As always, it is a pleasure to see you in the Chair, Ms Buck. I congratulate my hon. Friend Neil Coyle on an incredibly powerful speech that was very detailed and knowledgeable about this issue. Obviously, my hon. Friend was speaking from personal experience, which was very brave of him.
It is clear from the findings of the independent review of the Mental Health Act, published last year, that the current legislation needs significant reform. There has been a 47% increase in detentions under the Act over the past decade, while the proportion of people living with a serious mental illness remains relatively unchanged, so clearly there is some imbalance there; it cannot be right that the number of detentions is going up. I echo the points that have been made about the link between this issue and the cuts to, and failings of, other services in the community that might be able to help at an earlier stage. Perhaps that is one reason why people are ending up in the most serious of circumstances; that is, being detained.
Being detained in a secure mental health unit is obviously going to be an intimidating and frightening experience for anyone. However, it is particularly intimidating for people with learning disabilities and autism, especially young people with those conditions, so I will focus on those groups in my speech. I raised this issue at Health questions on Tuesday, and the Minister—not Jackie Doyle-Price, but another Minister from the Department of Health and Social Care—gave a very thoughtful response.
One of the things that the Minister said was that learning disabilities, autism or other special needs are often not diagnosed until a child is detained in a mental health unit, which again shows the failings. Child and adolescent mental health services are incredibly under-resourced, and schools are really stretched when it comes to education, health and care plans and working with children who show signs of mental health problems. It is so important that we put proper resources in, so that we can give those children the help they need as early as possible. I am sure that the Minister responding to today’s debate, the hon. Member for Thurrock, agrees with that.
Under the Act, people with learning disabilities and autism can be sectioned with no mental health diagnosis if they are displaying challenging behaviour. The independent review found that the Mental Health Act was
“being used inappropriately for people with a learning disability, autism or both, to deal with a crisis that has arisen because of a lack of good community care or placements…It is particularly intimidating for a person with autism, learning disability or both to be removed from a place they are familiar with or from people they know, even if at the time there seemed little alternative…Instead of improving their mental health, the environment (including relationships with staff) has made them worse, not better.”
One of the common characteristics of autism, for example, is being wedded to routine, and being uncomfortable with unfamiliar circumstances and stimuli that those people would perhaps not get in a more protective environment. That can be particularly challenging.
The Equality and Human Rights Commission echoes such concerns, stating:
“The Commission is concerned about the lack of suitable provision for people with learning disabilities and autism, who may be in restrictive institutional settings because there is insufficient community-based support. The Government failed to meet its minimum target to reduce the number of people with learning disabilities and autism detained in inpatient settings, and at the end of March 2019 there were still 2,260 children and adults living in these institutions. On average, they had spent almost 5 and a half years detained away from home. There were more than 2,600 restrictive interventions recorded against inpatients with learning disabilities and autism in a single month, including physical, chemical and mechanical restraint, seclusion and segregation. Of these, 875 interventions were used against children.”
Most of those people should never have had to go into an in-patient unit, let alone be subject to those types of restrictive intervention. They are ending up in such units because of challenging behaviour due to unmet needs in the community. Those needs, as I have said, should be met with vital investment in community mental health services.
From my experience of people who have come to my surgeries, other casework that we have been dealing with and what I have picked up from visiting institutions, it seems that mental health services suit certain people because of the pathways developed in the NHS, but others do not fit into that category. For example, a child with learning disabilities was rejected for anxiety counselling, and they were later diagnosed with autism. To do the standard CAMHS anxiety counselling, someone has to have a certain ability to rationalise their actions and think about how they operate. That cognitive behavioural therapy-type approach was not suitable for that child, but that meant that nothing was available, because that was the pathway for young girls suffering from anxiety.
I had another case where a constituent was told that she was too traumatised by a recent experience to go through the counselling on offer through her GP. She clearly was not in a serious enough condition to be sectioned, however, so it seemed like she was caught between two things. She clearly needed help, but she was deemed to be too serious a case to get the help that was available. We need to look at the people, rather than just trying to fit them into categories and, when they do not fit into categories, rejecting them from the system, almost as though we are saying, “Come back when you are a lot worse, and then perhaps there is something we can do for you.” That has to be the wrong approach.
