting out professional guidance, but, with respect, I do not believe that is sufficient on its own. When children are being placed in adult psychiatric wards, potentially for weeks at a time, or being sent far from home in moments of crisis, we must do more than issue guidance—we must provide clear legal safeguards. This is not about placing unrealistic constraints on the NHS or criticising frontline professionals, who we know are working under significant pressure with limited resources. It is about ensuring that when difficult decisions are made, they are made transparently, in the best interests of the child and only when absolutely necessary. We have a rare opportunity in the Bill to put those protections in place. I hope the Minister will consider the evidence submitted to the Committee, the recommendations of previous reviews and the cross-party consensus on the importance of getting this right. Let us not miss this opportunity to ensure that our mental health system treats every child with the care, dignity and protection they deserve, and to set out clearly and transparently the standards we expect when they are at their most vulnerable.

• 19 Jun 2025 · Mental Health Bill [ Lords ] (Eighth sitting) · Hansard source

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  As we have heard, the clause removes police stations and prisons as designated places of safety for individuals in mental health crises, ensuring that they are instead taken to appropriate healthcare settings. In my view, this is a pragmatic and practical part of the Bill that supports patients going through an extremely challenging time. Perhaps, in the past, it has been all too easy to look to police stations as, if not the default option for those suffering a mental health crisis, certainly an easy one. That is not because police stations are the right place for patients, but because alternative provisions were not readily accessible. Clause 49 brings about several critical changes. First, it redefines “place of safety” so that for adults it now refers exclusively to hospitals that are willing and able to provide care. For children and young people, the definition aligns with the Children and Young Persons Act 1933 but crucially, it explicitly excludes police stations. Furthermore, the clause repeals section 136A of the Mental Health Act 1983, which previously allowed police stations to be used in so-called exceptional circumstances. The crux of the clause is to recognise that a mental health emergency is a medical crisis rather than a criminal one, and our system must reflect that.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

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  My hon. Friend makes an important point. If parents are not acting in the best interests of their children, there is a wider safeguarding issue that needs to be considered. One would question why such parents had been left in a situation in which they have responsibility for their children and are potentially harming them. That leads me nicely to another point, which is that introducing the additional wording would bring mental health in line with physical health. For someone under the age of 16, it is their parents who have the responsibility to act in the best interests of their physical health; it seems to me that one would expect the same for mental health. I therefore urge the Committee to support amendments 54 and 55. Let me return briefly to the overarching aims of clause 24. I underscore the point that the wider principle at stake—patient autonomy—is one that I support. The ability to make informed choices about one’s care should be a central component of our care system. In mental health, where individuals can feel particularly vulnerable, that becomes even more essential. Granting patients the power to nominate someone who will advocate for them, advise them and represent their wishes is a powerful act of empowerment. Moreover, this change enhances safeguards for patients. It ensures that the person acting on their behalf is someone they have chosen and trust. It reduces the potential for conflict and opens the door to a more collaborative and compassionate model of care. If the Committee agrees to the amendments, which would provide the necessary safeguards for children, who I believe should be considered separately to adults, my overall view is that clause 24 represents a pragmatic, compassionate and patient-focused update to the Mental Health Act. It aligns with our modern understanding of mental healthcare and puts trust, respect and dignity at the heart of our legislative framework.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Fifth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Desmond. I rise to support amendments 54 and 55, tabled by my hon. Friend the Member for Runnymede and Weybridge, but I will first briefly speak to clause 24, which is an important and long-overdue step towards modernising the Mental Health Act 1983, crucially strengthening the rights, dignity and autonomy of individuals subject to it. The reform of the existing nearest relative provisions, replacing them with a new system that allows for the appointment of a nominated person, is an important part of ensuring that individuals get the right support, and modernises an outdated system. The current model is based on a rigid and outdated hierarchy in which the role of the “nearest relative” is determined by law, not by the wishes of the patient. This one-size-fits-all approach fails to account for the complexities and nuances of individual relationships. It can result in someone unsuitable, or even actively harmful, being placed in a central role in a person’s care and treatment journey. Indeed, the limitations of the system have been acknowledged by practitioners, patients and policymakers alike. It is too often disempowering, and the patient can lose agency at a time when they need to be empowered to feel in control of the situation as much as possible. As the shadow Minister says, clause 24 is the cornerstone of the reforms. It is an important change to the current legislation to reaffirm the commitment to