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7.24 pm
John Bercow (Buckingham) (Con):
It is a great pleasure to follow the hon. Member for Hendon (Mr. Dismore), many of whose concerns I share.
Notwithstanding those concerns, my view is that the Bill should receive a Second Reading tonight precisely because of the welcome and protective amendments that were made on a cross-party basis and with great expertise in the House of Lords.
I listened carefully and attentively to the Secretary of State as she introduced the Bill this afternoon. She invoked, in support of the Government’s determination to reform the treatability provision, the need to catch within the net people who currently are not being caught. Specific reference was made, and justification was provided, in the cases of people with severe personality disorders. I have to say that I have listened over a period of weeks and studied some of the evidence, and my distinct understanding was that there was a misapprehension about that category of person. In so far as such people have not been treated in the past, it is principally because of a combination of reasons, including an absence of resources; a mistaken and outdated belief that such people could not be treated; and, as the corollary of those two states of affairs, the lack of effective treatments to secure the desired result. If in fact one secures a proper interpretation of the existing legislation and one has the resources to deliver what is necessary, it seems that that fox is easily shot.
I respect the Minister’s intentions and her humanitarian philosophy, but I suggest that she is wrong on this issue. The use of the term “appropriate treatment” is far too broad and potentially invasive. I do not think that it can be justified. Ministers were put to the test in the other place by Lord Howe, Baroness Barker, Baroness Meacher, Baroness Murphy and Lord Carlile—to name but a few—who tabled an amendment that said “we don’t want that. What we want is to ensure that there is provision that will guarantee that the alleviation of, or the prevention of deterioration in, the condition should be the criterion that has to be satisfied if compulsion is to be deployed.” That is entirely reasonable. If the Government think that people will benefit—that a therapeutic gain will be derived, or an improvement or prevention of deterioration in the condition will, in most circumstances be the predictable consequence—I do not know of what exactly it is they are afraid.
I do not doubt the intentions of the Minister and I do not seek to impugn her integrity, but if the Government get their way, the inevitable prospect is held out of an expansion of preventive detention, if not on an industrial scale, at any rate in terms of significant increases in numbers. Simply as a matter of logic that must be what is portended by Government intentions. If the Government do not intend in any way to change the numbers, why do they need to go to such lengths to defy the professional wisdom and change the law?
My view is that the Government are wrong. They should accept the Lords amendment and there is a powerful consensus on that point. It is the view of the Joint Committee and of the Richardson review, which was requested by the Government. It is the considered judgment of the House of Lords and the opinion of the Mental Health Alliance, as well as the determination of the Scottish Executive. In terms of humility, the Minister might like to consider the
possibility that she is in splendid isolation for the simple reason that she is mistaken.
Lynne Jones: I agree with the hon. Gentleman that “appropriate treatment” is inadequate, but is not the problem in the very words that he uttered? One cannot guarantee that treatment will bring about therapeutic benefit or prevent deterioration. I hope that we can find some compromise that will improve on “appropriate treatment” but not go so far as to say that we can guarantee the outcome.
John Bercow: That is a perfectly reasonable point, but I think—I shall stand corrected tomorrow if I am mistaken—that study of the record will show that I went on to say “guarantee” what the “likely outcome” would be. The hon. Lady is absolutely right. I concede the point: there are no certainties in this field and it does not do to be either arrogant or presumptuous, but we have to work on the balance of probability of the effect of one policy as distinct from that which is likely to flow from another. That is one area of concern and I beseech the Government at least to reconsider their position.
My second concern is that we should preserve the judicious amendment made in the House of Lords to bring the rights of people who suffer from mental illness into line with those of people suffering from physical illness. In other words, if someone possesses full decision-making capacity about his or her mental health, I cannot see why he or she should be subjected to compulsory detention and compulsory treatment—compulsorily undertaken, manifestly, against his or her will—when that person has said, “I don’t want it”. If somebody suffers from a physical condition and is told, “You’re ill, you could be treated and it would benefit you”, but the person does not want to be treated because of the pain incurred, the side-effects experienced, the financial loss sustained or the family disruption entailed, that individual is entitled to say no. I simply point out to the Minister that if that principle applies in the context of physical illness, it ought in all propriety and equity to apply in the context of mental illness, too.
