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Others have already highlighted the fear and anxieties of families such as one in my constituency. A family member was murdered by her husband, who had a mental health problem. The family were frustrated by a system which they felt left their sister vulnerable. Within a very few years of her murder, her husband was seen in the local community in the company of a nurse. The family felt betrayed and insecure, not knowing whether this man would be in their street, shop or pub. They were angry that they had not been consulted about community rehabilitation plans, or made aware of an appeal to the mental health
review tribunal. They, and I, feel strongly that victims’ families should have such rights.
Like others who have spoken, I welcome the duty placed on health authorities to admit children to age-appropriate settings, and to provide specialist assessment and supervision for detained children. My constituency has the highest suicide rate among young males in Wales. I have spoken to parents of young people who are afraid of being returned to adult wards that are frightening and threatening and increase their vulnerability at the time of greatest need.
Many years ago I lodged an advance directive with my GP. I set out the limits to treatment that I wanted to establish in the event of my losing capacity. I believe that those who are mentally well should be able to write an advance directive nominating the person whom they wish to act as their nearest relative, primary carer or advocate, specifying people with whom information can be shared by medical practitioners, and giving directions about future treatments. Such documents should be taken into account by those making decisions on the provision of treatment and on compulsion. An advance directive gives individuals a voice at a time when they may well be unable to speak for themselves in their own best interests, and can reduce anxiety for patients’ families and friends.
For a time I managed a specialist health and social services project for people with dementia. Joint assessments were made by the community psychiatric nurse and me when people were referred to our service. Our assessments and conclusions were different, reflecting our different training and perspectives, but they were better assessments for being joint. I fear that there will be a risk of “medicalisation” of assessments if the social workers and two doctors are replaced by a range of health professionals and a responsible clinician, especially if they work in the same mental health team. I hope that care will be taken in the training provided for that new role, and that advocacy of the service user’s perspective will not be lost.
It is in the best interests of the Bill for the fundamental principles to be written into it, and the status accorded to the code of practice clearly identified. I believe that that will reassure users, carers and mental health professionals about the ethos on which mental health services are predicated. It will provide evidence of the Government’s commitment to improving services consistently in line with those principles, and demonstrate their commitment to the mentally ill while also protecting the public.
As I have said, the Bill deals only with the very small percentage of people who require compulsion. We should not forget that it is aimed at that small percentage of people with severe mental health problems. It is sad that much of the debate, and the anxiety that has been created, relates to issues outside the areas covered by the Bill. We have sometimes been sidelined into discussing things that are missing from our mental health services, rather than the good aspects of the Bill and the safety and security that it provides for people at their most vulnerable. I trust that the anxieties expressed by Members today will be discussed again in the Committee on which I hope to serve.
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Mr. Charles Walker (Broxbourne) (Con): I am afraid that I will not be able to do the subject justice, because we have heard excellent speeches from the hon. Members for Rhondda (Chris Bryant) and for Caernarfon (Hywel Williams) and from my hon. Friend the Member for Buckingham (John Bercow). However, I shall try my best.
Ever since I came to this place, I have taken an interest in mental illness. We all have our own reasons for pursuing such an interest, but I am always touched and humbled by those people who come up to me and thank me in a quiet way for being their voice and for raising their concerns. Very often, people with mental illness feel marginalised and feel that there is no one out there listening to them.
That was brought home to me when I visited an outreach centre in Cheshunt where, after a roundtable discussion, the director of the centre said that one of the patients would like to have a word with me in private. I went into a room and met a gentleman who suffered from schizophrenia. He wanted to educate me about the illness. I was moved by the conversation—he did not need to validate himself to me—because he said that if someone had cancer or heart disease it would not define them. They would still be Charles with cancer or with heart disease, but he was all too often referred to as schizophrenic. I thought that that was very upsetting.
Mental illness makes many MPs feel a little uncomfortable. I have heard Members talk in the Chamber about personal experiences, but I think that I am right in saying that never in the history of Parliament has a sitting MP admitted to having a mental health problem. That was touched on by my hon. Friend the Member for Windsor (Adam Afriyie). I often wonder why there is a reluctance to come forward.