patient-centred care, to dignity and to the principle that those receiving treatment under the Mental Health Act should have a voice in decisions about their support network. The aim of the clause—to put the patient first—is important. It acknowledges that the person best placed to advocate for the patient may not be their closest relative. In some cases, family dynamics are fraught. In others, the designated relative may hold views about treatment that conflict with the patient’s wishes or medical advice. We have seen real-world examples in which the imposition of the “nearest relative” role has led to tension, distress and, ultimately, a breakdown in trust. That is not the kind of environment in which recovery is fostered. Amendments 54 and 55 would address the specific issue of nominated persons and those with parental responsibility for children under the age of 16. It is important that we consider situations in which a young person may be in a vulnerable position and their decision on who their nominated person should be may not be in their best interests. We have a particular duty to ensure that children are safeguarded. Clause 24 as it stands will allow under-16s to choose someone who is not the parent to have significant power, including the ability to discharge the child from hospital. We must listen to and actively try to support any young person who needs that kind of intervention—it is not that their views should not be considered. However, there is a very real risk that a vulnerable child or teenager might be coerced by or under the control of an older partner, for example, as my hon. Friend the Member for Hinckley and Bosworth pointed out. Perhaps they might choose an older friend. We need to consider that a decision made by the nominated person, such as an older friend, may have implications for those with parental responsibility. For example, that older friend may decide to discharge a child from hospital and into the care of the parents, who would not provide advocacy or be part of that decision making. The Minister said that safeguards will be put in place, but can he expand on that? There are some real concerns here. Let us consider a situation in which there has been a decision by a court to determine which parent has responsibility for the child. If complex family issues have already been considered by the family court, it is right that the decision be followed. I respectfully ask the Minister to reconsider this point. We must respect the fact that parents of those under 16 are best placed to advocate for, support and act for their children. This is about capacity, consent and, ultimately, safeguarding.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  I rise to speak to the implications of clause 34 for clinical decision making, patient safety and the operation of the Mental Health Act more broadly. The clause introduces a new requirement for the responsible clinician to consult another professional, from a different professional discipline, who is involved in the patient’s care before they make a decision to discharge a patient from detention or from a community treatment order under section 23 of the Mental Health Act 1983. If the patient is on a community treatment order, the clinician must consult the relevant community clinician. At its heart, the clause seeks to ensure that decisions about discharge are not taken in isolation. It reflects a wider shift in mental health care towards collaborative, multidisciplinary approaches. We should welcome that in principle. These are often complex decisions that involve vulnerable individuals, and a single viewpoint may not always capture the full clinical picture. By requiring consultation with someone from another discipline, be that a nurse, an occupational therapist or a psychologist, we can help to ensure that decisions are more thoroughly considered and less likely to overlook risks. The clause provides an important safeguard against premature or inappropriate discharge, particularly in cases where a patient may continue to pose a risk to themselves or others. It builds in a degree of professional scrutiny that supports safer and more consistent practice and, in doing so, should improve confidence among patients, families and practitioners. I would be grateful if the Minister provided further clarity on a few practical points about how the clause will operate. First, it requires consultation but does not appear to specify whether the consulted clinician must agree with the responsible clinician’s decision in order for discharge to proceed. In cases where there is disagreement between clinicians of different professional backgrounds, what is the expected course of action? Is the responsible clinician ultimately free to proceed, or will there be an escalation mechanism? It would be helpful to understand how differing professional opinions are to be balanced and how potential deadlock is to be managed. Secondly, although I welcome the intention to improve the rigour of decision making, will the Minister reassure the Committee that the additional consultation requirement will not introduce unnecessary delays into the discharge process? It is, of course, essential to get these decisions right, but it is also important that we do not create new barriers to discharge when a patient is clinically ready to move on. Delays in discharge can have a negative impact on patient outcomes, as well as increasing pressure on services. Although the consultation must be meaningful, it should also be proportionate, timely and clearly understood by all involved. Will the Minister comment on how the requirement will be implemented in practice? For example, will guidance be issued to support clinicians in understanding their duties under the clause and to ensure consistency across services? Overall, the clause represents a thoughtful and measured reform. It strengthens patient safety, promotes professional collaboration and introduces a safeguard that is both reasonable and necessary. Notwithstanding the clarifications I have raised, I hope that it will help to ensure that discharge decisions are made with greater confidence and care without becoming unduly bureaucratic.