Tim Loughton: My hon. Friend is making an excellent case and expanding on the point that I tried to make earlier, but which the Secretary of State clearly failed to understand. On the Government’s logic, does not my hon. Friend agree that the 92 per cent. of heart disease patients who fail to take their statins according to prescription, or the cancer patient who declines chemotherapy because of the possible after-effects, should be subject to a degree of compulsion, because they do not agree with the diagnosis and the medication for their physical condition? Why should the two be treated differently?
John Bercow: My hon. Friend is absolutely right. He has reiterated on the Floor of the House a powerful point made by my noble Friend Earl Howe in the other place. I was surprised and disappointed at the paucity of the comeback of Lord Hunt of Kings Heath—an extremely experienced Minister with considerable expertise.
John Bercow: I shall give way just once more because it is the Minister and it is courteous to do so.
Ms Winterton: I thank the hon. Gentleman for giving way as there is a point I need to put to him. There are people, particularly young women with personality disorders, who do not lose their judgment—they do not have impaired judgment and do not lose capacity—but if left untreated and uncared for they would commit self-harm and, in some instances, suicide. Is the hon. Gentleman prepared to say that we should turn our backs on those people and not give them treatment?
John Bercow: I did not say that we should turn our backs on them, but that we should have respect for them and be willing to accept the verdict they give. That is where, in a sense, never the twain shall meet between us.
Finally, in terms of the Bill’s architecture, I turn to the subject of community treatment orders. Let me say at the outset that there is scope for some consensus on this point, although I do not particularly approve of the way in which the Government handled the matter—the evidence was suppressed and published late, which seems rather a pity—but the suggestion has been made that CTOs could be the way forward for the structure of modern provision in the community. I see some merit in that suggestion although I think that the case is unproven.
My argument is not against the community treatment orders per se, but rather, as articulated by the hon. Member for North Norfolk (Norman Lamb), against what seems to be envisaged in terms of conditions and restrictions on the lifestyle of the people who would be subject to the orders. What is proposed by the Government in a rather all-encompassing power seems to me quite frightening. It is a disproportionate, far-reaching and adverse provision that could have an impact on a great many people. There is reference to the entitlement to impose a condition that a patient shall refrain from “particular conduct”—conduct gloriously unspecified. Might Ministers have it in mind to say that patients should not be allowed to go to a public house, or that they should have to observe a curfew from six in the evening until six in the morning? I do not know quite what Ministers have in mind, but we have to be careful that we are not guilty of an intolerable infringement of human rights and, throughout the Bill, an approach that would have another damaging effect in practical terms—to drive mental illness underground. We do not want to do that. United across the House would be the conviction that we must avoid that eventuality; the disagreement is about the means to do so. I listened to expert voices, including that of the former chief executive of Broadmoor, who is known to me and who says that is his particular fear. Many others have said the same.
Having expressed my concerns about the Government’s intentions on treatability, severe impairment and the conditions to be imposed in CTOs, I conclude on this point. In the media—especially the less responsible and more hysterical elements thereof—there is all too often a single view of the mentally ill as a homogeneous and undifferentiated group who
should, almost without exception, be regarded with suspicion, anxiety and probably foreboding, too. That is to do a great disservice to hundreds of thousands, indeed millions, of people who at some time in their lives suffer from mental illness. My appeal to the House is to accept that, whatever our views, Parliament has a duty in this matter not to play to the lowest common denominator—I do not suggest that the right hon. Lady is doing so and I hope others will not suggest that either. We should not in any sense fan the flames of popular and misguided prejudice; rather we should seek to raise our game, to recognise that pertinent and compelling points have been made to us by the mentally ill, by people with extensive professional experience and by Members of the other place who spent a great deal of time in detailed scrutiny and deliberation of these matters. I am sure that some of what the Government intend, and which is in the Bill, will be of benefit, but I worry about Ministers’ fixity of purpose at this stage, when they say, “We don’t like those amendments, they’re bad news and we shall use our majority to get rid of them”. I appeal to the Government, in the interests of the mentally ill, the community as a whole and the reputation of the House, to think again. It is not too late.
