Mental Health Bill [HL]

Committee (1st Day)

Clause 1: Principles to inform decisions

Amendment 1

1: Clause 1, page 1, line 11, at end insert—

“Equity

addressing inequalities in treatment, particularly racial inequalities, outcomes, and related provisions regarding protected characteristics”

Member’s explanatory statement The purpose of this amendment is to include a fifth guiding principle to ensure that there is equity in treatment and outcomes addressing inequalities related to protected characteristics, particularly racial inequalities, in the operation of the Code of Practice and the Mental Health Act 1983 more generally.

My Lords, in moving Amendment 1 standing in my name, I will also speak to Amendment 3 in my name. There are other important amendments in the name of the noble Baroness, Lady Whitaker, in this group.

Before I turn to my two amendments, I would like to make one general point. On these Benches we very much welcome this long-overdue Bill and will work with others to strengthen it further. The 1983 Act, which we are amending, is more than 40 years old and no longer reflects current understanding, attitudes or best practice in relation to severe mental illness or learning disability and autism. We need to ensure that the final law is truly fit to serve people’s needs for years to come, and our proposed amendments reflect a comprehensive effort to strengthen mental health services by promoting equity, tackling racial disparity, supporting the well-being of children and young people and ensuring that adequate resources are in place to deliver the Bill’s provisions.

A brief look back at the history shows that significant changes to mental health legislation happen on average every 15 to 20 years. That is understandable because it takes time for legislative reforms to take shape and be implemented. This Bill is likely to be the legislation that impacts on the health and well-being of people with mental health conditions for the next two decades. During our debate, we will be raising issues. It may not be possible to deal with them all in the legislation but they are important to mental health services overall, so I hope the Government will view them as part of a wider package of reform, be they issues around resources in the community or the interface between this Bill and the Mental Capacity Act. It is all part of our wider scrutiny, and I hope that the Government welcome that.

Amendment 1 would add a fifth principle to the existing four set out, which of course I fully support, and provide additional momentum towards the goal of addressing the racial disparities in the Mental Health Act. I believe that making equity one of the guiding principles, as in my amendment, would give it far greater clarity, weight and focus. If we look back at the underlying rationale for this legislation, addressing inequalities, particularly racial inequalities, is one of the key issues identified in Sir Simon Wessely’s review of the Act and is one of the key drivers behind this Bill. However, concerns remain in the sector and beyond that the Bill as drafted does not go far enough to address this deeply entrenched inequity. Adding such a principle would also reflect existing duties under the Equality Act and the requirements of the patient and carer race equality framework, a point made by many noble Lords at Second Reading. This would go some way to recognising one of the key drivers behind reforming the Act: to address racial disparities.

While know that the code should not be departed from unless there are good reasons, it remains a fact that, if the principles are written into the code in this way, they can indeed be departed from. Indeed, in the case that I quoted, it was ruled that the challenged policy was lawful but did deviate from the code of practice.

Finally, an important practical point is that health professionals responsible for these reforms simply will not have the time to review the code to understand exactly how the principles might apply. If they are fully incorporated in the Bill, that makes it clear to everyone making decisions under it that they must consider the principles when doing so.

There is a strong case for giving these principles statutory force to ensure that the Bill, when it becomes law, can provide a compass to decision-making under mental health law and give people more power to challenge treatments that fall short of these principles. I beg to move.

My Lords, I first apologise for not having been able to speak at Second Reading; I would have welcomed the Bill. In speaking to Amendments 2, 49, 52, 60, 112, 114, 118, 119 and 126 in my name, I declare my interests as honorary vice president of the Royal College of Speech and Language Therapists, as a former member of the Tavistock and Portman NHS Foundation Trust board, as a patron of the British Stammering Association, and as a stammerer myself. I thank the Royal College for its briefing and my noble friend Lord Bradley and the noble Lord, Lord Patel, for their support. I also warmly support Amendment 1 in the name of the noble Baroness, Lady Tyler. I shall add amendments consistent with it in a later group.

My amendments, which are supported by 49 professional, charitable and training organisations, are all based on the premise that speech and communication difficulties are an insufficiently recognised component of a very great number of mental ill-health symptoms and that professional speech and language therapy could—and should—enable more successful treatment. One study found that 80% of people accessing mental health services had a difficulty with language and 60% with communication or discourse. Especially in the case of children and young people, those with a mental health disorder report having five times more speech or language problems than those without. One study found that 81% of children with social, emotional and mental health needs had significant unidentified language deficits.

