Stephen Kinnock
MP for Aberafan Maesteg · Labour · United Kingdom
“I thank the shadow Secretary of State for her kind words and look forward to our exchanges across the Dispatch Box. I am ready to engage with her on getting the maximum benefits for the people of Wales.”
“I thank the right hon. Lady and look forward to working with her. My understanding is that there were challenges around the helicopter capability. Decisions were taken by Natural Resources Wales some time ago to change the way that the tendering for helicopter capability works. We certainly need to look at that.”
“I thank my right hon. Friend for his question. Like him, I pay tribute to all those involved in the collective and heroic response to the wildfires.”
“I thank the right hon. Lady for her question. Many of the ideas coming forward for devolving power right across our United Kingdom, beyond Cardiff Bay and Holyrood, are very exciting, and I look forward to exploring them with her.”
“Just to be clear, this is not about staying out of the issue; it is about respecting the devolution settlement, but being prepared to work constructively where we can in partnership with the Welsh Government. The hon.”
“I know about and welcome the right hon. Gentleman’s strong connections to Wales. I recognise the connectivity benefits that WSMR’s proposal could deliver, particularly for passengers in Wales and the west midlands.”
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“The hon. Gentleman is absolutely right to point to the neglect and incompetence of the past 14 years. We are fighting to get NHS dentistry back to where it needs to be. An important first step, of course, is the 700,000 additional urgent appointments and supervised tooth-brushing programme, but long-term contract reform is what is needed, alongside the investment that will come through the spending review.”
“My hon. Friend is right to raise that important point. It is truly shameful that 4.5 million children in the UK now live in poverty. We are developing an ambitious strategy that tackles root causes, and we are already taking action. Alongside cross-Government work on free school meals, breakfast clubs and funded childcare, the Department is investing £56 million in Start for Life services and supporting healthy diets for 358,000 people through Healthy Start.”
“The hon. Gentleman is right to point to the anomalies in the eyecare system. There are concerns about the role that some aspects of the independent sector are playing, particularly in the light of the lucrative nature of cataract operations. If he writes to me, I will be happy to set out the issues, and I guarantee that he will get the response in due course.”
“The spending review has just been published. The key now is to secure the allocations within the overall financial envelope. That will take a matter of weeks, and I will be happy to report back to the hon. Member once we have that clarity.”
“I thank my hon. Friend for that question and her relentless campaigning on this issue. She is right that the 700,000 urgent dental appointments are a first step, and we are looking to embed that so that it goes forward every year of this Parliament. The broader issue is around contract reform. There is no perfect contract system—the current one clearly is not working—and we are looking at options around sessional payments, capitation, and getting a contract that works and brings dentists back into the NHS.”
“Members will be aware that the Delegated Powers and Regulatory Reform Committee will issue its own consideration of the Bill, which will of course be made available to all parliamentarians. Amendment 3 seeks to shorten the commencement period to three years. Should the Bill pass, an entirely new service with robust safeguards and protections will need to be carefully developed and tested, with input from a range of delivery partners. The Government’s view is that the Bill, as amended in Committee, with a four-year backstop for commencement would be more likely to provide for safe and effective implementation.”
“Amendments 105 to 107, amendment (a) to new clause 13 and amendment (a) to new clause 14 would restrict the scope of Henry VIII powers available to the UK and Welsh Governments to make provision about assisted dying services. They would further restrict the use of powers in relation to the regulatory framework for approved substances and the devices used to administer them, and to the prohibition on advertising. I point Members towards the delegated powers memorandum published by the Government, which sets out our consideration of the Henry VIII powers in the Bill. As with legislation more broadly, the Government recognise the need, in appropriate cases, for amendment by Henry VIII powers.”
