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The current wording of the Bill compromises this independence by implying that the AMHP will be working “on behalf of” or “at the behest of” the local authority, with the implication that his or her decisions can be countermanded by the authority and influenced by the interests of the authority, which may be different from the interests of the patient. The amendment clarifies the point by making it clear that the approved mental health professional is expected to make an independent assessment of the person’s health and social care needs and carries individual

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responsibility for their decision, not that the local authority can direct that decision.

As regards the second issue, the noble Baroness, Lady Howarth, has already suggested that the wording of the amendment would be improved if it stated,

but she thinks that the part about,

does not mean anything. But social workers believe that it might help them to cover cases which take an exceptional amount of time.

This will ensure not only the independence of the assessor but also the availability of an AMHP at short notice, if necessary, and around the clock. The present Act requires local authorities to provide “a sufficient number” of approved social workers, but this duty has been widely disregarded. A recent survey funded by the Department of Health shows that there is currently almost a tenfold difference between the best and worst performing authorities in the number of ASWs they employ per head of the population. I beg to move.

Baroness Royall of Blaisdon: Amendment No. 33B seeks to amend Section 13 of the Mental Health Act which deals with approved social workers—under the Bill, AMHPs—making applications for a patient’s admission under the Act. The amendment removes the requirement for the AMHP to be acting on behalf of a local social services authority, LSSA. It also introduces a requirement that the assessment should be carried out within a reasonable time having regard to the circumstances of the case.

The Government are concerned to ensure that the case of a patient who may need to be admitted under the Act is assessed by an AMHP within a reasonable time. However, where a statutory duty is not carried out within a reasonable time it is already the case that this is likely to constitute a breach of that duty. Therefore, the duty to arrange for an AMHP to consider a patient’s case for application already implicitly includes the duty for a local authority to do so within a reasonable time. This will be explicitly highlighted in the codes of practice for England and Wales and we do not believe that additional legislation is needed to achieve the effect that the noble Baroness is seeking.

The second aspect of Amendment No. 33B would remove the requirement for an AMHP to act on behalf of a local authority when considering a patient’s case for admission. I note the concerns expressed by the noble Baroness that if an AMHP is said to be acting on behalf of an LSSA, the LSSA could in some way direct the decisions of the AMHP. But this is not the case. An AMHP is required to make an independent decision about whether to make an application. I can assure your Lordships that nothing in the Bill changes this.

Paragraph 5(2) of Schedule 2 to the Bill makes it clear that AMHPs must make an application only if they are personally satisfied that it is necessary and

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proper so to do. The decision cannot be overturned by the local social services authority for which they are acting. The AMHP acts independently and will continue to do so in their decision-making.

The Bill makes it clear that an AMHP carries out its functions on behalf of the LSSA. This underlines the independence of the AMHP from the trust that may employ the doctors who also examine a patient’s case for admission. It also ensures that the responsibility for providing that an AMHP service is in place still clearly lies with the local social services authority, whether or not it chooses to enter into arrangements with another body, such as a trust, to provide the service.

I hope your Lordships will agree that it is important that we maintain this line of responsibility to the local social services authority for providing the AMHP service. I therefore invite the noble Baroness to reconsider the amendment.

Baroness Gardner of Parkes: I thank the Minister for those comments. They will be very valuable to the people concerned, who were worried that they would not be seen to be independent. It is quite clear that the employer is the local authority, which carries the ultimate responsibility. I should mention that the noble Baroness, Lady Howarth, said I could quote her. She has been very helpful in discussing this issue.

The fact that those comments will now be on record in Hansard will in itself be valuable. It may be that the matter does not need to be pursued further. But that remains to be seen. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 34 not moved.]

Baroness Gibson of Market Rasen moved Amendment No. 35:

The noble Baroness said: Amendments Nos. 35 and 37 relate to the children of mentally ill patients. The amendments are supported by Barnado’s, Young Minds, NCH, NCB and the NSPCC.

It is estimated that one-quarter of adults who are known to mental health services are parents. In at least one-third of families who are referred to social services due to concern about child protection, parental mental health or substance misuse plays a major role. Very often a child of a parent with mental health difficulties finds himself or herself as a main carer for the parent. Such children face a number of difficult or distressing situations that they have to overcome on their own. Severe mental health

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problems can have a serious effect on a parent’s ability to parent, especially if there are few other adults around to give support.

It is estimated that there are 175,000 young carers aged under 18 in the UK, a substantial number. Their average age is 12, but they can be as young as five. Twenty per cent of young carers miss school because of their caring responsibilities at some time or other. Generally, schools do not or cannot provide either counsellors or other means of support to help these very vulnerable and often isolated young people, and young carers themselves are often reluctant to tell teachers or social workers of their situation. The experiences of young carers obviously differ but they have one thing in common. As one Barnardo’s children’s services manager put it,

Because of their parents’ condition, children may find themselves affected by what we would regard as inappropriate behaviour; for example, a child being kept up all night to play by a parent who is in a manic phase of their illness, or a child having to look after themselves and get their own meals because of a parent’s depression. The child does the housework, the washing and anything else that needs to be done. Such examples were provided to me by Barnardo’s, and they show how vital support for such carers is.