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  My hon. Friend makes an important point. This is not a simple or straightforward addition; it would require potentially substantial training. We would not want somebody in a role that they were not adequately prepared for. With any amendment, we would need to ensure that training, and the time and expense of it, had been factored in. Even with the best intentions, the success of any extended support role, such as that envisaged in the amendment, will ultimately rely on the availability and integration of local services. Where appropriate services are in place and are working well together, advocates can play a valuable role in signposting and supporting access. Rather than placing additional responsibilities on the IMHA, our focus should be on working with community providers to ensure that the necessary support, particularly for social and financial needs, is consistently available and is effectively joined up across the system. Having said that, I recognise and welcome the emphasis placed by the hon. Member for Winchester on the role of carers and family members. Too often, they are overlooked in discharge planning, yet their involvement can make a critical difference to a patient’s successful transition from hospital to home. When carers feel informed, supported and prepared, it gives patients the reassurance and stability that they need to continue their recovery with confidence. The primary responsibility of the independent mental health advocate, however, must remain their responsibility to the patient. I am concerned that the drafting of the amendment could create ambiguity about who the IMHA is principally there to support. Financial stress is undoubtedly a real and urgent concern. Mental ill health can severely affect an individual’s capacity to work, to manage their finances or even to engage with systems of support. Equally, financial instability can exacerbate mental health difficulties. Those are serious challenges that must be addressed, but I would question whether the IMHA is the right professional to take on that role directly. Instead, we should ensure that they are well placed to refer individuals to appropriate services without assuming responsibility for co-ordinating that support themselves.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  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.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  I rise to speak to clause 41, which brings into sharper focus two pillars of a fair and rights-based mental health system: the provision of clear information to patients and the strengthening of independent mental health advocacy. It rightly recognises that, when a person is detained under the Mental Health Act 1983, often during a period of acute crisis and difficulty in their life, they need to feel that their clinical needs are being met, but in a way that respects them as individuals, with the same entitlements to dignity and agency as any other member of our society. The clause provides for informal patients to be eligible for an independent mental health advocate. I welcome the extension to enable more individuals to access this vital advocacy. It empowers patients to know that independent advocacy is available, but we must ensure that there are sufficient resources so that those who choose this help are given sufficient support when they are in a potentially vulnerable position. As someone representing a constituency that is in England but borders Wales, I also welcome that these changes bring care into line so that advocacy help is offered to informal patients, regardless of which side of the border they are accessing treatment. The clause places a renewed duty on services to ensure that information is given to patients clearly, promptly and in a form that they can understand. It introduces an obligation for advocacy providers to determine, through an interview, whether a qualifying patient wishes to use the service. This support is important; no person should be expected to navigate the complexities of mental health legislation, or their rights under it, without proper guidance. However, where there is a duty “on hospital managers and others to notify providers of advocacy services about qualifying patients”, can the Minister clarify who is meant by “others”? Will there be a list of people and roles who are given this responsibility? The role of an independent mental health advocate is vital. These individuals can be a lifeline. They can help people to understand their rights and any medical treatment, and crucially, can support an individual to have their say about any treatment. Clause 41 rightly reinforces the importance of independent mental health advocates, and it is important that we match that ambition with the legal and practical steps to support them. It is entirely right that we welcome the recognition of the role of independent mental health advocates, who serve a vital function in ensuring that patients’ voices are heard and their views represented, especially when navigating what can be an incredibly complex legal and clinical environment. Their independence is fundamental to not only their effectiveness but the confidence that patients and families can place in the system, which brings me back to my point. It is therefore important that we support independent mental health advocates with the resources that they need to do their job effectively. If we are to rely further on advocates, we need to ensure that they are in a position to deal with that, so that we do not create statutory entitlements that are difficult to act upon. Actions, as well as words, are needed. At present, many areas already struggle with advocacy coverage. If we now place additional expectations on the service, and I believe that we will through this provision, we must ensure that there are sufficient numbers of trained, experienced independent mental health advocates across the country to meet rising demand. Can the Minister reassure the Committee that the necessary people with the skills and training are available