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I do not understand why the Government oppose the Lords amendments to clause 24 on age-appropriate assessment, services and accommodation. They have said that that would not be available in an emergency, but clause 24 is perfectly clear about assessment in an emergency, when it might not be possible to provide such facilities. It is clear that what is required in terms of accommodation is what is sufficient for the needs of children and young people and that what is sufficient for the needs of children and young people might be different in an emergency from what might be available when there is more time. As I said to the hon. Member for Birmingham, Selly Oak, Ministers must accept that Parliament wants to make it clear that it is unacceptable for three children and young people a day
to be admitted to adult in-patient facilities. That must stop, and we must find not only the means but the will to make it happen.
I have mentioned the safeguards on revolving-door patients, and I find it astonishing that Ministers will not accept the Lords amendment, which seems to deliver precisely the kind of safeguard that Ministers have called for.
On therapeutic benefit, the Secretary of State and I had an exchange on the issue of personality disorder. That comes down to the question of medical necessityis it necessary for somebody to be admitted under compulsion? In another place, the Liberal Democrat Lord Carlile, who cannot be accused of treating lightly the protection of the public, quoted Professor Eastman, who is professor of law and ethics in psychiatry at the university of London and head of forensic and personal disorder psychiatry at St. Georges medical school. Professor Eastman has said:
Therapeutic benefit to the individual is of crucial importance in terms of protecting the boundary of what is the business of mental health professionals. I am not at all against protecting the public, of course not, but it must be in conjunction with some benefit to the individual that goes beyond simply stopping them offending. If you adopt a definition of treatability which is simply the reduction of risk or the avoidance of offending, that means that locking somebody up is treating them.
We do not agree with the proposition that locking somebody up is treating them.
This is a health Bill, and it must be about treating patients successfully. We have to protect patients from harm and we have to protect the public, and improving access to and the effectiveness of mental health services is the best way to achieve that. In specific circumstances, compulsory detention and compulsory treatment in the community will be necessary. We have a responsibility in Parliament to define those circumstances with the greatest possible care. I have no doubt that those circumstances must be determined by the therapeutic benefit to the patient as well as the necessity of compulsion to prevent harm to others. We must not widen the scope of compulsion to such an extent that it threatens patients and drives them away from access to services and compliance with treatment. Conservative Members welcome the Bill as introduced in this House, and unlike the Government, we will vote for it on Second Reading while agreeing with its principles.
Madam Deputy Speaker (Sylvia Heal): Order. I remind all right hon. and hon. Members that Mr. Speaker has placed a 10-minute limit on speeches by Back Benchers.
Mr. David Blunkett (Sheffield, Brightside) (Lab):
First, I congratulate my right hon. Friend the Secretary of State and her ministerial colleagues on persevering with this legislation in the face of misleading and, sometimes, scurrilous campaigning, which has led to great fears among those suffering from mental health problems. Those fears were expressed on the radio this morning, when someone who is willingly receiving
support and treatment and gaining therapeutic benefit from it stated their belief that the Bill would take away their liberty. It behoves all those who are debating and campaigning on the Bill, with which I have been involved for a number of years, to be careful about what they say in order not to create unnecessary worry. That includes the idea that 2,000 people will immediately be rounded up as though we live in a police state, which we do not.
Secondly, I congratulate my right hon. Friend on the balance that she is attempting to achieve between the liberty of the individual and the protection and needs of the public. As she has rightly pointed out, she has a substantial personal background in this area, which she has brought to bear on the legislation.
Thirdly, as part of the extensive listening that has taken place over the past few years by the Government, I hope that my right hon. Friend will ensure that issues of advocacy, which were originally in the legislation, which are being campaigned on by YoungMinds and which are complicatedfor example, a parent would not want a 10-year-old in the same ward as 17-year-olds with particular health problemsare resolved. I know that there is deep concern about that among hon. Members on both sides of the House.
Fourthly, an issue that concerns the Zito Trust is that victimsor, more appropriately, victims familieshave the same rights in relation to murder and distress caused in the circumstances that we are debating as they would if action were taken under the criminal justice system, which was strengthened in that regard by the measures taken in 2003.
We should be wary of presuming that because people have the right intentions they are automatically right. That is clearly demonstrated by the Lords amendments, which would create fear unnecessarily. Let me refer particularly to issues relating to exclusion. Some people assume that if the Bill does not specifically exclude the possibility that there is an evil regime just around the cornereven in my worst moments, I do not presume that that will happen after the next general election, or the one after, or in 50 years timethat possibility means that issues of sexual identity or orientation, or of peoples involvement in disorder or in acts of cultural, religious or political belief, are somehow associated with its measures, leading them to believe that there is another agenda.
