My Lords, as well as moving Amendment 46, I will speak also to Amendments 47, 53, 54 and 95 in this group. These amendments have one central aim in common, which is that of maximising the therapeutic benefit of being cared for in a secure mental health unit. That aim should be common to all mental health patients, young or not so young, but it is largely the concerns of younger mental health patients which have prompted these amendments.

Blooming Change is a small independent charity whose membership is comprised of children and young people who have experienced detention in mental health in-patient units in England as children. It is at their urging that I have tabled Amendments 46 and 47. I have done so after hearing some first-hand accounts of incidents in which children in mental health settings have been treated in a fashion that is the very opposite of therapeutic, by which I mean treated with a lack of understanding, with an obvious vindictiveness, sometimes, and sometimes even with outright cruelty.

It is perhaps hard to imagine this happening when we know how professional and caring most staff in mental health units are, but I am absolutely persuaded that it does happen, and not just rarely. Medical interventions such as nasogastric feeding or sedation are threatened and used as punishments. Patients who have raised concerns with their parents have been silenced by their parents being told by staff that they should take no notice of the concerns, because the child was either unwell or lying.

One young person reported as follows: “Young people on section were essentially incarcerated, yet still not able to voice views or share how they felt or generally engage with their treatment. This would lead to overuse of medical interventions or the threat of this, leading to young people living in fear and not having a way to raise concerns. Many of these things had a long-lasting impact on me. Had this coercion not occurred and medicalisation not been used as punishment, I would have been able to access treatment and recover, instead of the treatment compounding my illness and in many ways contributing to me being stuck in the cycle”.

Blooming Change has pointed out the significance of childhood trauma as a factor underlying a large number of mental health admissions involving young people and the challenging behaviour that they then exhibit. The problem is that, all too often, the link between childhood trauma and the way that a patient behaves is not recognised or understood. As a result, someone with autism or a severely troubled and traumatised young people person going into meltdown —as was well described, incidentally, by my noble friend Lady Browning during our first day in Committee —is simply viewed as wilfully disruptive or downright disobedient, with punishments doled out in response.

What can be done about this? The Minister will not thank me if all I do is come up with problems without suggesting answers. The best answers must surely lie in promoting greater transparency and greater patient empowerment. Alongside that, we must find ways of fostering that vital degree of understanding on the part of mental health staff as to the root causes of certain challenging behaviours, to enable them to respond in the right way.

As far as greater transparency goes, part of the remedy may lie in the lap of the CQC. In part to assist the CQC, I suggest in Amendment 95 that, after discharge from hospital, there is a place for a debriefing process, whereby children in particular are given an opportunity to feed back their experiences during their time as in-patients—first, as a way of holding institutions accountable and, secondly, to enable those individuals to heal from those experiences by being listened to and taken seriously.

This debriefing process need not be resource intensive. There is a clear case for using technology as much as possible to facilitate the feedback. However, the hospital management then needs to assimilate the feedback in whatever way it sees as appropriate, and on the back of that to instigate necessary change. What often gets lost in hospitals is institutional memory. This would be one way of building an institutional memory and protecting it.

There is a need for such a process. Again, Blooming Change quotes one of its members as saying:

“I’ve never felt more unsafe than when I’ve been on wards. I think they’re the most scary place that a child or young person could ever be. It’s a catchphrase, ‘hospital makes you worse’ … Everyone makes jokes about going into hospital with one problem and then leaving with trauma, new behaviours, new diagnoses, assaults, PTSD – it’s awful”.

It is depressing to put this on the record, but there is research that shows that the experiences of in-patient care from children and young people are consistently poor. A survey conducted by Mind in 2023 found that 69% of young people surveyed said that their experiences in hospital had not been positive. The Children’s Commissioner has uncovered similar stories.

One part of the story, as I have indicated, is children receiving poor therapy; the other part is children receiving no therapy—or no therapy that is appropriate. Blooming Change has told me that it has members who have been child patients in mental health in-patient units who had no access to therapy of any kind. One said: “In the wards I’ve been on, they just drugged us and restrained us … we left with even more trauma and no help in place, so then we would end up back in hospital and the cycle would repeat. So much pain could have been prevented had the wards had better things in place”. Another put it even more succinctly: “Without therapy, mental health unit become prisons”.

Hence my Amendment 53, which proposes that, where suitable therapy is available to a particular patient, there should be a duty on the part of the hospital to offer the treatment to that patient, without any compulsion for the patient to accept and receive it. Therapy should not be used coercively. The best safeguard against this happening is the presence of psychologists in the in-patient unit as the professionals best placed to ensure that the environment of the unit is genuinely therapeutic.

In that same spirit, I am proposing in my Amendment 54 that, for a patient with autism or a learning disorder, there should be a higher hurdle than usual to allow any departure from the patient’s wishes as to a preferred treatment, as expressed either in an advance choice document or by the patient’s nominated person. The hurdle should be a requirement that two appropriately qualified clinicians would need to agree that such a departure was right for the patient.

There could, of course, be circumstances in which two clinicians might conclude in good faith that a patient’s express wishes should be overwritten—for example, where there was a doubt over the bona fides of the patient’s nominated person. But the point of the amendment is to add an extra layer to patient autonomy when the morale and mental equilibrium of the patient is so very shaky. I hope the Minister can provide some words of reassurance on these very troubling and sensitive matters. I beg to move.