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Dr. Evan Harris (Oxford, West and Abingdon): Will the Secretary of State give way?
Mr. Milburn: Let me continue this point. I shall let the hon. Gentleman intervene in a moment or two.
The current system does nothing to protect those patients and it certainly fails to protect the public if a small minority of dangerous people with mental disorders in those circumstances go on to harm or even kill others or themselves. In the draft Bill, we shall introduce one broad definition of mental disorder and one set of tight conditions to govern the use of compulsory powers. If those conditions are met and treatment is available, compulsory powers may be used. That will close the loophole and ensure better treatment for dangerous mentally disordered patients and provide better protection for the public.
Similarly, my right hon. Friend the Home Secretary will have powers to direct those who are already serving prison sentences to be assessed and treated. Subject to the new mental health tribunal process, which I will describe shortly, it will be possible to detain dangerous people with severe personality disorders for as long as they continue to present a high risk to others. New services are currently being developed for that small but high-risk group of patients, and my Department and the Home Office are committed to providing more than £120 million to make them available to all who need them.
Dr. Harris: There is clearly a great debate to be had about the Secretary of State's definitions of mental disorder and mental illness, but I want to ask about his view of treatment. He seemed to imply that there was treatment for severe personality disorders. Does he accept that there is at least controversy about whether effective treatment exists, and that, notwithstanding good intentions, defining treatment as including the general
term "habilitation"—which means, to an extent, teaching people how to behave—does not solve the problem, which is that he wants to detain people who cannot be treated?
Mr. Milburn: The hon. Gentleman is right: there is controversy. There is certainly not a set view in clinical circles.
Some interesting experimental therapeutic interventions have been made in the United States and Holland, for example, involving precisely the small cohort of patients whom we are discussing. We are trying to learn from the impact of those interventions. As I think the hon. Gentleman knows, we have already provided funds for pilot programmes at Broadmoor prison, and we plan other tests at Rampton and Broadmoor to try to ensure that the right range of treatments is available.
The hon. Gentleman could put his question in a different way, and ask what else we should do. Should we throw up our hands and say that there is nothing we can do? People in the system know fine well that although this is a very small minority of potential patients, they pose a substantial risk to themselves, their families and the wider public. Given those circumstances, what are those of us in decision-making positions to do? Are we to say there is nothing we can do, or try to close a patent loophole in the law?
I think it right for us to publish our Bill in draft: White Papers are one thing, but seeing legal, statutory proposals in black and white is quite another. I know that there is concern, and that there will be controversy, but I say in all candour that unless we do something we shall see more of the problems in our constituencies of which we are only too painfully aware.
Dr. Fox: What the Secretary of State is saying is important. He has rightly drawn a distinction between the draft Bill and the current legislation, pointing out that there is now a single definition of mental disorder and that the treatability criterion is being abolished. He says that he is doing this because a proportion of patients with severe personality disorders would otherwise pose a risk to the public. According to the Government's own research, what proportion of those patients might expect to be detained under new legalisation?
Mr. Milburn: That depends on the process, which I will describe in a moment.
As the hon. Gentleman probably recalls from earlier debates—I think my last statement to the House on the subject was made at the time of the White Paper's publication—we currently estimate that between 2,100 and 2,400 people make up the small cohort of potential patients whom we are discussing. Most are in contact with the criminal justice system, and the overwhelming majority are already in prison. We are revising the estimate, however, and it is likely to be revised upwards rather than downwards. Although the number is small, unless appropriate treatment and management are available there is a grave danger of precisely the problems that the hon. Gentleman mentioned in his speech.
Other changes in mental health law are needed. In the past, too many people with mental health problems were rightly removed from crumbling acute hospitals, but wrongly placed in the community with little support and poor treatment.
Some lost touch with services, with tragic results for them and their families. Some started on a cycle of detention in hospital and discharge to the community, only to be forced back into hospital when a crisis hit. That revolving door is bad for patients and their families, and we intend to tackle it in the Bill.
