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Mental Health

3.33 pm

The Secretary of State for Health (Mr. Alan Milburn): With permission, Mr. Speaker, I wish to make a statement on the Government's plans for new mental health legislation, set out in the White Paper "Reforming the Mental Health Act", which my right hon. Friend the Home Secretary and I are publishing today. It includes our plans for managing patients who are dangerous and have severe personality disorders.

Millions of people--perhaps as many as one in six of the population--face mental illness at some point in their lives. About 630,000 patients with serious mental health problems are being cared for by specialist mental health services across England and Wales at any one time; and for every individual with serious mental health problems, there are many others--families, carers, friends and, indeed, members of the wider public--who are affected, sometimes with tragic consequences. It is for those reasons that the Government have made improving mental health services a key clinical priority for the national health service.

First, we have made investment a priority. For the first time, ring-fenced funding is expanding what have for too long been Cinderella services, especially for those who are most seriously ill. By April next year there will be almost 500 extra secure beds, at least 320 extra beds staffed 24 hours a day, and 170 assertive outreach teams. Every patient with complex health needs will have access to services 24 hours a day, seven days a week

We have already recruited 3,000 new staff in mental health services. The NHS plan that we published in July announced a further £330 million investment in those services over the next three years. There will be further substantial increases in staff and new investment in specialist community health services and improved primary care services for all people with mental health problems. That investment will help to ensure public safety and will improve patient care.

Secondly, we have made reform a priority for mental health services. Last year, we published "Mental Health National Service Framework", to give local health and social services for the first time, clear national standards against which to operate. That will help to tackle the lottery in care which means that some patients in some areas miss out on services and treatments that others receive as of right. It provides a clear statement for patients and their carers about what services they can expect, wherever they live. It has been widely welcomed by patients, carers, clinicians and managers.

The White Paper that we are publishing today will now underpin those improvements in mental health services with reforms to mental health laws. Good quality care and treatment are the key to making sure that most people with mental health problems never need to fall within the scope of mental health legislation. Despite public perceptions to the contrary, the overwhelming majority of people with mental illness are a threat to no one. Indeed, many mentally ill patients are among the most vulnerable in the community.

Reducing the stigma which attaches to people with mental illness should be a priority for any caring, civilised society. There will always be some people with a serious

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mental disorder, however, who do not seek care and treatment when they need them. Sometimes, they do not recognise how ill they are; sometimes, they are so disabled by their mental illness that they are not able to seek help; and sometimes, they choose not to seek help. In some cases, that means that people with serious mental disorder will pose a significant risk to other people in their family or in the community, as well as to themselves.

In those circumstances, the Government have a duty to protect both individual patients and the wider public, when a person poses such risks. Mental health legislation should help us to do just that. The Mental Health Act 1983 is largely based on the last major review of the mental health legal framework, which took place in the 1950s. Since then, the way in which services are provided has dramatically changed. More seriously, the current laws have failed properly to protect the public, patients and, indeed, staff. Under existing mental health law, the powers compulsorily to treat patients are only available if they are in hospital. However, the majority of patients today are treated in the community. Public confidence in care in the community has been undermined by failures in services and failures in the law.

The policy lost public confidence because, in too many cases, neither services nor the law properly protected either patients or the public. There have been no requirements for local health and social services to exchange relevant information about patients. Services have too often worked in isolation from one another. Too often, severely ill patients have been allowed to drift out of contact with mental health services altogether. Many patients have failed to comply with treatment. Clinicians have been in the absurd position of having to wait until patients in the community become ill enough to require admission to hospital. That prevented early intervention to reduce the risks to both patients and the public. In particular, existing legislation has failed to provide adequate public protection from those whose risk to others stems from a severe personality disorder.

As a result, patients and the public alike have been put at risk. They have been denied the protection that they need. The tragic toll of over 1,000 suicides and 40 homicides every year involving patients who have been in touch with mental health services in the previous 12 months graphically illustrates the failure of the old legal framework. It is outdated; it is in desperate need of reform.

Our proposals today clarify the circumstances in which care and treatment should be provided without the consent of people with mental disorder, either in their own interests or in the wider interests of public safety. They introduce new safeguards to protect patients' rights when care and treatment is given without their consent.

We have consulted widely over the past year on our plans for reform. They will mean major changes in four key areas. First, safeguards will be improved for patients. Removing an individual's liberty against his will is a very serious step to take and must be balanced by suitable safeguards that are fully consistent with the Human Rights Act 1998.

For the first time, all decisions to apply compulsory powers to treat a patient for more than 28 days will be subject to independent scrutiny by a judicial body--the new mental health tribunal. The tribunal, which will be chaired by a senior lawyer, will consider the care and

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treatment plan proposed by the clinical team. It will take independent advice from medical and other experts and from patients or their representatives. Its decisions will be binding on the NHS and will be regularly reviewed. Patients who are subject to compulsory powers will, as now, have the right to free legal advice. They will also, for the first time, have a right to help from a specialist independent advocacy service.