7.37 pm
Chris Bryant (Rhondda) (Lab): It is always a delight to follow the hon. Member for Buckingham (John Bercow). It is a delight, too, when he joins us in the Division Lobby, which he seems to be doing more regularly of late—I do not know whether it portends anything.
I particularly wanted to speak in the debate because I have had a few experiences of mental illness, although not in my own life. My mother committed suicide after many years of alcoholism and several attempts at suicide. She had been in many psychiatric wards and followed many forms of psychiatric treatment and she died in 1993 from a cocktail of paracetamol and alcohol—she probably took her own life.
One of my first and most difficult cases as a Member of Parliament involved a delightful and sensitive young man called Matthew Davies. He, too, had an alcohol problem and committed suicide on Saturday 29 June 2002. In his case, too, there was a pattern of self-harm. At the time of his death, he was on a community rehabilitation order so he was in regular contact with the criminal justice system through the probation service, with many forms of medical treatment, with the local authority and with housing associations that were trying to find suitable housing for him, his girlfriend and their baby. Throughout the process it became clear that a combination of different organisations failed him, although I do not say that to attribute blame to anybody. He took his life having rung for help only the day before. He found it impossible to get additional help from the professional services.
Another case involved a friend of mine—the actress Lynda Bellingham, whom many Members may know as the Oxo mum. She owned a flat two floors above her home and let it to a tenant in 2001. After a month or so, it became apparent that he was not well when he started to accuse her and her sons of shouting obscenities at him and stalking him. She had to have
him removed from the flat and a few months later the police came round to tell her that he had accused her son of firing pellets at him, despite the fact that her son was abroad at the time.
Then there was a solicitor’s letter, saying that she had been stalking this man, Mr. George Millar. By the following February, things had gone quiet until one day a home-made bomb was thrown through her window—a brick wrapped in a lit firework and a tee-shirt that had been doused in petrol. Her tyres were slashed and the police mounted an investigation. In fact, they had already mounted several previous investigations. When they arrived at the man’s house, the screensaver on his computer said, “Revenge, like Oxo, is a dish that is best served cold”.
That story is particularly chilling because although the police and the authorities took action, it took a year for the case to go to court, during which time the man was under detention. He was charged with arson and threat to kill, but the judge said that he was not in a sufficient condition to be judged by a jury and that if the woman was prepared to drop the charges, he would ensure that the man was sectioned. Unfortunately, two days after she had withdrawn the charges, the police came round to her house to say that since the man had been in psychiatric care for the last year, he was well enough to be out on the streets. In fact, his then girlfriend acknowledged a week later that he was not taking his medication as he had promised. He was readmitted to a psychiatric hospital from where he escaped, after hitting one of the psychiatric nurses over the head with a chair. Eventually, he hanged himself in his room.
In that case, it is abundantly clear that the combination of the criminal justice system, forensic psychiatry and the psychiatric health system had failed the man, failed the woman and failed the community. It is thus important to move forward towards a better combination of all those different services so that we serve the individuals better. I believe that this is primarily about the safety and care of the individuals themselves rather than that of the wider community. Several hon. Members have made the point that the number of those who self-harm and commit suicide is far higher than the number of homicides relating to people who have been in psychiatric care, which is why I believe that individuals should be the prime focus of our debate.
My basic principles are pretty simple. The first is that there is still an enormous gap in provision. The Government have done a lot to increase provision, but the talking therapies that are available in wealthier middle-class areas are not available in poorer areas. That is partly because many poorer communities do not produce the number of local counsellors or people trained in these therapies that the other areas do—an issue that we need to address.
Another concern is that in far too many areas of the country, the response to depression and many of the lesser psychiatric illnesses from which many people suffer and which can be cured, is merely pill popping. Many of my constituents are on incapacity benefit because they have got used to years and years and years of taking antidepressants and have become addicted to them.
Mr. David Winnick (Walsall, North) (Lab): My hon. Friend, like other hon. Members, is making a powerful speech, recognising the necessity of the measure before us. Does he nevertheless recognise the concerns expressed, for example, by my hon. Friend the Member for Hendon (Mr. Dismore) and the hon. Member for Buckingham (John Bercow), about the wide powers in the Bill? Those powers are bound to be the cause of concern, so one hopes that there will be a tightening up in Committee.