One of the problems with the lack of specialised staff to help such children is the demoralisation or challenging behaviour that comes from frustration with unmet communication needs, quite apart from the impediments to treatment. I could quote many examples of this, as well as some success stories—for instance, where speech and language therapy effected a sizeable reduction in the use of restraint in a secure children’s home, or enabled psychological treatment to work and give the inestimable benefit of the ability to cope. I must emphasise that most of us take the ability to communicate for granted, perhaps without realising how essential it is to our lives. It is when it is lacking that you notice what it means. I am therefore sure that it must underpin the principles of this excellent Bill.

My Lords, I rise to speak in support of Amendment 2, to which I have added my name, but first I declare my interests as listed in the register, especially as honorary vice-president of the Royal College of Speech and Language Therapists and as an honorary fellow of the same organisation. I am able to speak briefly as a result of the excellent explanation of these amendments by my noble friend Lady Whitaker, which I am pleased to support.

As we have heard, the lead amendment would place a requirement in the statement of principles to specify in the table the communication needs of the individual and recognise the disability, difficulty or difference to ensure they will be identified and supported. This requirement then flows throughout the Bill—as evidenced by the number of amendments to which I have also added my name—ensuring a thread of consistency for this vital area of support. These include, as we have heard, Amendments 49, 60, 112, 118 and 126, but I will not speak specifically to each of those and test the patience of the Committee.

The importance of Amendment 2 is clearly laid out in the excellent briefing, as we have heard, prepared by the Royal College of Speech and Language Therapists and endorsed by at least 46 related organisations representing this crucial area of work and service.

As we know, communication is fundamental and foundational to human life. It is central to how we express ourselves, how we understand others and how we interact. It is also fundamental and foundational to the aims of this Bill. It underpins the principles to inform decisions and is key to the matters to be addressed. Crucially, it ensures the individual is properly involved in the decisions taken as a consequence of this legislation. As we know, many people accessing mental health services have some form of communication disability, difficulty or difference. This can affect whether they are able to make themselves understood, understand what is being said to them, and how they interact with people. Left unidentified and unsupported, it can subject people to a range of negative outcomes, including inaccessible referrals, assessments, treatment and care and, potentially, unnecessary detentions and detentions longer than necessary.

My Lords, I will speak briefly in support of all these amendments, including Amendment 114 in the name of the noble Baroness, Lady Whitaker. I apologise for having to scratch my name from the speakers’ list at Second Reading, as I had been struck down by the dreaded virus.

In all areas of healthcare, communication between patient and healthcare professionals is extremely important for diagnosis and treatment, and to achieve the necessary outcomes. This is drummed into medical students and other health professionals daily.

I declare an interest: I am an honorary fellow of the Royal College of Psychiatrists—an honour awarded to me by the noble Baroness, Lady Hollins, who is not in her place, when she was its president. The citation of unknown accomplishments in mental health on my part was read out by the noble Lord, Lord Alderdice, who is also not in his place.

I remember, however, that although my professor at the time, Sir Ivor Batchelor—a well-known psychiatrist—was a quiet man, during our psychiatry clinical attachments he used to drum into us that not all mental health patients can communicate well. We had to be patient to learn and understand their ways of communicating to help them communicate their problem. I had forgotten that I was taught that; at the time, I think he hoped that he would make us all psychiatrists, but that did not happen.

The noble Baroness, Lady Whitaker, has highlighted the extent to which patients with mental health problems have communication disability, difficulty or difference. NHS Digital research has shown that children and young adults with mental health problems are five times more likely to have communication problems, and that in 81% of children with social and emotional needs their needs remain unidentified. Even without communication disability, difficulty or difference, people with chronic acute mental health problems also show communication problems.

In paragraph 130, the Explanatory Notes recognise the need to address communication issues, stating that a person’s care and treatment plan “may” include other information, such as

“how the patient’s communication needs will be met”.

I suggest that this needs to go further and should say—I hope this will be in the code of practice, as mentioned by the noble Lord, Lord Bradley—that the needs of people should be identified and the plan should clearly state how those needs will be met.