Sojan Joseph MP: speeches

Speeches

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

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  As a clinician, I hope that the hon. Gentleman will understand what I am trying to say. There are many mental health patients who do not have any insight into their illness and often refuse to take medications. It is important that, as the clause says, “‘qualifying person’ means a person who has capacity or competence to make the statement,” so that people do not make inappropriate decisions in their advance choice documents. It is important to keep the clause as it is, whereby a qualifying person is someone who can make a competence decision.

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

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  Does the hon. Member agree that section 136 is used when the police are alerted to a disturbance in a public place? If I saw a disturbance outside the Palace of Westminster, I would call the police, not a mental health professional. If the police arrive and think that the person is suffering from a mental illness, they will use the power under section 136. How can we give powers to health professionals to attend a public disturbance?

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

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  I thank the hon. Member for that important intervention. Healthy conflicts between professionals can be useful and can be used as a reassurance to people who are concerned about the overuse of CTOs. However, capacity can sometimes be an issue, especially in community settings, an issue that new clause 4 addresses. It is also important to understand that mental health services have changed over the years. The consultant who treats the patient in hospital may not know much about them or how they are in the community. In the past, all those patients were followed by a care co-ordinator—not necessarily a mental health psychiatrist, but a mental health nurse or social worker who followed the patient throughout their journey and kept an eye on them. We do not have enough capacity these days, so nobody is following the patient. A community treatment order helps them to have at least minimum contact when they have to go and see a patient to administer medication. I support that conflict—sometimes it can be very healthy—but I also acknowledge that we need more capacity in the community. Clause 22 makes a new distinction between a patient’s responsible clinician with overall responsibility for them, including in hospital, and a community clinician with the responsibility for the patient in the community. It will impose specific duties on the community clinician where they are not the responsible clinician. For example, subsection (2) will amend section 17A(4) of the Mental Health Act to require that where the responsible clinician is not the clinician who will have care for the patient in the community after their discharge, that community clinician must also agree in writing that the community treatment order criteria are met. That will ensure continuity of care of the patient from the hospital into the community, and it will have the added benefit of additional professional oversight in respect of the need for a community treatment order. That is to be warmly welcomed. I also highlight subsection (4), on the power to recall a community patient to hospital. That will mean that if the community clinician is not the responsible clinician, the community clinician will still need to be consulted before a patient can be recalled under the community treatment order, unless such a consultation would lead to an unreasonable delay. That seems an entirely welcome and sensible reform. In some cases, an unreasonable delay may not be helpful, because some patients need to have their medication at regular intervals. For example, a patient on clozapine who misses their medication for three or four days in a row may have to restart their whole treatment regime, which will mean an even longer in-patient admission process. Subsection (6) will require a community clinician to make a statement in writing, if they are not the responsible clinician, in support of the renewal of a patient’s community treatment order, if that is the conclusion of the responsible clinician. Getting written confirmation from the community clinician who is intimately involved in the patient’s care that a renewal of the community treatment order is both necessary and appropriate and is the correct thing to do. Once again, it is about ensuring that a further professional opinion is considered; it is also about checking whether the patient still needs the support of a community treatment order. Clause 23 will make changes in relation to the conditions that a person subject to a community treatment order may be required to follow. It will amend section 17B of the Mental Health Act so that conditions can be imposed only if they are “necessary”. This is a simple and welcome update from the current wording, “necessary or appropriate”. Clause 23’s second modernisation is to give the tribunal a new power to “recommend that the responsible clinician reconsider whether a condition…in the community treatment order is necessary”. This would apply when the tribunal has decided not to discharge a patient completely from a community treatment order, but has come to the conclusion that not all its conditions are required. Once again, this is a welcome reform and is in line with the principle of therapeutic benefit. Some conditions put on patients can be seen as restrictive: for example, if a condition states that patient cannot use alcohol or illicit drugs, the clinicians will be looking at whether the patient’s use of alcohol or illicit drugs has an impact on their mental state or on their non-compliance with treatment. That is very important. I welcome the changes in clause 23.