Young people who are responsible for the care of their parents have enormous responsibilities not faced by other children of their age and can find their own mental health affected by their circumstances. Often they suffer from stress and have low self-esteem. Unfortunately, there is quite a lot of evidence that the needs of children who are carers are too often overlooked by our welfare services and that children’s and adult services do not work together to ensure that services provided to an adult are placed in the context of the wider family.

In research from a Joseph Rowntree report, published in 1998, children who had experienced parental health problems, domestic violence or parental substance misuse reported that they had no confidence that a professional would help them and that professionals often spoke to them in a way they did not understand. That experience is summed up by one young person who said, “I needed good age-specific information about my mother's condition and its consequences. And I needed someone to talk to who would listen in confidence and help me to express and explore the complex feelings and situations I was dealing with”. Equally, there is evidence in research by Kroll and Taylor in 2003 in a number of settings, not only mental health. They found that many professionals were themselves uncertain about making referrals to children’s and families’ social work teams in respect of parents and were often unsure about when or how to make a referral.

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Section 5.6 of the National Service Framework for Children, Young People and Maternity Services refers to adult health services. It states that the safeguarding of children is a priority in any assessment or ongoing

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treatment of parents who may be unable to respond to their child's developmental needs. It also states that any care programme responding to an adult health or treatment need should include consideration of the needs of any child or young person. However, as currently drafted, the Bill provides no clear link between treating the adult and assessing the needs of any children in the household. Additionally, the Bill has no specific provision for an assessment of need for any children living in the same household as a person subjected to compulsory treatment. It may be that an assessment of a child, such as one under Section 17 of the Children Act, could take place when a parent is subjected to compulsory treatment. However, the Act does not require such joined-up action to take place.

The purpose of these amendments is to strengthen the current position by making it compulsory for the child to be informed of what is happening in an age-appropriate way and for a full assessment of the child’s needs to be made. I beg to move.

Earl Howe: I am very much in sympathy with the amendments tabled by the noble Baroness, Lady Gibson. The needs of child carers are not often recognised in legislation. The Mental Health Bill as drafted provides no recognition of the needs of these young people. They are excluded, quite rightly, from the ability to act as the nearest relative for their parent and, as such, are therefore excluded from the right even to be informed that an application has been made in respect of the parent. The provisions on social reports in the Act provide no recognition of the need for a separate assessment to consider the needs of any children who may be affected by the application for compulsory treatment made in respect of their parent.

The amendment, as the noble Baroness said, aims to deal with that omission by providing children living with people with mental health problems with specific rights under the Act. That is in line with standards 2 and 5 of the National Service Framework for Children, Young People and Maternity Services. Standard 2 states that collaborative arrangements should be in place between services for adults and services for children and families. I am sorry to say that there have long been problems of poor co-operation between adult and children’s services. Changes to services since Section 14 of the Mental Health Act was drawn up have not put right those stresses and strains. The recent introduction of children’s trusts under the Children Act 2004 has meant that adult services have effectively been split from children's services. These amendments would ensure co-operation between adult and children’s services and ensure that the needs of children, particularly young carers, who are affected by their parent’s illnesses, are not ignored. I hope that the Minister will be receptive.

Baroness Walmsley: I have added my name to the amendments, because I am as concerned as the noble Baroness, Lady Gibson, that the Bill provides no clear link between treating the adult and assessing the

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needs of any children in the household. Although the framework for the assessment of children in need and their families may be used to determine whether a child is in need under the Children Act 1989, there is no requirement in this Act that such joined-up action take place.

The children’s charities which the noble Baroness listed are very concerned that, without an explicit requirement in the Bill placing a duty on both health and social services to look into this matter, vulnerable children could—and they do—slip through the net. The amendment would provide an additional safeguard to ensure that joined-up working between health and social services professionals takes place and that the needs of any children who may be affected by an adult being detained under this Act are automatically thought about within that process.

The Minister may feel that the amendment is unnecessary and that the matter is dealt with by the standards that the noble Earl, Lord Howe, mentioned and other legislation on children’s services, but I shall relate to him a few case histories from real life to illustrate that the current legislation and guidance are not working in every case. I hope he will feel that they back up our feeling that this needs to be made explicit in the Bill.

I turn to the first example. Last year, a single mother in a travelling community was seriously depressed. The mental health services and social services were involved with the family. Very sadly, the mother committed suicide at home in front of the children. The two young children were left in that home for two days with their mother’s body before relatives kicked down the door. Nobody knew that there were young children in a household where the mother was so seriously depressed as to be at risk of suicide.