“That may present workability challenges, as licensing is not possible if the approved substances do not meet the definition of “medicinal product” under the current relevant legislation. Furthermore, licensing is reliant on the manufacturer applying to the MHRA for a marketing authorisation for that indication and providing the necessary evidence of safety and efficacy in support. Should the Bill pass, the Government would work to put in place an appropriate regulatory regime for the approval of substances. It may be helpful to note that my hon. Friend the Member for Spen Valley has tabled new clause 13, which recognises the need for a robust regulatory framework and would provide the powers needed to introduce such a framework.”
“That means that assisted deaths would be scrutinised by a medical examiner rather by a coroner unless reported to the coroner by anyone who has concerns about the death. Amendments 92 to 94 would ensure that the Secretary of State and Welsh Ministers have powers to make necessary regulations to approve assisted dying services in Wales. Amendment 95 would bring the Welsh commencement powers in line with the devolution settlement and remove the requirement in clause 54 for Welsh Ministers to lay commencement regulations before the Senedd for approval, to align with usual procedure. I now turn to amendments tabled by other Members that the Government assess as creating potentially significant workability challenges. Amendment 97 would require the MHRA to license the approved substances to be used in assisted dying.”
“Let me start with amendments tabled by my hon. Friend the Member for Spen Valley. New clause 13 and amendments 69, 53 and 72 would allow the Government to create or change legislation to set out the end-to-end process in relation to approved substances to be used for assisted dying. They would allow for monitoring and for a regulatory regime to be designed that will offer robust oversight of approved substances and the devices used to administer them, specifically in the context of assisted dying. Amendment 54 and new clause 15 would replace clause 35, which is currently unworkable in the wider legal context. They would align the scrutiny and certification of assisted deaths with the existing process for deaths that are not deemed unnatural.”
“I thank Members on all sides of the debate for their contributions during the extensive consideration and scrutiny that the Bill has received. Given the time, I will confine my remarks on the amendments to those about which the Government have significant legal or operational concerns, and those tabled by my hon. Friend the Member for Spen Valley (Kim Leadbeater) to address significant workability concerns. Before I get into the detail, I remind the House that a full list of amendments tabled by my hon. Friend that the Government deem essential or highly likely to contribute to the workability of the Bill can be found in the letter sent to all Members by me and the Minister of State at the Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), on 15 May.”
“I associate the Government with the words of the Opposition spokesman regarding the tragic incident in India. As Members will know, the Government remain neutral on the passage of the Bill and on the principle of assisted dying. We have always been clear that this is a decision for Parliament. However, the Government are responsible for ensuring that the Bill, if passed, is effective, legally robust and workable. Let me start with a brief observation about the process and, in particular, the time made available to Parliament to scrutinise the Bill. The Bill has received over 90 hours of parliamentary time, which is more than most Bills receive. More than 500 amendments were tabled and considered in Committee.”
“I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target. Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.”
“I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.”
“The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act.”
“New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer. I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials.”
“I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service. Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court.”
“I beg to move amendment 26, in clause 5, page 11, line 22, leave out— “by a constable or other authorised person”. One of the tests for detaining a person under the mental health legislation is that harm may be caused, or that treatment is not possible, without detention. This amendment and amendments 27, 28 and 29 remove wording stipulating that the detention that is necessary must be detention by a constable or other authorised person (as defined).”
“We are not seeking to raise the bar on detention, which could put patients and the public at risk. However, we think that when the serious decision is taken to deprive someone of their liberty, and potentially to treat them against their wishes, there needs to be consistent consideration of the potential risk of harm to a person or to others to justify that. The revised risk criteria will not apply to part 3 patients. There are already tailored risk criteria for patients in the criminal justice system. Those are considered by the court and the Secretary of State for Justice, and allow for all relevant factors, including public protection, to be considered on a case-by-case basis. For those reasons, I commend Government amendments 26 to 29 and clause 5 to the Committee.”
