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“A section is an act of kindness and it’s bizarre to restrict it to hospital”.
Will the hon. Gentleman comment on that? His remarks seem to be totally about murder, which relates to only a tiny percentage of the people we are talking about. Many patients and families want there to be compulsory treatment. If every other patient who needs it is given treatment, surely mental health patients should have that option, too.
Norman Lamb: I have made the point that we accept the case that sometimes compulsion is necessary. The point is that it needs to be subject to stringent safeguards. It is the Government who talk the whole time about public safety. It seems to me to be distorting the debate to talk only about those cases. In my contributions, I was seeking to address the point made by the Government that the public will be less safe if the Government do not get their way. That palpably is not the case.
Hywel Williams: The hon. Member for Hackney, South and Shoreditch (Meg Hillier) has put her finger on the problem: the trouble with the mental health system is the lack of accessibility. Everyone should have a right to an assessment, if that could be managed and if the resources could be made available.
Norman Lamb: I absolutely agree with the hon. Gentleman.
I want to state the clear principle that depriving a person of their liberty when no crime has been committed is a very serious act, and we must always be aware of that. Those people have rights too.
Lynne Jones: Will the hon. Gentleman give way?
Norman Lamb: I should like to make some progress, but I would be happy to give way later.
The focus must be on ensuring high standards of service provision. The Government put this rather well in their response to the Joint Scrutiny Committee, in which they said:
“In terms of the small minority of people with a mental disorder for whom compulsion might be necessary, we want to achieve a level and type of service provision that minimises the risk of people with a mental disorder deteriorating to the point where compulsion is necessary. When compulsion has become
necessary, we want that service provision to be of a level and type to ensure that everything possible is done to prevent the need for any further episodes of compulsion. In other words, by improving the services to promote better mental health, we want to reduce the need for compulsion.”
I completely sign up to that statement of intent by the Government. It is a good basis on which to develop the law and our approach to mental health services.
In the past 12 months, however, the deficits in the health service have had a damaging impact on those very mental health services in many parts of the country. I acknowledge the improvements that have been made in those services over the years, but in the past year, damage has been done. Before Christmas, the Health Committee produced a report on deficits which specifically highlighted mental health services as one of the “soft targets” that was suffering as a result of the cutbacks in funding. It is particularly depressing that those cutbacks should be happening just as the Government’s emphasis appears to be on creating more draconian powers. This undermines the fine aspiration that they expressed in their response to the Joint Scrutiny Committee.
I want to highlight the concerns expressed by many people about the potential impact of the original Bill on black and minority ethnic communities. The Minister will be aware of the genuine fear that, without proper safeguards, the Bill could disproportionately affect people from BME communities. Last December, it was revealed that a report by a Government advisory group chaired by Rabinder Singh QC warned that the Bill could lead to more black and ethnic minority patients being subject to compulsory treatment. Already, as a result of the Mental Health Act 1983, in-patients from black Caribbean, black African and other black groups are between 19 and 38 per cent. more likely to be detained compared with the average for all in-patients.
In November last year, the Department of Health published a race equality impact assessment on the Bill. However, on 7 February this year, the Commission for Racial Equality announced a formal investigation into the Department of Health to
“uncover the extent to which it is failing to meet its duty to promote race equality under the Race Relations Act 1976”.
Anthony Robinson, the CRE’s director of legal services said:
“We are concerned about the Department of Health as we have reason to believe that they have not been meeting their obligations under the law”.
What is going on? That is an extraordinary statement for the commission to make. I hope that the Minister will be able to offer some reassurance on this matter. Improving the way in which people from BME communities are dealt with by mental health services clearly presents a significant challenge. The Commission for Racial Equality has called for amendments to guarantee the effectiveness of the race equality duty. Will the Government consider those proposals in a constructive way?
Meg Hillier:
I represent a constituency in Hackney, and in the City and Hackney primary care trust as a whole, 40 to 45 per cent. of the people detained are from African and Caribbean groups, and are mainly men. We all recognise that many more black people are
detained and treated differently, but the Bill is not the place to fight that battle. I am fighting that battle, and I would happily join the hon. Gentleman in fighting it too, but he is wrong to conflate the two issues. The Bill might have an effect on people, but whatever we do to it, it is not going to solve this problem.
Norman Lamb: I am grateful to the hon. Lady for that intervention, but my point was that, under the existing regime, black and minority ethnic communities are treated disproportionately severely, and that if there is any increase in compulsion as a result of the Bill, there is every likelihood that those groups will be disproportionately affected by it. It is a question of logic. We must take the opportunity of this mental health legislation coming before Parliament to address the concerns about the way in which black and minority ethnic communities are treated, so as to ensure that mental health services do not discriminate against people from those communities.