A new Commission for Mental Health will also be established with a clear remit to monitor the quality of decision making and whether the powers in new legislation are being used in a way that is consistent with the key principles that underpin it. The commission will provide new safeguards to protect the rights of people with long-term mental incapacity who are in need of specialist treatment for mental disorder, but who are not able to participate fully in decisions about how that care is provided. The commission will be fully independent and will report annually.

Secondly, there will be new safeguards to protect patient and public safety by extending compulsory treatment powers from the hospital ward into the community. The complexity of current laws which mean that there are several routes to compulsory treatment will be simplified. In future, there will be a single entry point to compulsory treatment based on a full and fair assessment of each individual's care and treatment needs.

New care and treatment orders will mean that patients subject to compulsory treatment, whether in hospital or in the community, will have to comply with the terms of their treatment programme. Refusal to do so could result in the patient being readmitted to hospital. Care plans will take into account a patient's best interests and any risk that they pose to other people. Compliance with treatment and contact with services will both be enforced under the new legislation in a way that was never possible under the 1983 Act.

Care and treatment orders in the community will allow clinical teams to intervene earlier to prevent a patient's condition from deteriorating. The risk that patients may pose to themselves or to others should be reduced as a result.

Thirdly, public protection will be further strengthened by introducing new duties, backed up by robust safeguards, to cover the disclosure of information about patients suffering from mental disorder. Inquiry after inquiry has demonstrated that a breakdown of communication between local services responsible for a patient's care has been a significant factor in many of the homicides and suicides committed by severely mentally ill people. This situation cannot be allowed to continue.

There will be new powers to exchange information between statutory agencies to parallel the other steps that the Government are taking to improve co-ordination between health and other local services.

The Government are also committed to improving the level of service provided to victims generally and giving proper recognition to the needs of victims of mentally disordered offenders in particular. The new legislation will allow victims of mentally disordered offenders to be given appropriate information about the offender's discharge as well as his detention. We also aim to enable victims to make representations to the mental health tribunal when it considers discharging the offender from hospital.

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Fourthly, there will be new criteria giving clear authority for the detention of patients who pose a significant risk of serious harm to others as a result of a mental disorder. They will include the detention of dangerous people with a severe personality disorder. The Government are determined to deal with the challenge to public protection posed by that small group of people.

Our proposals have been the subject of extensive consultation following publication of the joint Home Office and Department of Health document in July 1999. Neither the law nor services are currently geared to cope with the risks posed by dangerous people with a severe personality disorder. Many cannot be compulsorily detained in hospital because they can be defined as untreatable under the current law. Many are sent to prison after committing a serious crime and are a danger to the public upon release. As a consequence, there has been a gap in the protection that mental health laws should afford the public--a gap that we will now close.

In place of the flawed concept of treatability, new criteria will separate those who need treatment primarily in their own best interests from those who need treatment because of the risk that they pose to others. In cases that involve those who present a high risk of harm to other people, the use of compulsory powers will be linked to a care and treatment plan, which describes how to treat the underlying mental disorder and manage behaviours that arise from it. Compulsory treatment can go ahead only after a full assessment by doctors and with the agreement of the independent mental health tribunal. High-risk people who are before the courts for an offence will be able to be remanded for assessment and treatment.

Similarly, my right hon. Friend the Home Secretary will have powers to direct those already serving a prison sentence to be sent for assessment and treatment. Subject to the new mental health tribunal, dangerous people with a severe personality disorder will be able to be detained for as long as they continue to present a high risk to others--indefinitely, if necessary. It should go without saying that the full range of safeguards that I outlined earlier to the House will apply to that group of people.

The Government recognise that new powers to deal with those who pose the greatest risk to the public will not by themselves be enough to safeguard the public. New specialist services are also needed. In the recent spending review, £126 million has been allocated across the Department of Health, the Prison Service and the Home Office to develop assessment and treatment services for that high-risk group.

The extra resources will allow extra staff to be employed and will provide 320 new specialist places in high-security settings in the Prison Service and the health service, as well as 75 specialist hostel places. New approaches to the assessment of the group are currently being piloted in both the Prison Service and the NHS. Treatment pilots will begin next year. The evidence will be used to inform future decisions about how new services should best be structured.

The changes amount to the biggest shake-up in mental health laws in four decades. They will strengthen the current law, introduce new safeguards for patients, and improve protection for the wider community. Taken with the major investment and reforms that are now occurring

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in our mental health services, the proposals will enhance the safety both of patients and the public. I commend them to the House.

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