When people believe that, they start making up in their own minds about what might happen. Take the shadow Health Secretarys views on therapeutic outcomes. Of course, we can debate an holistic approach and whether we can judge therapeutic outcomes in terms of managing someones condition. However, in dealing with the question of community treatment orders, it ill behoves us to presume that those who are prepared to continue to receive support in the community, to accept their treatment and to continue to collaborate with the services are at risk of being dealt with under this legislation, because all Members know that they are not. We are not talking about people who would continue to take medication or receive therapeutic outcomes, but about people who would breach the decisions that were taken while they
were in compulsory hospitalisation. All of us, perhaps with the exception of the Member who asked an inappropriate question earlier on, would accept that we have had compulsion for the past 125 years. We are debating precisely how we deal with the delicate area of people whom we know are at riskor at least some psychiatrists would accept that they are at riskbecause they have been into compulsory hospitalisation at least once. It is strange that those who rightly argue against revolving doors, and who would be deeply concerned about patients who were continually in and out of hospital without appropriate community action being taken to avoid their returning to hospital, have reversed the coin completely and are saying that they want to continue with a revolving doorpresumably to the point where someone demonstrates by their actions that they are a risk to themselves and others. We cannot have it both ways.
Nor do we want there to be a lawyers field day, as there usually is. I have more than one regret about things that I did as Home Secretary, partly to do with the balance in sentencing and the misunderstanding with the judiciary. Another regret that I had as Home Secretary concerned the nature of peoples understanding of what was taking place when we legislated. The more we legislate, the more lawyers make moneythere is no question about that. In my view, they would have a field day if we left in place the House of Lords amendments. I should know, because they have had a field day in making money out of mefortunately with success on my side. However, that does not stop me from being deeply suspicious of anything that means that people have to resort to law to be able to understand what we were trying to legislate about and its interpretation.
For instance, I have experienced situations where people argued after a murder had taken place that the individual had a mental health problem and should therefore not be sentenced normally through the criminal justice system but be dealt with through the mental health tribunal. I have a terrible fear that the arguments are now moving the other way, whereby people would argue that the fact that someone was prepared to commit homicide demonstrated that they had a mental health problem, but were not prepared to accept, even though the person had been in hospital under detention before, that that could have arisen. These definitions and clinical decisions are very difficult. We must be careful that we do not impair peoples liberty, but we must also be clear that if we fail to act, we let people down.
I go back to the time when I was shadow Health Secretary, when I first met Jayne Zito. I pay tribute to what she has done over those years since the death of her husband, Jonathan. It seemed to me absolutely crucial that we listened and learned from such events, just as I listened and learned when I went to see the man with a mental health problem who tried to commit suicide, failed and ended up as a paraplegic. Of course, he was having to be supported and treated. He desperately wished that someone, as we would if we saw a person jumping off the parapet of a building, had been prepared to interveneto grasp his hand and stop him doing it.
We are trying, with difficulty and with all sorts of things being said about us outside the House, to get
that balance right. I hope that with the support of this House we will eventually pass an Act that protects people from themselves and from others.
Norman Lamb (North Norfolk) (LD): It was good to hear the belated recognition by the right hon. Member for Sheffield, Brightside (Mr. Blunkett) that passing endless new legislation does not necessarily make the world a better place. The Bill is all about the safeguards that are in place to ensure that people with mental health problems are treated properly and that legislation cannot be improperly abused because it is too loose and does not sufficiently safeguard the interests of the individual.
The proposed legislation has had a tortuous journey to get to this point, and the Bill that we have before us, as amended in the other place, is a good one that will have Liberal Democrat support. The sadness is that the Government will seek to unravel the good work that has been undertaken in the other place. Like the Conservative spokesman, I pay tribute to the extraordinarily well-informed debate in the other place and the scrutiny of the Bill that took place there.
The only point where consensus has been achieved is on the need to reform mental health law. There is widespread acceptance of the fact that the Mental Health Act 1983 needs updating, but nine years on from the Governments appointment of an expert committee back in 1998, it is remarkable that far from building consensus and support for new legislation, we will have a greater divide between the Governments position and that of most people working in mental health services. The Government make a lot of the amount of consultation and debate that has taken placethe Secretary of State mentioned it in her speechbut the problem is that they give every indication of rejecting all the evidence and advice that has come as a result. That evidence and advice have come from a remarkable alliance of organisations working in mental health servicesan alliance of, I think, 79 organisations, covering service users, psychiatrists, social workers, nurses, psychologists, lawyers, voluntary organisations, charities, religious groups, research bodies and carers groups. Together, they have expressed their concerns and maintained their opposition to the Bill as originally presented to the other place. The Government ought to take careful note of such a powerful alliance of concern.
Judy Mallaber (Amber Valley) (Lab): Will the hon. Gentleman accept that the alliance of all those professionalsthis includes Amicus, the British Association/College of Occupational Therapists, the British Psychological Society, the Royal College of Nursing and Unisondoes not agree about the changes made in the House of Lords to move away from the multidisciplinary role and put all power back in the hands of doctors? Will he accept that on that issue that alliance does not represent the views of a large number of people working in mental health services in the health service?
Norman Lamb: I accept that and certainly we will listen to the concerns as the Bill goes through Committee. I appreciate that there is a divergence of views on that issue.