“The clause will replace the existing criteria, which the independent review of the Mental Health Act found were too vague, and will take forward changes recommended by the review. It will strengthen and clarify the criteria to require a risk of “serious harm” to justify detention. Consideration must also be given to the nature, degree and likelihood of the harm. For a patient to be detained for treatment under section 3, there must be a “reasonable prospect” of therapeutic benefit. The code of practice already directs clinicians to consider the “nature”, “likelihood” and “severity” of harm. We believe it is right to formalise those considerations by putting them in primary legislation. We have not defined serious harm in the Bill. We will work with stakeholders to provide guidance on that in the code of practice.”
“It would not be appropriate to involve police officers in clinical decision making about whether a person meets the criteria for detention for assessment or treatment under the Act, or to involve them unnecessarily in the temporary detention of patients who are already in hospital to enable a Mental Health Act assessment to take place. We also seek to remove clause 50 from the Bill; we look forward to discussing that at the appropriate time on a future day in Committee. I will now move on to clause 5 in its entirety. The grounds for detention provide decision makers with criteria that must be applied when deciding whether it is appropriate to detain, or to continue to detain, a person under the relevant sections of part II of the Mental Health Act, covering civil patients.”
“It is a pleasure to serve under your chairship, Ms Furniss. Government amendments 26 to 29 seek to remove previous amendments to the clause tabled by Lord Kamall, Earl Howe and Baroness May of Maidenhead, which added police and other authorised persons to sections 2, 3 and 5 of the Mental Health Act 1983, giving the police additional powers to detain people under the Act where they currently have no powers to intervene. We do not support extending police powers in that way, and we understand that the police do not support an extension either.”
“It will be a comprehensive and detailed development of the code of practice, and will address the issues around cumulative and escalating behaviour, the public safety issues and training. On cumulative and escalating, it is worth noting that under the reforms in both the Bill and the current Act, clinicians have the power to detain on the basis of a risk of harm that may occur, not that already has or is happening at the time. That power already exists.”
“I will touch on the questions that have been asked on cumulative and escalating behaviour, on having a review of public safety and on the training plan. The details will be provided for in a mixture of the code of practice and the annual written ministerial statement. The code of practice will be based on consulting both those who use the new criteria, such as clinicians, approved mental health professionals and members of the tribunal and, then, of course, on the other side, those with lived experience, service users, families and carers. It will be shaped and drafted on that basis. It will then go out to public consultation and will be laid before Parliament so that Parliament will have an opportunity to debate it.”
“Let us please take a pragmatic approach to this. The police do not want an extension of these powers, and the Home Office is clear that that is the case. There seems to be a fundamental misunderstanding at the heart of the lengthy debate that we have just had. On that basis, I thank hon. Members for their interventions and I commend the amendments to the Committee. Question put , That the amendment be made.”
“In many cases, it is simply impossible to legislate for these incidents. By definition, every person experiencing trauma experiences it for different reasons, and it manifests itself in different ways, so top-down micromanagement of that would be deeply counterproductive and unhelpful. Officials in the Department of Health and Social Care and in the Home Office have engaged with senior representatives of the police on these amendments in great detail. I can give the Committee an 100% assurance that the police do not support an extension of their powers to sections 2, 3 and 5. I am therefore baffled by the fact that Opposition Members appear to be claiming that they know better than the police whether their powers should be extended. Let us stop trying to pretend that we have the police’s expertise.”
“Approved mental health professionals have powers under section 115, section 6 and section 137 to enter a person’s home and to assess and convey said person to a hospital. That is the first point: all the concerns that have been raised by the Opposition are very clearly addressed by the powers that already exist for AMHPs. We support “right care, right person”. Policing is of course operationally independent, and those “right care, right person” arrangements are planned and developed through detailed multi-agency partnerships on the ground. We need to be pragmatic and recognise that “right care, right person” is the right way forward. The Government are committed to it, so let us let the practitioners, the experts and the police on the ground work in a practical and pragmatic way to address these incidents as they occur.”