• 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 welcome the changes proposed in clauses 22 and 23. Clause 22 seeks to amend the Mental Health Act to require the community clinician responsible for overseeing the patient’s care as a community patient to be involved in decisions regarding the use and operation of community treatment orders. While I was practising as a mental health professional, I was personally involved in many community treatment orders and in recalling patients to hospital. Although I acknowledge the concerns raised by various charities and members of the Committee about the overuse of community treatment orders and restrictions on patients, such orders have many benefits. As the Minister has highlighted, they help to release the pressure on in-patient settings. They also help patients to live in a home environment: without such provision, some patients would have to stay in hospitals for longer, which can be more restrictive than being in the community. The Committee needs to understand the kinds of patient who are often considered for community treatment orders. These patients are already well known to mental health services. They may have a long-term serious mental illness and may have to take medication continuously. More often, they are on regular injections of what is called depot medication; mental health professionals administer such medication either once a month or once every three months. Community treatment orders enable clinicians to make sure that patients receive the medication they need, so that they do not relapse and so they can have a good quality of life. By introducing an additional professional check on whether the patient really needs the support of a community treatment order, and by requiring more evidence that the patient needs the support of the community treatment order to get better, clause 22 will adopt two of the four principles of treatment proposed in Sir Simon Wessely’s independent review, namely the principle of least restriction and the principle of therapeutic benefit.

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

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  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?

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

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  I welcome the strengthening of section 132 of the Mental Health Act in respect of information about complaints, as proposed in clauses 42 to 44. Clause 42 deals with information about complaints for detained patients. Currently, through the code of practice, there is a requirement that hospital managers will pass on that information. They should do so both orally and in writing, ensuring that the information is accessible, including in easy-read format for people with learning disabilities. Hospital managers should also ensure that the information has been understood. The clause would amend section 132 of the Act by placing that statutory duty on hospital managers, supplying detained patients and the nominated person with the necessary information about complaints, and taking practicable steps to ensure that the information has been understood. Proposed new subsection (2A) deals with the types of complaints covered by that duty. They include complaints about carrying out of functions under the Act and about medical treatment. Proposed new subsection (2A)(c) ensures that the statutory duty covers information about the patient’s right to complain to the Parliamentary and Health Service Ombudsman about the maladministration of such complaints. Proposed new subsection (2B) sets out that the duty is triggered “as soon as practicable after the commencement of the patient’s detention”. That means that the duty will be triggered each time the section under which the patient is detained changes, and when the authority to detain under that section is renewed. In respect of part III of the 1983 Act, which concerns restricted patients to whom automatic renewals do not apply, the duty will be triggered every 12 months from the start date of detention. As I mentioned earlier, much of that process is already expected to take place, but ensuring it takes place in future by making it a statutory duty is a sensible and welcome strengthening of that safeguard. That is also the case for clause 43, which relates to information about complaints for community patients and seeks to amend section 132A of the 1983 Act. As a result of the clause’s changes, there will be a statutory duty on hospital managers to supply information about the complaints procedure, as set out in clause 42, to community patients and the nominated person. That will mean that the patient must be provided with complaints information as soon as practicable after they are placed under a community treatment order, and each time that community treatment order is renewed. Clause 44 deals with information about complaints for conditionally discharged patients and inserts proposed new section 132B, which requires hospital managers to give complaints information to conditionally discharged restricted patients. The proposed new section states that such information must be provided before the patient leaves hospital, or as soon as possible when the patient is conditionally discharged. Patients must receive the information when they are first detained in the hospital, and again whenever they are conditionally discharged. As with clause 42, the hospital manager must ensure that the patient has received such information both orally and in writing, and that practical steps have been taken to ensure that the patient understands the information. A copy of the information must also be given to the nominated person within a reasonable timeframe, unless the patient has requested otherwise. I support the clauses, as the changes made by it will strengthen the Act.

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

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  I was a clinician and I practised on wards; patient records are electronic for staff. When staff complete the explanation of section 132 rights, they record that on the electronic patient records. Does the hon. Member agree that that would be a good place to get the data?

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

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  Does the hon. Gentleman agree that CTOs help to keep people out of hospital so that rather than having long-term admissions, they can live in the community and in their own house, and that clinicians can recall patients to hospital if they are not complying with the agreed treatment?