In 2004, the Joint Scrutiny Committee reached a conclusion that one would have thought would be largely uncontroversial. It said:
The primary purpose of mental health legislation must be to improve mental health services and safeguards for patients and to reduce the stigma of mental disorder.
That does not appear to be the Governments view. The Government define the purpose of the Bill very narrowly. They say that it is
about the legal processes for bringing people under compulsion.
Clearly, that is an incredibly important issue, but the divide in perceptions of purposes of legislation is remarkable.
I want to say something about protection of the public. The Government make much of that, and in many respects rightly so. It is of course entirely legitimate and right to consider public safety and to ensure that people are not unnecessarily put at risk, but we need to ensure that legislation is guided by evidence, and it is incumbent on us all not to stir up fear where evidence might provide reassurance.
The Governments approach appears to be based on an assumption that mental ill health, particularly in severe forms such as schizophrenia, is necessarily linked to violence and that the problem is getting worse, caused by care in the community and the inadequacies of the Mental Health Act 1983.
What is the evidence? According to the evidence that I have seen, 5 per cent. of homicides are committed by people who have at some stage had contact with mental health services. That position has remained largely unchanged for the past 50 years. In other words, the emergence of care in the community appears to have had very little impact on those statisticson those trends. Far more murders are committed by people under the influence of drink or drugs, and there is certainly no suggestion that we should be locking them up on a preventive basis.
If we look at the number of murders committed by people who are currently suffering from a mental health problem, we again find little change. There have been 30 to 40 a year since 1997, yet the overall murder rate has increased by some 30 per cent. in that time, so murders committed by people with mental health problems form a reducing percentage of the total number of murders. Only one person in 20,000 with schizophrenia commits murder.
As I understand it from talking to experts, there is also the problem that it is very difficult, if not impossible, to predict which person could be violent. I understand that attempts to predict are wrong in 97 cases out of 100. We would have to lock up 2,000 to 2,500 people to prevent a single homicide. On the point made by the right hon. Member for Sheffield, Brightside, of course we are not suggesting that we are going to lock up that number of people, but if we do not, we do not achieve the objective of preventing people from being killed.
Chris Bryant: That is a completely false understanding of how logic works. It is entirely wrong to suggest that we would have to lock up 2,000 people. We might have to lock up only one person to prevent one homicide.
Norman Lamb: It would be like looking for a needle in a haystack. The point that I am trying to make is that the experts make the case that it is impossible, or certainly very difficult, to determine who might be the person who commits violence at some future point.
Hywel Williams: Therefore, if the provision goes through, are not we in danger of locking up some people who are not likely to turn out to be murderers, and of not locking up people who are?
Norman Lamb: Of course, that will always be the risk.
If we look at the findings of the various inquiries that have taken place into the tragic deaths that have occurred, we see that the focus tends to be on the human failures of those providing care and on inadequate resources, rather than on a lack of sufficient powers. The problem is always poor communication, poor care planning, overstretched professionals failing to heed warnings and inadequate service provision.
I was listening to a consultant psychiatrist this morning, who was saying that it is the people who are not in the care of professionals, not the people already in the system, who are often the problem. The findings of the Michael Stone inquiry were typical of that. There was no recommendation for changing the law.
Many observers have highlighted the concern that if the Government get their way, the public could end up less well protected. Two reasons are cited. First, the use of powers of compulsion is resource intensive. It ties up professionals in bureaucracy and skews resources towards acute care and away from early intervention. The second reason is the risk that increased use of compulsion could drive service users away from mental health services.
Dr. Tony Zigmond, the honorary vice-president of the Royal College of Psychiatrists, made that point today. He said that his experience is that the threat of compulsion can drive people away from the very services that can help them and make the public safer.
Angela Browning: I was present when Dr. Zigmond made that statement today, but it is not only him as an individual, eminent though he is, who takes that view. It is the official view of the Royal College of Psychiatrists as a whole profession. Those professionals do not want to have to take on the responsibility of picking out the people who just might some day commit an offence. That is an impossible task to ask professionals to do.
Norman Lamb: I am grateful to the hon. Lady for that intervention. She makes a very good point. It reinforces the point that the Government are playing a very dangerous game in going against the views of so many eminent and experienced people in seeking to force the measure through.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op):
It is true that that is the view of the Royal College of PsychiatristsDr. Zigmond is sitting up in the Gallery, listening to usbut the point is that it is quite
possible to meet psychiatrists who disagree with that view. I have met many of them. That viewpoint is obviously arrived at through a democratic process, but it is not true to say that it is the belief of every psychiatrist practising today.
Norman Lamb: I have never at any stage suggested that it is the unanimous view, but it certainly appears to me to be the overwhelming view of psychiatrists.
The conclusion that we should reach is that although it is accepted by everyonethe Government sometimes seem to distort this pointthat compulsion is sometimes necessary, it should be used as the last resort and should be subject to effective safeguards to ensure that it is used only where appropriate.
Meg Hillier: Talking of the views of consultant psychiatrists, one said to me:
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