“I thank the hon. Member for the intervention, but I simply repeat that under both the Act and this Bill, which will reform that Act, clinicians have the power to detain on the basis of a risk of harm that may occur, not one that has already or is happening at the same time, so, in my opinion, this power already exists. What is the point of over-embroidering and adding more questions and considerations when those questions and considerations are already answered? Let us just try and streamline things, please, and make things simple rather than complicated. We had a lengthy debate on the amendment. Let us just boil this point down to its essence: the majority of mental health incidents are managed without police involvement.”
“The Bill increases professional oversight by requiring the community clinician to be involved in all decision making relating to CTOs. That aligns with Lord Scriven’s amendment, but, rather than that person being a General Medical Council-registered psychiatrist, it is more appropriate that they be an approved clinician, meaning that they have specific training regarding the Mental Health Act and approval to make decisions under the Act. We have also increased the frequency of tribunal reviews so that they will happen automatically at renewal periods following the initial six-month period, after a further six months and after any subsequent 12-month periods. We are already providing a new power for the tribunal to recommend that the responsible clinician reconsider whether a CTO condition is necessary. Clause 6(3) would duplicate that.”
“Government amendment 30 would remove clause 6(3) from the Bill on the basis that it is unnecessary. The requirement in section 118(2D) of the Mental Health Act for decision makers to have regard to the code of practice already ensures that they must take it into account when making decisions in relation to community treatment orders. Imposing a maximum duration of 12 months on community treatment orders, with the option to renew them after a review every six months, is also unnecessary. That is because the Bill already requires community treatment orders to be reviewed before renewal after the initial six months, again after the next six months and then yearly. The responsible clinician can renew the CTO only if there is a risk of serious harm without it and a reasonable prospect of it having therapeutic benefit for the patient.”
“It is a pleasure to serve under your chairship, Mr Vickers. I turn to amendment 11, tabled by the hon. Member for Winchester. Under the Bill, English qualifying patients subject to the Mental Health Act 1983, including those on a community treatment order, will be covered by a new opt-out approach to advocacy. That means that the relevant hospital manager must provide the advocacy provider with information about the patient so that they can arrange for an advocate to interview them to determine whether they wish to use advocacy services. Requiring oral and written information about their right to an advocate would therefore be unnecessary. I hope that that is satisfactory, and I encourage the hon. Member for Guildford to withdraw the amendment.”
“However, the independent review rightly noted that considerably more people than expected were being put on a community treatment order—about 5,500 people a year—and that there were racial disparities in the use of CTOs. Clause 6 therefore amends the community treatment order risk criteria in line with the new detention criteria set out in clause 5. It is now the case that, to be put on a community treatment order, the patient must be at risk of serious harm and there must be a reasonable prospect of therapeutic benefit for the patient.”
“Where there are differences, the current provisions are more appropriate, for example in requiring a community clinician to be involved in all decision making. Let me move on to clause 6 in its entirety. CTOs allow individuals detained under the Mental Health Act to be discharged into the community, under specific conditions, to ensure continued treatment. CTOs aim to maintain contact with mental health services to provide support and prevent relapse. Patients on CTOs can be recalled to hospital under that Act in certain circumstances. The main purpose of introducing CTOs was to improve care for higher-risk patients and to enhance public safety. We believe that community treatment orders remain necessary in a small number of cases to ensure continued treatment and to protect both patients and the public.”
“I pay tribute to my hon. Friend for her expertise and am pleased to hear that she feels reassured by my remarks. It is absolutely the Government’s ambition to bring more consistency and clarity to this area. A number of hon. Members have raised issues around racial disparities; I plan to come on to that. That is a specific focus, I know, for her and other colleagues. More broadly, this is about ensuring that the CTO system is proportionate, well regulated and managed on the basis of a patient-centric system. We therefore wish to remove clause 6(3), as we do not think that it is necessary. It duplicates some provisions in the Bill or, in the case of the review periods, conflicts with existing renewal periods, and under the current drafting it is not clear how the two would interact.”