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

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  What the hon. Member read is absolutely right. I was talking about sections 135 and 136. I am talking here about sections 2, 3 and 5. I absolutely stand by what I said about sections 135 and 136, and I am happy to come to that. As a former mental health nurse, I certainly would not support giving the police greater powers under sections 2, 3 and 5 of the Mental Health Act. I am also opposed to the amendments passed in the other place because I believe that the extension of legal powers held by the police to other healthcare professionals would represent a major shift in the roles and responsibilities of healthcare and care professionals, placing significant additional pressure on the NHS and social care providers. The Royal College of Psychiatrists, the Royal College of Nursing and the British Medical Association are among the health and social care organisations that have warned against such an extension, saying that it is “a radical proposal with a number of serious and potentially dangerous consequences”. Those organisations also point out that the proposed extension has not been properly tested with relevant health and social care professionals and has been given minimal serious consideration during the eight years in which reform of the Mental Health Act has been under discussion. The majority of assessment under the Mental Health Act already happens without police involvement. However, where the police may be required to make a detention, I know from my experience working in mental health that the presence of officers can often ensure that an otherwise risky situation remains contained and everyone remains safe. Entering someone’s home without permission is fraught with huge risk and currently is done only with the assistance of police intelligence. Under section 135, health professionals ask the court for an order to remove somebody forcefully from their residence and the police use that order to do so; sometimes, they have to break in. That is the power that the hon. Member for Hinckley and Bosworth spoke to earlier. Without it, health and social care professionals would be expected to enter homes without police help, and without crucial intelligence that could ensure their safety. As Dr Lade Smith, the president of the Royal College of Psychiatrists, said: “It is well known that at times, people experiencing a mental health crisis cannot be safely reached and cared for without the assistance of the police. Delegating police powers without proper consultation or planning is likely to disproportionately affect those from minoritised backgrounds and would increase risk to patients and compromise the safety of others. It sets a dangerous precedent.” I am also concerned that the amendments passed in the other place granting police powers to authorised persons risk damaging their therapeutic relationships with patients. They would have the effect of lessening clinicians’ ability to treat patients, and I fear that patients would be less likely to attend an appointment if they thought they might be forcibly detained by the clinician.

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

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  Does the hon. Gentleman agree that this is more an issue of practice than of the law itself?

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

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  Does the hon. Member agree that, since detentions under sections 2, 3 and 5(4) of the Act often happen in clinical settings, are completed by consultants, psychiatrists and social workers, and do not involve police, we do not actually need police presence on these occasions?

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

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  I rise to support the Government amendments, which will simply remove the words “by a constable or other organised person”. On Second Reading, I highlighted my concern about the amendments made to the Bill in the other place that sought to extend police powers of detention under sections 135 and 136 of the Mental Health Act to other organised persons, including medical practitioners, approved mental health professionals, mental health nurses or doctors and further healthcare and social care professionals. I know that the noble Lords who introduced the amendments intended to remove the need for the police to be present at mental health incidents in the absence of any risk. However, they would grant the police greater powers; as an unintended consequence, they would also apply to detentions under sections 2, 3 and 5 of the Mental Health Act, where the police currently do not have power to intervene. A section 2 application is completed by two doctors and a social worker, and the patient may already be in a clinical setting. Section 3 relates to somebody who is already receiving treatment or already has a known diagnosis in a clinical setting. Doctors’ powers extend to that section; the police currently do not have any role in completing a section 3 application. Section 5(4) provides nurses with a holding power for a patient who is already in the clinical setting, where the nurse believes that the patient is at immediate risk; again, the police have no role. If we did not make the Government amendments, we would give more power to the police to get involved under those sections of the Mental Health Act and put more pressure on police services.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (First sitting) · Hansard source