to fulfil this expanded role? We must also consider the patients’ experience, as has been the focus of so many of the remarks made in the Committee today. Again, I emphasise the vulnerability of patients at times of crisis. If we are to tell patients that support in the form of an advocate is there for them, we need to ensure that it is accessible and easy to reach and understand. Clause 41 moves us in the right direction, but implementation is everything. It must be backed by local accountability, adequate funding and clear operational guidance. This includes ensuring that all patients, regardless of background, language or capacity, are given support that is appropriate and effective. It is vital to consider the wider implications of this clause. The reinforcement of the independent mental health advocate’s involvement should be mirrored by greater investment in advocacy services, stronger integration with care planning and more regular engagement with patients themselves on how these services work in practice. In our earlier discussions, my hon. Friend the Member for Farnham and Bordon suggested that we use trials, which could also be considered here to ensure that, as changes are brought in, they are matched by appropriate service levels. I am largely supportive of clause 41, which I think moves us in the right direction towards a transparent mental health system that is there for patients, ensuring that they have a voice and are not an afterthought. As long as it is deliverable in practice, and does not give false hope to patients, the clause strengthens the Bill.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  That is an important point. These are quite substantial changes, and we do not know the full impact that they would have on the system. We have talked about issues such as whether there is sufficient training for advocates and a joined-up approach with what is happening in the community. A pilot would provide the opportunity to see where it is working and where there might be things that need to be changed or considered. It would certainly be a sensible approach. We all want to ensure that we are supporting individuals to be discharged in a safe way that minimises the likelihood of their being readmitted, but we need to do so without overcomplicating the roles and the system that are currently in place. I commend the hon. Member for Winchester for bringing these important issues to the attention of the Committee. His amendment raises legitimate and timely concerns around the support offered to individuals leaving hospital, as well as the wider context in which recovery takes place. I hope that I have been able to offer some reflections that will assist hon. Members in considering the matter further.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  On the discipline of the second clinician consulted, is there any guidance as to who might be appropriate? I mean not just the list of potential professions but whether there is guidance on who would be appropriate in different situations. We welcome the multidisciplinary approach, but I would like some clarification. Given your earlier response, saying that they need to agree, it is not really clear how this would add to the process. It would help if there were clarity on the professions.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  I rise to make a few brief remarks about clauses 42 to 44, which would amend the 1983 Act to place statutory duties on hospital managers to supply complaints information to both the patient and the nominated person in respect of detailed patients, patients subject to a CTO and conditionally discharged patients. These are important clauses. The people concerned are potentially vulnerable individuals. They need to know that they have a voice in this process and feel empowered to speak out and complain, should they wish. There is a duty on hospital managers to ensure that detained patients understand how to make complaints. However, I ask the Minister how that duty will be checked and evaluated. We all agree that the ability to speak out to make a complaint is important, but we need to ensure that proper safeguards and parameters are in place on how that will happen. I also welcome the provision requiring that the information must be provided as soon as is practicable. That is important to give patients confidence. The timing requirements will potentially make a huge difference. The journey of a patient may change rapidly over the course of their treatment, so not leaving it too long will potentially make a substantial difference to their ability to recover swiftly, and ensure that they have been able to speak out if they are concerned not just about their detainment but about the way that their treatment is being carried out, and the potential implications of that. Like many of the measures that we have discussed, these clauses might have administrative implications. We need to ensure that we have fully considered and are able to put in place the necessary support for hospital managers to deal with complaints appropriately. It is important that if someone comes forward with a complaint, it can be dealt with swiftly. As mentioned on some other matters, we need to ensure consistency for patients, so that they understand the information that they are being provided and that, whatever region they might live in or hospital they might be at, consistent information is provided. I would like the Minister’s reassurance on that point. Overall, however, the clause improves patients’ awareness of their rights and how they can seek redress. I think we all agree that that is extremely important. It will promote accountability in mental health services by encouraging feedback and complaints. I would like reassurance of some oversight to ensure feedback on any complaints that come forward so that we identify where consistent issues come up, to provide better services not just to the individual but to future individuals. Overall, the clauses support better outcomes by addressing potential grievances and ensuring that they are addressed early and constructively, so I am supportive of them.