“My hon. Friend raises a very valid point that, as he says, we will come on to in greater detail. Right across our health service, in every aspect, early intervention is always better than trying to pick up the pieces after a crisis. That is the same for both physical and mental health. We believe that the advance choice documents will be a helpful tool in building an earlier understanding of the challenges that a particular individual faces and, on the basis of that earlier understanding, enabling earlier intervention. Giving the opportunity to patients, while they are in a position to do so, to set out what their advance choices are will enhance their autonomy and enhance trust in the interaction between the patient and the system. That trust piece is so important to the entire picture.”
“The fundamental drive of the Government is to move from sickness to prevention. We want to build a preventive state, and the mental health part of that is vital, for the reason my hon. Friend has just elucidated.”
“My hon. Friend is absolutely right, and we could go into the question he has just raised in a profound way, because the social determinants of ill health are such an important part of the picture. Many people in our communities are dealing with all sorts of incredibly challenging and traumatic issues in their lives, often driven by a whole range of social determinants. We have to recognise that there is a need to build capacity in the system as well. I am pleased that the Government reconfirmed in the spending review yesterday the 8,500 additional mental health specialists in the system, a mental health trained specialist in every school, 24/7 mental health hubs being opened around the country and £26 million being put into opening mental health crisis centres around the country.”
“I emphasise that people are often discharged without going to tribunal, so those numbers are not a full picture. On evaluation, we are developing a monitoring and evaluation strategy for the Mental Health Act, as the Bill will become once—one hopes—it gets Royal Assent. It will be important to monitor new processes such as discharges and changes to CTOs to assess whether reforms are being delivered as intended and to monitor uptake among patients. There was also a question about racial equalities, but I think I have answered that. With those remarks, I hope that the Committee will support Government amendment 30 and that the hon. Member for Guildford will withdraw amendment 11.”
“The change in the criteria for a CTO is intended to reduce the number of inappropriate community treatment orders being given, reducing restrictions on patients and helping to protect against the disproportionate use of coercion among racialised communities. Only those for whom there is a risk of serious harm and who will benefit therapeutically should be subject to a community treatment order, and it should be removed when it no longer provides benefit. I want to touch on some of the questions that have been asked. The Opposition spokesman asked about the number of CTOs being overturned at tribunal. According to Care Quality Commission data from 2023-24, 129 discharges by tribunal took place following 4,438 applications against CTOs.”
“We have piloted culturally appropriate advocacy models, which ran up to March 2025. An evaluation of the pilot will be published in the summer, and that will feed into the evidence base for the impact and deliverability of culturally appropriate advocacy at local level. We will use the learnings from our culturally appropriate advocacy pilots to inform our understanding of how to increase uptake of advocacy for community treatment order patients from black communities, who are disproportionately likely to be put on a CTO. A lot of that evaluation and investigation work is happening, and I am sure that hon. Members across this Committee will read the findings in the summer with great interest.”
“The detention criteria ensure public and patient protection, while also protecting patients from lengthy and unnecessary detentions when they no longer pose a risk to themselves or others. I therefore commend clause 7 to the Committee.”
“Clause 7 will amend the grounds for discharge by the tribunal to align with the revised grounds for detention set out in clause 5. The tribunal must consider whether the patient continues to meet the criteria when deciding whether to discharge a patient. These changes will provide decision-makers with a clear and consistent set of considerations when assessing whether a patient continues to meet the detention criteria, and therefore whether detention or a community treatment order continues to be justified. The tribunal must consider all elements of the detention criteria, including whether there is a reasonable prospect that the patient is receiving therapeutic benefit from treatment and whether there is a risk of serious harm.”
“It is not just about capacity in the communities and the community mental health services; it is also about capacity in the court system, the number of judges and the whole additional capacity and workload required for that, which is an important part of those considerations.”
