The process of reforming the Mental Health Act has been a long one, but we’ve now reached the end of committee stage in the House of Lords. During this phase, peers from across the House came together to scrutinise the Bill. They brought amendments to strengthen the Bill and debated on these changes across five days. Committee stage has now come to an end, but what were some of the key topics raised for both children and young people and adults? 

Children and young people 

From the outset, peers highlighted the importance of children and young people and ensuring their needs are met in a timely manner. Several amendments were tabled to the Bill to strengthen safeguards for children and young people, including: 

  • Introducing a statutory decision-making process for under-16s  
  • Strengthening safeguards for informal patients by extending statutory care and treatment plans and advocacy for under 18s admitted informally 
  • Ensuring services in the community are available to all children and young people   
  • Ensuring the process for appointing a nominated person (a person chosen by the patient to be consulted on decisions regarding their care) is consistent and provides a clear framework for approved mental health professionals when they are required to appoint a nominated person on behalf of a child or young person  
  • Ensuring sufficient safeguards are in place to ensure children are only placed on adult wards in exceptional circumstances. 

Speaking on behalf of the Government, Baroness Merron highlighted the importance of getting the Bill right for children and young people and acknowledged the importance of the amendments put forward. However, the amendments were not accepted, with Baroness Merron stating that the issues raised in the Committee stage debates would be addressed in the update to the Mental Health Act Code of Practice.   

While we were pleased to see the challenges children and young people face raised from the outset, we are disappointed that at this stage none of these amendments are being taken on. These amendments provide the necessary safeguards to help transform inpatient care for children and young people, and it is crucial that they are implemented.  

Adults 

A number of important amendments to address the critical gaps in mental health support and ensure robust protection of rights for adults were also tabled. Some of these included:  

  • Ensuring that Community Treatment Orders (CTOs) are reviewed after 12 months with a second professional opinion 
  • Ensuring people subject to a CTO are informed orally and in writing about their right to an independent mental health advocate 
  • Including provision to protect the patient’s housing and accommodation as part of care and treatment plans.  
  • Establishing a Mental Health Commissioner for England as a statutory office within government 

In response to the amendments on CTOs, Baroness Merron agreed that reform is needed, and that the Government are committed to ongoing monitoring in this area. She also stated that the revised Code of Practice would provide opportunity for further guidance on how to increase the uptake of advocacy and that the Government would be consulting on this issue. It is vital that CTOs are reviewed after 12 months to help tackle the inequality in their use. We hope to see the Government take this issue seriously in upcoming stages of the Bill. Furthermore, the critical gap in support for people on CTOs must be filled and so it is disappointing to see that the amendment on advocacy has been withdrawn. We hope to see increased uptake of independent mental health advocates as an outcome of the Government’s further consultation on this issue.  

The minister also agreed that it is important for patient’s housing needs to be considered during care and that there are a range of provisions already in place in statutory guidance on discharge, in NHS England guidance and in the Code of Practice. We welcome the existing provisions specified to protect housing rights for patients, but this must go further. Despite the existing guidance and provision, patients still face housing challenges, including being made homeless during inpatient care. This has devastating effects including exacerbating their mental health difficulties. Therefore, the Government must consider how to safeguard patients more sufficiently in regard to this issue. 

Finally, while the Minister acknowledged that improvements to the system are needed, she stated that a new body is not the answer, and that the role of a Mental Health Commissioner would duplicate the efforts of existing organisations such as the Care Quality Commission (CQC). However, this is not the case: both roles would have distinctive powers, responsibilities and functions. While both roles would have the power to inspect services, the outcomes they would pursue would differ and complement one another, as the Children’s Commissioner complements the work of Ofsted. We fully support this amendment which would offer sustained leadership for mental health. As was raised in the Bill, we hope to see peers continue to fight for this role in report stage.  

What next? 

Going forward, the House of Lords will undertake report stage and third reading of the Bill before it passes through to the House of Commons. We look forward to seeing the Bill continue to be strengthened to ensure that children, young people and adults receive the most appropriate, considered and compassionate care.