Many MPs who want to discuss a personal issue must pause for thought and perhaps the following things might occur to them. They might think that mental illness is perceived in our society as a huge weakness. They might wonder how their association would react. “Would it throw a supporting arm around me or would it move to deselect me? How would my children fare in the playground if I, as an MP, admitted to having a mental illness? Would they be teased or possibly even worse? How would the local and national press react? How would my constituents react? What would be the response from my colleagues in this place?” All these factors might weigh on an MP before they discuss a personal issue.
We understand that mental illness does not sell well on the doorstep. If we were talking about heart disease or cancer, the Chamber would be much fuller. I am sure that there are MPs who, in their hearts, would like to be here speaking up for the mentally ill against what might become a fairly oppressive piece of legislation. However, they are risk-averse. What would happen if they had the courage to speak up and one of those isolated tragedies occurred in their constituency? Would they be pilloried by the local press for supporting “loonies and nutters”? Those are not my words, but they are words that are used far too often by the media to describe sick people who deserve our compassion.
Mrs. Moon: Does the hon. Gentleman agree that the fact that we have a ten-minute rule on speeches in this debate and that so many MPs have spoken with passion indicates the huge amount of support and interest in this House for people with mental illness? I am concerned that the hon. Gentleman is suggesting that that interest is not there. I believe that it is, as has been demonstrated by tonight’s debate.
Mr. Walker: I have paid fulsome tribute to the speeches of Members this evening but my views are little different from those of the hon. Lady and I hope she will accept that.
I am concerned that we may be deliberately, or mistakenly, pandering to the tabloid press and validating some its more screaming headlines. I did some research; the Daily Mail had the headline
“Knife maniac freed to kill...Mental patient ran amok in the park”,
“Violent, mad. So docs set him free. New community care scandal.”
They are appalling misrepresentations of people with mental illness, and it does our media a great disservice that they persist in bringing them forward. However, I believe that we live in a civilised society and that our Government will in their heart not want to regulate in this area to satisfy the tabloid press.
The media reporting of mental illness is shameful. The Royal College of Psychiatrists has stated:
“The media’s obsession with reporting cases of mental health patients who become violent has seriously distorted the truth. Mental health is not a predictor of violence against others for almost all diagnosis”.
“There is a slightly higher risk of violence with a diagnosis of schizophrenia but this is insignificant compared with the relationship between other conditions and violence—alcohol consumption being the main one.”
Before I leave the subject of the press, I wish to say that it is unacceptable at a time when we have consigned phrases such as “cripple” and “retard” to the scrapheap that many of our leader writers still think that it is legitimate to use words such as “nutter” and “loony”. Much of the media’s reporting can be put down to laziness and avarice to keep their circulation up.
Recent research by the Glasgow University Media Group into the attitudes of senior production staff to the reporting of mental illness resulted in the following conclusions—unsurprisingly:
“News and features emphasise the newsworthy rather than the worthy. Stereotypes are therefore enormously useful and they short circuit the need to spend time understanding a topic. They simply follow a rapid tried and tested formula which is known to work commercially.”
Commenting on the research, Graham Thornicroft, head of the health service research department at the Institute of Psychology said:
“This is consistent with the tendency for people with mental illness, when not shown as violent predators, to be allocated to the category of helpless victim.”
One of the tragedies of the Bill proposed by the Government is that there was not much compassion in it. There is a lack of willingness to challenge some of the distortions of mental illness peddled and promoted by the media. I have a great deal of time for the
Minister—I have met her privately on a couple of occasions to discuss my concerns about mental health problems in my constituency— but in her ministerial press release of 1 March, after the Lords amendments were passed, she mentioned public protection no fewer than six times. What she mentioned was public protection—not the interests of the patient, but the interests of the public. Public protection is a consideration, but it should not overshadow the main purpose of any mental health legislation, which is the care, safety and well-being of patients.
Let me give a further quote from the Royal College of Psychiatrists:
“The law should seek to reduce stigma and discrimination against people with mental illness. Wherever possible the principles governing mental health care should be the same as those which govern physical care enabling people to feel able to seek help early, to ask about their fears and difficulties, without fearing scorn, humiliation or loss of status, freedom, job and friends is the best way to bring about improvement in their health.”
I will not dwell on statistics, but it is worth pointing out that people in this country are almost four times more likely to be killed in a motor traffic accident than to be murdered and 80 times more likely to be killed in a motor traffic accident than to be killed by someone suffering from schizophrenia. In our tolerant society, we cannot live without risk and still call our society free. With the best intentions in the world, the Government cannot legislate to create a risk-free society.