We will do so by allowing compulsory treatment to be provided in the community, as well as in a hospital. That will allow earlier intervention to prevent a patient's condition deteriorating and so help to reduce the risks that patients may pose to themselves or to others. New orders will mean that patients subject to compulsory treatment, whether in the hospital or in the community, will have to comply with the terms of their treatment programme.
In his speech, the hon. Member for Woodspring asked about medication. I know that concerns have been expressed about that matter. I can assure the hon. Gentleman that it will never be appropriate, under the terms of the draft Bill, to provide compulsory medication in a person's home. Instead, orders will set out the form of treatment that should apply. For example, if a patient in a clinic refused to comply with the order, he or she could be readmitted compulsorily to hospital.
Mental health legislation, by necessity, must tread a delicate path between protecting those who are most vulnerable and ensuring public safety. In the draft Bill, the new powers that I have just described are balanced with additional safeguards for patients. Each patient will have an individualised care plan, on which any compulsory treatment will be based. Unlike now, those making decisions about compulsion will also have to consider the patient's wishes and feelings about his or her treatment and the views of his or her carers.
There will be proper safeguards, and patients will be helped to make use of them. Most significantly, all orders for compulsory assessment and treatment for more than 28 days will have to be authorised by an independent judicial body—the new mental health tribunal—and its decisions will be regularly reviewed. For offenders, of course, the initial decision to apply compulsory assessment and treatment will be a matter not for the tribunal, but for the courts.
Mr. Tom Clarke (Coatbridge and Chryston): I am grateful to my right hon. Friend for giving way, and for his approach to these matters. In 1986, some of us managed to steer an Act through the House dealing with some of the issues touched on today. I remind my right hon. Friend of two things. First, that legislation provided that patients leaving long-term care would receive a proper assessment and a response to their needs. Secondly, and more importantly, it provided that advocacy would be crucial to a patient's rights. Will my right hon. Friend assure me that those factors have not been forgotten?
Mr. Milburn: They certainly have not been forgotten. I commend the work that my right hon. Friend did in 1986, and still does today, on many of the issues to do with the very difficult problems associated with long-term care for some of the most vulnerable in society, and with the role of carers. He is right about what must be included in the barrage of safeguards that we must put in place.
Removing a person's liberty is an extremely serious step to take. That might be the right thing to do in some circumstances, both for the individual and society, but the power must be balanced with new safeguards for the person involved. As is the case now, those safeguards will include the provision of free legal advice for those who need it. For the first time, people will also get the right to new independent advocacy services, which are intended to help them through what can be the rather byzantine maze of mental health legislation. Those free and independent advocacy services will be available to every patient who goes through the compulsory treatment process.
Mr. Hinchliffe: I listened carefully to my right hon. Friend's detailed analysis of the draft Bill in respect of the role of tribunals. He made it clear that tribunal decisions will be subject to review. A constituent of mine received a mental health tribunal decision more than a year ago, but it has not been implemented yet. How would the circumstances of a person like that man be affected by the new arrangements proposed in the draft Bill?
Mr. Milburn: I am not familiar with that case, although if my hon. Friend writes to me about it, I shall be happy to consider it. Let me say two things. First, under the draft Bill, the decisions of the mental health tribunal are binding on the national health service, and we would expect the national health service to act quickly to implement them. Secondly, there are safeguards, too. Compulsory treatment will be allowable for the first 28 days without recourse to the mental health tribunal, although the right of appeal to the mental health tribunal exists even during that period. Thereafter, the tribunal can make compulsory treatment orders, for up to six months in the first instance, for a further six months in the second instance, and, finally, for periods of 12 months and so on. Rights of periodic review will exist within that if the person concerned wants to challenge it or their carer has a view about it. I want to assure my hon. Friend that, all along, we have tried to balance safeguards with proper protection for the public.
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