Chris Bryant: My hon. Friend makes an important point and I will come on to the specific issue of when detention is right and when we should be reluctant to use it as a means of control.
John Bercow: In pursuance of the point made by the hon. Member for Walsall, North (Mr. Winnick), may I press the hon. Gentleman on a specific question of the conditions imposed on people on community treatment orders? Given that there is a potentially draconian power here, does the hon. Gentleman agree that people should at least be allowed to appeal against an imposed condition?
Chris Bryant: That is an important area that needs to be discussed and should be teased out in Committee.
I believe that we do not yet know everything that there is to know about a whole series of mental disorders. The hon. Member for Tiverton and Honiton (Angela Browning) made an important point about progress with autistic spectrum disorder and I am sure that the same will apply to many of the personality disorders that, 20 years ago, were considered absolutely untreatable, incurable and beyond the pale. I believe that in 20 years’ time we may have a completely different attitude, which is why it is so important to have legislation that is able to meet changing perceptions in the future.
There are two specific areas in which I am not entirely sure that the Government have got it right. The first is the issue of appropriate treatment—the so-called treatability clause. I believe that the amendment passed in the House of Lords places a very high hurdle, but it is not actually the hurdle that the hon. Member for Buckingham gave us, which was actually a variation of the Lords amendment. In fact, his was a much lower hurdle because he put several qualifications into it.
Innovative treatments will come along in the next 10, 20, 30 or 40 years in respect of which no clinician will be able to guarantee that they will ameliorate the condition or, indeed, prevent deterioration of it—certainly not in the first few months. The very fact of detention may lead to deterioration of the condition for a short period, but the mere fact that one cannot guarantee that that effect will be produced, as the House of Lords determined it, should not necessarily lead to an automatic get-out clause. I think that it is possible—
Chris Bryant:
The hon. Gentleman has not been in his place for all of the last part of the debate and I want to suggest a possible line of amendment. The
Lords suggested that appropriate medical treatment should be defined as a medical treatment
“which is likely to alleviate or prevent a deterioration”
in the patient’s condition. Could not the Government consider wording along the lines of treatment “which is intended to alleviate, manage or prevent a deterioration in his condition”? I do not believe that the enormous difference or gulf between the different sides of this debate is as large as others have suggested.
Martin Horwood: I have been in my place for the whole debate. However, in respect of amendment, the hon. Gentleman seems to be looking for the word “guarantee”, but it is not there. The word used is in the amendment is “likely”. Surely he can accept that the amendment is asking only for the probability that help can be available or that the condition will not deteriorate.
Chris Bryant: I doubt whether many lawyers would agree with the hon. Gentleman about the meaning of “likely”. That is precisely the problem, as many clinicians have expressed to me.
Another important issue is the exclusions in the 1983 Act, which are not in the Bill. I question—it is no more than that—why it is seen as right and proper to detain someone under the Bill for bulimia or anorexia nervosa, while exempting people in respect of alcohol or substance abuse. In practice, many of the treatments might well prove to be similar. Many of the processes that would have to be gone through would be the same and there is an element of compulsion. Yet many people treating anorexia nervosa and bulimia would say that volition is a very important part of the process of treatability.
I also question the removal of the exemption for sexual identity, sexual deviancy and promiscuity. I understand what the Government are saying, but no one today believes that being homosexual is a reason for putting someone in a psychiatric ward. I entirely accept that. However, if sexual identity or orientation is not such a big issue, why not allow the Lords amendment to retain the provision?
I also question how the treatment of paedophilia is handled. The law may well want to allow a clinician to detain someone whom he believed was about to engage in paedophile activity. However, according to the clinical definition, only 5 per cent. of child sexual abuse cases are actually perpetrated by clinically defined paedophiles. Any clinician I know who felt that a patient had a tendency towards paedophilia would be most likely to refer him to social services or to the criminal justice system. That is the proper place for that to be dealt with. Of course, it is also possible to draw an important distinction between somebody who believes themselves to be God and somebody who believes in God, so it should be possible for us to have an exemption for religious belief. But it is important for the Government to remember that the House of Lords wording retains the word “solely”, which is an important hinge in terms of how the provision works.
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