• 17 Jun 2025 · Mental Health Bill [ Lords ] (Sixth sitting) · Hansard source

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  Does the Minister have any more detail on that? Is there a timeframe for recruiting these advocates and putting the training in place? That would help reassure the Committee that there is provision to ensure that the timing will fit with the introduction of the changes in the Bill.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source

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  It is extremely important that people are not put at risk, and that is exactly the point I have been making. People need to be properly trained, and we need to set out who those individuals can be, rather than leaving ambiguity in the wording. The Government amendment will undo exactly the protection that the hon. Lady rightly points out.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source

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  It is a pleasure to serve under your chairship, Ms Furniss. Government amendments 26 to 29 risk undoing some of the good work done in the other place, where careful improvements were made to strengthen the Bill and ensure a more compassionate and effective response to mental health crises. I am concerned that by removing the words “by a constable or other authorised person” and deleting clause 5(7), which provides a clear definition of who the authorised persons are, we will open up ambiguity about who is permitted to detain someone under the Mental Health Act. This is not just a technical or drafting issue; it has very real consequences for the people involved. I understand and support the principle of enabling more flexible and clinically led responses to mental health incidents. We all recognise that the police should not be the default option in every case. The amendments made in the Lords acknowledged that and broadened the group of people who could respond to mental health crises beyond police officers to trained and equipped professionals: mental health nurses, approved mental health professionals, paramedics and, crucially, someone trained and equipped to carry out detentions under the Act and who would not be put at unnecessary risk by doing so. “Trained and equipped”—that is the key point. The definition of “authorised person” in the Bill as it stands makes it clear that those given such a serious responsibility must have the appropriate training and experience and must not be “put at unnecessary risk” when carrying out that role. That wording is important. As the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth, said, it provides a framework of accountability, not a free-for-all. By removing that structure, the Government’s amendments will leave a legal vacuum. The law will say that someone must be detained, but not by whom. That uncertainty will create a risk that services will simply revert to defaulting to the police. I stress again that that is not fair on the police, who are already under immense pressure. Yes, they are used to seeing people at their most vulnerable, but dealing with someone in a mental health crisis is a very particular challenge, and one that they might not be fully trained to manage. The College of Policing’s 2019 mental health snapshot found that almost 95% of police call-outs flagged as involving mental health did not actually require a police response, yet police officers continue to be sent out because the system lacks clarity and capacity elsewhere. Baroness May, speaking from real experience as a former Home Secretary, made that very point in the other place. She said that police officers were being sent to mental health incidents for which they had no training or clinical expertise, and were being asked to make judgments that they simply were not equipped to make. She went on to say that “the very essence of a police presence—somebody in the uniform coming to deal with them—could actually exacerbate their mental health situation”. —[ Official Report, House of Lords, 20 January 2025; Vol. 842, c. 1525.] I would add that, for the individual experiencing a mental health crisis, being approached by the police may feel criminalising rather than supportive. It reinforces a justice-led response rather than a health-led one. That is not the direction in which we should be going. Although I welcome the Government’s intention to offer more flexibility in emergency and clinical settings, we have to be careful about how we achieve that. Removing the wording inserted into the Bill will not create clarity; it will create confusion. In a system already under pressure, confusion tends to mean delay, risk aversion and inappropriate responses. Removing the specification will not free professionals; it will expose them, and it will expose patients to the possibility of being handled by someone without the right qualifications, which may worsen their condition or create a longer-term distrust of mental health services. I hope that the Minister can offer some reassurances, both about who will be expected to carry out these detentions and about how we can ensure that they have the proper training, resourcing and protection. Without a clear definition of “authorised person”, we cannot be confident that those involved will have the right expertise to support extremely vulnerable individuals at times of acute need. I want to touch briefly on the importance of early intervention and de-escalation. Situations involving mental health crises can often be tense, and support in the early moments can be critical. De-escalation is a vital skill; the presence of a calm, trained mental health nurse, for example, in those early moments can change the outcome of a person’s crisis. Having the right professional present—someone who can act without waiting for the police to attend—can be the difference between escalation and calm. The identity of the responder matters. This is not just about outcomes, but about the experience of the individual. Removing the criminal justice framing from the outset is essential to delivering dignity and the right kind of care.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source

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  My hon. Friend helpfully expands on the points that I and other Opposition Members have been making. If we are not careful, the Government amendments will move us further away from the aim of a person-centred approach. I urge the Minister to reconsider the amendments. The wording inserted in the other place struck a thoughtful balance. The wording inserted in the other place struck a thoughtful balance. It allowed flexibility, but grounded it in clear criteria of training, safety and competence. Removing that definition will weaken the Bill. It will make it harder, not easier, to ensure that the right person is supporting someone at their moment of greatest need. We owe it to patients, professionals and the police themselves to get this right.