I want to deal with the amendments passed in the other place which, in the view of the Liberal Democrats, must be preserved. First, there are the exclusions from the definition of mental disorder. The right hon. Member for Sheffield, Brightside talked about exaggerated language being used by those who oppose the Bill, but some of the exaggerated and misleading claims made by the Government have been enormously damaging to what should be a good, high-quality debate.
At the Local Government Association conference last month, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) said that
“by adding a range of unnecessary exclusions, the changes forced through by the Lords will inevitably open up new avenues for patients and their lawyers to use to try to secure the premature discharge for some of the most dangerous patients.”
That is scaremongering. The exclusions are about making sure that the powers are not used inappropriately. Similar exclusions exist in most comparable jurisdictions, including Scotland, and there is no evidence of dangerous people roaming the streets as a result of those exclusions being put in place in the Scottish legislation.
I want to deal next with the amendments on impaired decision making. The Bill, as amended, prevents the compulsory treatment, including detention, of people who are fully able to make their own decisions about the provision of treatment. The Government claim that this will result in people who need treatment not being detained, putting them and others at risk. First, the Scottish legislation contains a similar provision and, again, there is no evidence of it causing a danger to individuals or to the public. Secondly, if someone with a physical health problem has the right to refuse treatment, should not the same rule apply to someone with a mental health problem? I think that the hon. Member for South Cambridgeshire (Mr. Lansley) made that point earlier. Thirdly, the Government’s own expert Committee, the Richardson Committee, supported an impaired decision making test, as did the Joint Scrutiny Committee. Fourthly, mental health clinicians advise that a person with a mental disorder who is suicidal or who poses a risk to others because of their condition would inevitably be
found to have impaired decision making, and so come within the scope of the legislation. So the amendment is a safeguard of real importance to the citizen’s human rights, and does not leave individuals or the public at risk.
Next, I want to deal with the treatability test. The Minister made an extraordinary claim on this in her speech to the Local Government Association. She said:
“This safeguard has, on occasions, been misrepresented as meaning that patients can only be detained if they can be cured, rather than treated. This confusion has led to too many patients with personality disorders, which can be treated but not cured, being turned away from services.”
If that is the case, the answer is surely to ensure that professionals interpret the law correctly, not to change the law in a fundamental and dangerous way. The amendment addresses the Government’s concern to ensure that someone with a personality disorder is covered by the Bill. It is a balanced amendment, and it should stay.
The Richardson Committee said that a health statute should authorise overriding patient autonomy only if there are
“positive clinical measures included within the proposed care and treatment which are likely to prevent deterioration or secure improvement in the patient’s mental condition”.
Again, the Scottish legislation uses the same therapeutic benefit test, and there is no evidence of disaster in Scotland.
The amendment on the renewal of detention is intended to provide a safeguard that is hard to dismiss other than on cost grounds. A medical practitioner would be required to examine the patient and to agree to their continued detention. Other health professionals have argued that the amendment goes too far, and we will take account of their arguments in Committee.
I join in the criticism of the Government for publishing research on the international experience of community treatment orders the day after the Bill completed its passage in another place, which I thought was extraordinary. We know that the report had been available for a considerable time. Why did the Government wait until the deliberations in another place had finished? Surely it is better to allow informed debate than to deny us valuable information.
The research revealed that there is little evidence of the positive value of CTOs. The Institute of Psychiatry concluded
“there is no robust evidence about the effects of CTOs on key outcomes, such as hospital readmission, length of stay, medication compliance, or the patients' quality of life.”
The report advised that enhancing community services was a better way of improving compliance and reducing the incidence of relapse. Surely it makes sense to accept the argument for CTOs in a limited number of cases, along with the safeguards introduced by the House of Lords.
The Minister claims that CTOs are intended to apply specifically to those dubbed “revolving door patients”: people who leave hospital, relapse because of failure to take medication, and go back into hospital. The amendment was designed to ensure that CTOs would
apply to precisely those patients. CTOs can impose wide-ranging restrictions on patients—many have described them as “psychiatric ASBOs”—and further amendments are needed to make them proportionate. It is important, for instance, to give patients the right to appeal to mental health review tribunals against conditions that have been imposed on them.
Amendments that give health bodies a positive duty to admit children and young people to age-appropriate settings, and to provide specialist assessment and supervision for detained children, are fundamental to a civilised society. The Secretary of State said that it was not possible to ensure that something happened by passing legislation. I wish that the Government had taken more note of that principle during the past 10 years, but in this instance we should surely set a standard. We must all accept that children should not be admitted to adult psychiatric intensive care units. It is nothing short of scandalous that one child or young person has been admitted to an adult mental health setting every day for the past three and a half years. It is also worth noting that the amendments are entirely in sympathy with the thrust of the approach recommended by the national service framework.