“It is a little bit dangerous for us to get into a numbers game, because I do not think it is particularly useful or productive to say, “As a result of the changes that we are making, we think it will decrease by x number or increase by y number”, because, by definition, we do not have a crystal ball and we cannot be sure. However, the impact assessment for the Bill— I do not have a copy of that with me right now—includes a range of scenarios and some predictions of the impact and associated costs that go with that. Those are important considerations that led us to the conclusion that we need a 10-year implementation period.”
“As has been said, that will apply to everybody who is currently detained. The key point is the balance of two things: harm to the patient him or herself and harm to others, and therapeutic benefit. Those will be the guiding lights of this entire process. I hope that I have managed to respond; I did not have a huge amount of time to take note of all the points, because there were not very many speakers on this clause. If there is anything I have not addressed, we can of course do so in writing. Question put and agreed to. Clause 7 accordingly ordered to stand part of the Bill. Clause 8 Appropriate medical treatment: therapeutic benefit”
“The numbers that I gave the hon. Gentleman earlier were things that had happened, rather than gazing into the future and reading the tea leaves, but I will do as he asks, and I will ask officials to take him up on the point about the capacity of the legal and judicial system, in particular the tribunals. On the questions the shadow Minister asked about retrospective application, we are supporting the tribunal to make decisions about whether a person should continue to be detained or subject to a community treatment order by providing clear and consistent criteria that focuses on the need for there to be a risk of serious harm and a reasonable prospect that the patient is benefiting from their detention in order justify continued detention for treatment under part 3 of the Mental Health Act 1983.”
“Under the Bill, for treatment to be considered appropriate, there will need to be a reasonable prospect that the patient will benefit from it. The therapeutic benefit criteria will apply at the point of detention and renewal to patients detained under section 3 in part II of the Act, patients on a community treatment order when they are first subject to the order and at the point of renewal, and all part III patients. The clause also retains the definition of the purpose of “medical treatment” in the 1983 Act: “to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.” A focus on therapeutic benefit will ensure that patients receive the care and treatment they need to support their recovery and enable discharge when it is safe for them to leave hospital.”
“The clause strengthens the concept of therapeutic benefit in the Mental Health Act to ensure that patients are detained for treatment or placed on a community treatment order only when there is a reasonable prospect they will benefit from their treatment. The current criteria for detentions under section 3 of the 1983 Act is that “appropriate medical treatment is available”, and the definition of medical treatment focuses only on the purpose of the treatment. In practice, that means that clinicians may not consider whether the treatment under section 3 will be effective. If we are going to deprive people of their liberty, it is vital that detention is of therapeutic benefit to them, regardless of whether the patient is detained for treatment under part II or part III of the Act, so the new therapeutic benefit criteria apply to both.”
“Although we recognise that childhood trauma may be a factor for many patients, it will not be a factor for all patients. It is critical that consideration of appropriate treatment is tailored to, and reflects, individual experiences and needs. All treatment interventions should include the aim of minimising distress and promoting psychological wellbeing. As well as legislative requirements, it is vital that all aspects of care in in-patient settings should be trauma-informed and that patients are always put at the heart of effective, compassionate care. That expectation is set out in NHS England’s “Culture of care standards for mental health inpatient services” and will be further emphasised in the revised Mental Health Act code of practice. I turn to clause 8 stand part.”
“The code of practice already states that patients should be offered treatment and care in safe, supportive and therapeutic environments, so that also addresses that point. I turn to amendments 44 and 45. We recognise the significant impact that childhood trauma can have on a person’s psychological wellbeing throughout their life. Mental disorder is defined in the 1983 Act as “any disorder or disability of the mind”, and that is already broad enough to include the impact of childhood trauma. Clause 8 requires decision makers to take into account “the nature and degree of the disorder”, what is “appropriate” in the person’s case and “all other circumstances” when considering whether medical treatment has a reasonable prospect of therapeutic benefit. That could include consideration of childhood trauma.”