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Fourth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak in support of amendments 44 and 45, which have been tabled by my hon. Friend the shadow Minister. These amendments seek to put patients at the centre of the Bill by promoting a safe therapeutic environment and recovery from any childhood trauma. Clause 8 provides for a new definition of “appropriate medical treatment”, which requires that treatment to have “a reasonable prospect of alleviating, or preventing the worsening of…a patient’s mental disorder.” Amendment 44 would introduce an additional criterion to the definition of “appropriate medical treatment” by establishing that an appropriate medical treatment should not only address the individual’s immediate health needs, but be designed with the intent to reduce psychological distress and actively support an individual’s recovery from the effects of childhood trauma. This recognises the long-term impact that early, adverse experience can have on mental and emotional wellbeing and ensures that treatment approaches are trauma-informed, compassionate and conducive to long-term improvement. People who present with serious mental health concerns need to know that they are receiving support and care in the right environment. They are at their most vulnerable, and having the confidence in their environment can make a world of difference. That is particularly pertinent for those who have suffered childhood trauma. It is important that we deal with the consequences of mental ill health, and adequately address the root causes. Among these, childhood trauma is one of the most serious and persistent factors contributing to long-term psychological conditions. By supporting this amendment, we would create a more resilient system that is equipped to respond to the reality and prevalence of childhood trauma in our society. I recently met with Alison, who heads up a fantastic organisation called WeMindTheGap. It is based in Wrexham, but it is now moving and expanding to cover parts of my constituency, Chester South and Eddisbury. It does a fantastic job supporting young people who have struggled in the conventional education system, are absent from school or have dropped out of the system. We discussed childhood trauma and the rise in the number of young people not currently in any kind of education. One of the points that Alison made that resonated with me is that absence from school is linked not just to deprivation, but many contributing factors, including difficult domestic situations, isolation and rural isolation. Many of these challenges are the most severe ones linked to childhood trauma, and although there are many wonderful organisations stepping in to support young people at an early stage, for some the impacts of childhood trauma continue to affect psychological wellbeing into adulthood. Sadly, childhood trauma is a societal issue that we face, and it is more common that we might imagine. Therefore, a step to embed trauma-informed care into the legal framework, specifically for childhood trauma, is a step in the right direction. Childhood trauma can lead to self-destructive behaviour in adults. There is, as my hon. Friend pointed out, evidence to show that it is a causal factor. We must recognise the long-term impact of adverse childhood experiences on mental health. This amendment, by adding a new criterion to the definition of “appropriate medical treatment” to require that treatment to aim to minimise distress and to support recovery from childhood trauma, would embed trauma-informed care into the legal framework. Amendment 45, by inserting the words “seeks to minimise the patient’s distress and promote their psychological wellbeing and recovery from any childhood trauma”, would reduce the risk of re-traumatisation. Responses to symptoms or behaviours must be supported; it is about helping people to move towards genuine recovery. Childhood trauma is unique, and it presents symptoms that are different from other mental health illnesses. Therefore, having a dedicated, compassionate and person-centred approach to care is incredibly important. Setting the right culture to support patients, recognising the trauma that they carry and ensuring that there is adequate support and provisions in the legislation and the legal framework, is the right approach. I am therefore pleased to support these amendments, which would strengthen clause 8.