Going back to children in particular, the UN Committee on the Rights of the Child has expressed specific concerns about the adequacy of therapeutic community-based services for children. Because of that lack of community provision, children are being detained when they should not be. According to NHS Digital, at least 1,777 people aged 17 or under were detained under the Mental Health Act in 2017-18. Of those, more than a thousand were admitted to a non-local bed, in many cases more than 100 miles from home. Some children and young people under care of Bristol, North Somerset and South Gloucestershire CCG had to travel up to 243 miles away from home for mental health care. That cannot be in the child’s best interests and will add to the sense of isolation and anxiety, and it can also prevent their families from being properly involved in their care.
A recent Children Commissioner’s report found that many parents feel they are being shut out of decisions about their children’s care and are not always informed about incidents involving their children. Serious incidents had happened in hospital without families even being told. Some families had even faced gagging orders where they had been prevented from speaking out about their children’s care. The independent review calls for better safeguards to protect children and young people, ensuring that they are treated in hospital only when necessary and that their rights as a child are clearly set out. There is a need to establish clear tests as to whether children and young people are able to consent to hospital admission or treatment and whether they should be involved in decisions made about them. Clear roles need to be established for parents in care planning and treatment.
The review also states that there needs to be more advocacy available for children and young people. That is particularly important where conflicts arise between the clinical team about how to meet the best interests of the young person, including where contact between young people and their parents is seriously restricted—in some cases, the mental health crisis might be the result of chaotic family circumstances at home or ill treatment—or where the wishes of the young person conflict with the wishes of the adult.
Every in-patient child or young person should have a personalised care plan that includes their views and wishes and access to an advocate. They should be regarded as a child in need under the Children Act 1989 so that parents can ask for help from their local authority.
As the British Medical Association lead for mental health, Dr Andrew Molodynski has said:
“Warehousing unwell people in locked wards far from home goes against the very nature of mental health rehab—to help them reintegrate back into society.”
Unnecessary detention of vulnerable patients is not only unhelpful in terms of their recovery, but an ineffective use of taxpayers’ money. Too much money is being given to private firms to look after people with serious mental health problems in units often hundreds of miles away from their homes due to a shortage of NHS beds. That figure was £158 million in 2016-17 and £181 million in 2017-18—an increase of £23 million.
Last year, an extensive study of mental health rehabilitation by the Care Quality Commission found that stays in private beds cost twice as much as in the NHS because they tend to last twice as long. It found that the annual cost of rehab was £535 million and that private beds were on average 30 miles away from patients’ homes, whereas in the NHS they are only nine miles away.
One of the cases that I have been dealing with recently is that of a child who is in a mental health unit 150 miles away from home, but the unit closest to her home is in special measures and not accepting new patients. However, the unit she is in is ranked as outstanding and she seems to be making good progress. Clearly, when parents are faced with such a choice, they want their child to go to the best unit possible, but that can put huge pressures on a family, in particular when they have other children, as well as jobs and lives. They might also not have the money to decamp to somewhere so they can visit their distressed child each day. There is a real lack of support in the system for families placed in such circumstances, with their whole lives disrupted by trying to be in two places at once.
Another problem is that the quality of care in hospitals can be highly variable. The Whorlton Hall case demonstrated just how awful situations can be, and how badly people can be treated in some places. In a recent investigation into children with learning disabilities or autism living in mental health hospitals, some families told the Children’s Commissioner about the excellent support that their children had received—it is important to put on the record that there is good care out there—but others had shocking stories to tell. For example, one family said that their son had not been washed for six months while in hospital. Basic care needs were not being met.
Despite improvements in recent years and the drive towards parity of esteem between physical and mental health services, it has not been realised. The aspiration is noble and shared by both parties, but we need to invest far more in our mental health services for people to get the support they need. I welcome the fact that the need for better community services was highlighted in the recent NHS long-term plan, and I am pleased that the Government have committed more funding to severe mental illness and to greater use of alternative mental health crisis provision, such as crisis cafés. However, an overhaul of the Mental Health Act is clearly needed if that investment is to be used in the best interests of patients by ensuring that their dignity and rights are protected and that they are treated in hospital only as a last resort.
The previous Prime Minister committed to new legislation to bring the Mental Health Act into line with a more modern understanding of how best to treat mental health. She confirmed that a White Paper would be published before the end of the year. The Minister is probably wondering whether she will be in post by the end of today, but even if she is moved on to greater things, I hope she asks the new Prime Minister to give that the same priority as the previous Prime Minister did.