The issues that we are debating are of fundamental importance. It is essential that we get the Bill right. It needs to stand the test of time, and it needs to have the confidence of those who work in mental health services. It is remarkable how cavalier the Government seem to be in the face of overwhelming opposition from those with real expertise.
The Bill is not perfect. We want core principles to be set out in it, and I see no reason why that should not happen. I agree with the hon. Member for Stafford (Mr. Kidney) that those facing compulsion should have the right to an independent mental health advocate, and should be made aware of that right. But if the Government insist on driving through the removal of clauses added in the other place that provide safeguards for vulnerable individuals, they will make a very serious and dangerous mistake.
Madam Deputy Speaker: Order. I remind hon. Members that it is not permissible for them to refer in their speeches to people sitting in the Public Gallery. I also remind them of the 10-minute limit on Back-Bench speeches.
6.54 pm
Mr. David Kidney (Stafford) (Lab): I agree with the hon. Member for North Norfolk (Norman Lamb) that it is not before time that we are updating our mental health law, as has already been done in countries such as New Zealand, Australia and Scotland.
I support the Government in respect of nearly all the proposals that we have debated. They also deserve the congratulations that they received from even the hon. Member for South Cambridgeshire (Mr. Lansley) on their extra investment in the health service generally, and particularly in mental health. Before 1997 we experienced decades of underinvestment in our national health service, and no service was treated more
harshly than mental health services, which is why practitioners described it as the Cinderella of services at the time.
I can give an eye-witness account of the changes that have taken place. For nearly 20 years before I was elected to Parliament I was a solicitor in Stafford, where we have a very successful hospital for mental health treatment, St George’s hospital. I regularly advised patients, had discussions and meetings with members of staff such as psychiatrists and hospital managers, and had dealings with the mental health review tribunal. I observed the problems that were created by underinvestment in services, particularly the lack of support for people in the community, which made hospital admissions more likely than they should have been. For the last 10 years I have been a regular visitor to that same hospital as the local Member of Parliament, meeting patients and other service users, doctors and nurses, and hospital managers. Today the story is completely different.
During my time as the local MP, we have also seen the establishment of a private hospital dealing with mental health issues. The hospital, which is in Wheaton Aston in my constituency and is a member of the Huntercombe Group, specialises in acute illnesses and eating disorders in young adults and children. It is experienced in those conditions, and has made valuable comments about the parts of the Bill that deal with services for younger patients. Also in my constituency, Staffordshire university has a centre for national research on older people and mental health. As the local MP, I have seen a good deal that is relevant to today’s debate.
St George’s hospital is part of South Staffordshire Healthcare NHS Foundation Trust. Let me say something about the way in which it has developed since 1997. It is now an exemplar for national services such as inclusion and regional services such as forensic sciences, and features local excellence in services such as developmental neurosciences and dealing with learning disabilities.
When I visit the hospital, I see a brilliant commitment among its staff. There is evidence of that for visitors in the form of the magnificent modern learning centre—which is proof positive of the commitment of management to staff—and also in what the hospital calls the values exchange, which enables staff to swap experiences and suggestions of ways in which to improve services. That approach extends to service users, who show a fantastic commitment to the hospital where they have received treatment. Much of the credit belongs to the chief executive, Mike Cooke, who is so brilliant that he is leaving us next month to take up a post with a larger trust in Nottingham.
I have also visited Huntercombe Stafford Hospital several times. It has great expertise in dealing with younger patients, and has much to offer this debate.
We have seen two attempts at wholesale reform of mental health legislation in the past, both of which failed. I think it a shame that all our mental health law cannot be kept in one place as a kind of code: it is sad that we could not achieve such a modernisation. This Bill represents a more modest attempt to modernise the Mental Health Act 1983. Psychiatrists at both the hospitals I have mentioned tell me that there are
advantages in that. The 1983 Act is familiar to practitioners. The definitions are well known to them, the practices are appreciated, and they like the idea of evolutionary rather than revolutionary change. There is also the opportunity to “mesh” the legislation with other reforms such as the Mental Capacity Act 2005.
Like those practitioners, I ask “What is this law for?” I accept the Government’s point that it is intended to provide a legal framework, but I still maintain that the quality of services is at the heart of the issue. With a good framework, services can flourish and meet need effectively; without it, they will be harmed. Like the Joint Scrutiny Committee I believe that
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