In the second example, a mother was sectioned. The father was left at home with the children. When the mother was sent home from hospital, but still under supervision, the father simply could not take any more and left the family. The mother tried to manage, but in the end could not. The professionals were unaware that the children were vulnerable and at risk, so no referral was made. The children could not cope in school and eventually dropped out. One of them is now in youth custody, which indicates what can happen to a child’s life when they do not receive the assessment which the amendment seeks.

YoungMinds has told me about a single mother with significant mental health problems whose illness means that she is periodically unwell. She has no support in looking after her seven year-old son who has autism. So the family has double problems. Social services are involved, but they have told the mother not to ring the out-of-hours emergency social work number when she feels that she is becoming unwell. As a result, when she feels that she is becoming unwell, she goes to the accident and emergency department in her local hospital, because she knows that it will make sure that someone goes out to look after her son. Staff in A&E have now told her not to come to them, because they are not the correct place

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to deal with her, but she continues to go there simply because she knows that somebody will do something about her son.

The final example involves a mother who was sectioned. She had two sons, aged 11 and 14. No one made contact with the children or asked her about them. The 14 year-old son had significant mental issues and was extremely violent. The 11 year-old brother was at serious risk of being attacked by him. Both boys were alone for a whole week until an outreach worker discovered them. Social services had been involved with this family, and the boys were on the at-risk register, but social services seemed to be unaware that the mother had been sectioned. The health professionals had not been talking to the social services professionals.

These examples make it clear that the joined-up approach is not always working as we would like. However, there is nothing like putting a duty on someone to do something to make them do it. We need a clear statement about this in the Bill; it is entirely appropriate to put it in. Besides, it is surely of benefit to the patient and his or her treatment and recovery to know that the children are being well looked after.

The second part of the amendment provides for children to be given age-appropriate information about the process of assessment and detention of their parent and about their parent’s illness. Of course, since quite rightly children cannot be considered to be the nearest relative, they do not gain the right to be informed of an application made in respect of a patient. So there is a gap in the Bill for the provision of information to any children who may be affected. The amendment states that that should be provided, in the light of the child’s age and understanding, which is crucial.

Nowadays social services must take into account children’s wishes and feelings when decisions are being made about their care, but how can a child adequately express his wishes and feelings if he does not know the truth about his situation in the light of his parent’s mental illness? Proper information, given in an age-appropriate way, will also help a child to deal internally and emotionally with the turmoil that the illness of a near relative causes to him or her.

There are many very strong arguments for accepting this amendment, and I hope that the Minister will do so.

Baroness Royall of Blaisdon: Amendment No. 35 would ensure that the needs of any child under the age of 18, residing with a patient immediately prior to an application for the admission of that patient, are fully assessed and that the child is advised about the application process. Amendment No. 37 similarly seeks to ensure that the needs of any child under the age of 18, residing with a patient immediately prior to their admission to hospital following an application by the nearest relative, are fully assessed and that the child is advised about the application process.

I pay tribute to YoungMinds, Barnardo’s and the NSPCC for the excellent work that they do with children who have mental health problems and the children of parents who have such problems.

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It is vital that the needs of children in the household are considered when an adult is assessed and detained under the Act and that children are given clear information, appropriate to their age and understanding, about their parent or carer's illness and treatment. As my noble friend Lady Gibson of Market Rasen informed us, many of the children whom we are talking about are themselves carers; it is extraordinary that children as young as five are acting in that role. However, there is already a legal framework to ensure that children’s needs are assessed and met. Section 17 of the Children Act 1989 places a duty on local authorities to promote the welfare of children within their area who are in need. Therefore, repeating this within the Bill would be duplication.

The Framework for the Assessment of Children in Need and their Families outlines a framework for all those who work with children and their families to decide whether children are in need under the Children Act 1989 and how best to provide help. There are also duties under Section 10 and, particularly, Section 11 of the Children Act 2004, under the duty to make arrangements to ensure that functions are discharged having regard to the need to safeguard children, which are relevant to all agencies—health and local authority—that work with children or with adults who have children. The decision about whether to carry out an assessment under Section 17 of the Children Act 1989 should be based on the individual child and carer's situation. Work is already under way to increase the awareness of adult mental health practitioners about the needs of children in the household.

Baroness Walmsley: If the social services do not know about the children’s situation because the health professionals have not told them, how on Earth can they make a decision whether to make an assessment?

Baroness Royall of Blaisdon: Indeed, we have to have much more joined-up working, as the noble Baroness said earlier, between social services and health to ensure that both services are aware of the situation of the family as a whole, not just those who are suffering from mental health problems. The noble Earl, Lord Howe, will not like my saying this, but that is a matter of best practice and ensuring that the services themselves work in the manner that we would deem to be proper.

I noted the very sad—indeed, terrible—cases raised by the noble Baroness, Lady Walmsley. Clearly at the moment not enough is being done to ensure that joined-up working or that the needs of children are properly being taken into consideration. However, I refer noble Lords to the report of the Social Exclusion Unit, Mental Health and Social Exclusion, published in June 2004, which identified at action point 16 the need for better support for parents and their children, and set out a detailed plan of action.

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