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  In the past, many people with mental health disorders have been detained in hospitals for months or even years because of a lack of proper social care provision in the community. Will the Minister also ensure that local communities, which will be providing social care for patients who are discharged from hospital, are part of that discussion?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I will briefly trot through the proposed amendments and new clause. We all know that the closure of learning disability hospitals was a gradual process. The reason was the institutionalisation of some of those patients, as seen in the Winterbourne View scandal. The aim was to create new community-based housing to look after people with learning disabilities and autism. Amendment 20 seeks to create appropriate fully staffed crisis accommodation. Will the Lib Dems clarify whether they are looking to create more in-patient settings? Are we going back to where we were years ago, or should we work with the new plan to create more community-based accommodation? Not all patients with a learning disability or autism need detention or community-based accommodation. Many of them are looked after by their family members, so we also need to look into the support we are providing to carers, so that we can keep those people at home with their family member’s support. I will keep this brief: as a member of the all-party parliamentary group on adult social care, I recently met with many people who have lived experience of this. They want their views to be heard. They are not asking for more hospital settings; they are asking for more support, including for carers. I was pleased to see that the Minister for Care was there to engage with those people. In the new NHS 10-year plan, the focus is on moving care from the hospitals to the community. Can the Minister clarify how we can make that happen? We have talked about that for many years, but we have never seen it happening. In my own experience practising in a mental health ward, many patients with a learning disability and autism were detained and, as the hon. Member said, kept in hospitals because we could not find a suitable place for them to be discharged to—it was not that they needed the hospital. I think we are all talking about the same thing, but we need to find a solution. That is why the new NHS 10-year plan and its focus on moving care from the hospitals to the community is important. Again, can the Minister clarify how we will do that? The Government have already started the work, and the new commission, led by Baroness Casey, should also be looking into where we will find the social care support for carers and the community provision for people with learning disability, rather than just creating more crisis accommodations.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I rise briefly to speak about training in our health settings. There is, in fact, too much mandatory training in NHS and care settings; the issue is that we are not complying with it. We also heavily rely on agency staff, whose training often nobody monitors. It is not that we are short of training. As my hon. Friend the Member for Thurrock mentioned, the Oliver McGowan training was rolled out across the NHS.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  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?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  Not at all. I am not claiming that there should not be training for people who work in any settings; I am saying that more and more training has been added every time we learn something and yet compliance with the training requirement is not being monitored. That is the point I am making—not that we do not need the training. I support training, because appropriate training is necessary, but we also need to ensure that the people who work in those settings are compliant with the training. That is the larger point I am making. This is not about the amount of training we might want to add to this legislation; we need to ensure that existing training is completed by the staff working in those areas.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I hope that Baroness Casey completes her commission work and gives us her report. It was promised in the Chamber that the initial report would be available within a year. Regardless of whether she is taking up another role, I hope there will not be any delay and that we get that report and a detailed report within three years. I am looking for a solid plan to fix this problem forever. I am not looking for sticking plasters or an immediate fix, but we need a plan, perhaps including a national care service. These are the people who are looking for a long-term solution to these problems. The hon. Member asked about how I will vote; unfortunately, I will not be supporting new clause 11. The Government have already started some work, which is why I am specifically talking about the NHS 10-year plan to move care from hospitals to the community, along with the social care commission, which is looking into how we can get good progress on that. This is the answer; we need to get a long-term solution to this problem.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  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.

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

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  I welcome this Government’s progress on reducing NHS waiting lists in physical health, but there are currently 1.6 million people on mental health waiting lists. People are eight times more likely to have to wait 18 months for treatment if their condition is mental rather than physical. Research by the charity Rethink Mental Illness shows that long waiting lists can lead to deterioration of symptoms, suicide attempts and people dropping out of the workforce. Will the Leader of the House find time for a debate on mental health waiting times so that we can address this crisis in our NHS?

• 19 May 2025 · Mental Health Bill [Lords] · Hansard source

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

• 19 May 2025 · Mental Health Bill [Lords] · Hansard source

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

• 19 May 2025 · Mental Health Bill [Lords] · Hansard source

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

• 19 May 2025 · Mental Health Bill [Lords] · Hansard source

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

• 22 Apr 2025 · Topical Questions · Hansard source

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  T8. Restricted patients are mentally disordered offenders who are detained in hospital for treatment and are subject to special controls by the Justice Secretary. What additional support is my right hon. Friend’s Department providing to help mental health trusts to treat and rehabilitate these patients, so that they can be released from this secure environment in a timely manner?