It appears that a different set of rules apply to the mentally ill—that the normal rules relating to limiting civil liberties and rights are suspended. Let us imagine what would be the outcome if we were to follow the advice offered in an article in The Daily Telegraph today. The article is entitled:
“MPs should vote to save innocent lives”.
It is written by Philip Johnston, who writes:
“If this Bill will save lives, then Parliament has a duty to support it.”
I can think of a couple of Bills—unattractive Bills—that might save lives, and which might have been brought forward in a less enlightened time, such as 30 or 40 years ago. We could introduce a Bill to ensure that people with AIDS are locked up so that they do not pose a public risk. That would be unattractive, but I am sure that it would save a few lives. We could go out and round up young black males in Peckham, which might save a few lives in that area, but that is an unattractive and unpalatable solution. So why is it that when we discuss mental health we too often separate sufferers from everyone else to whom we accord rights?
Things have improved for those suffering from mental illness and I would not be churlish enough to deny that, but the Bill is the acid test, because it deals with some difficult issues. Of course people who pose a danger to others should be given treatment and looked after. But 79 members of the Mental Health Alliance would not be supporting the Lords amendments or opposing the Government’s original drafting if the Bill would not massively extend the scope of the existing provisions to people who for good reasons should not be covered by the new legislation. I cannot believe that the 79 members of the MHA have got it wrong, or that the BMA and the Institute of Psychiatry have got it
wrong, but the Government have got it right. Surely the Government must recognise that when they are in a minority of one it is time to look at the issue again. The MHA is purely dedicated to looking after the interests of those who suffer from mental illness and I take their advice very seriously.
9.16 pm
Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): I listened with interest to the hon. Member for Broxbourne (Mr. Walker), especially when he questioned whether a Member of Parliament had ever admitted to having a mental illness. I thought of Winston Churchill, who admitted to having the “black dog” of deep, dark depression—
Mr. Walker: Not while he was a sitting Member of Parliament.
Ms Johnson: In any case, Winston Churchill achieved a great deal in his career as a Member of Parliament, and in recent weeks and months various people in public life have said that they have had mental health problems, but they too have achieved a great deal.
I was a member of the Mental Health Act Commission for several years and visited people who were detained in in-patient facilities in London and the south-east. The experience of meeting people who had been sectioned, received compulsory treatment and lived in wards—some of them in appalling conditions—was a salutary lesson for me about how we treat people with mental illness. It is important to remember, as my hon. Friend the Member for Bridgend (Mrs. Moon) said, that only a very few people end up sectioned and as in-patients in hospital, but they are an important group and we must get their treatment right. For a long time, they have been pushed to one side and not focused on properly. That is why I am really pleased by several aspects of the Bill, including the community treatment orders.
I am not saying that the care and attention given by NHS staff was lacking in any way, but I saw distressing conditions in some wards in some in-patient facilities where some people found it very difficult to hold themselves together. I remember seeing one person who refused to wear clothes and had to be kept in a room with no furniture and restrained for much of the time, because he was so unwell. We must get the treatment of such people right.
I raise that point because it is important to remember that in-patient facilities have improved enormously, but the whole thrust of the NHS reforms is about providing care in the most appropriate place for the person. For some people that will be an in-patient facility, but many people want care close to their home, if not in the home, so CTOs will be a real step forward in giving people with mental health problems that option. We want people to receive other forms of NHS treatment close to their homes, as some already do—so why not people who have mental health problems?
The multidisciplinary approach is prevalent in the mental health field, so it is right that we consider who
should make decisions about sectioning people; for instance, amending “responsible medical officer” to “responsible clinician” is the right way forward, as are the provisions amending the role of the approved social worker to include “approved mental health professionals”. Such steps will allow psychologists, therapists, nurses and social workers to play a full role, along with clinicians and consultant psychiatrists, and would show that we are taking a much more modern approach to dealing with mental health care, rather than using only a medical model, which is rather old-fashioned.
In Committee, I hope that we can look again at the provisions on nearest relatives to allow patients the option to nominate the person they want as their nearest relative. The list is too prescriptive at present and the patient is allocated a person. Family relationships are often difficult and the patient may not want their actual nearest relative to speak for them and take important decisions.
I was pleased that my hon. Friend talked about the advance directive, as it is an important issue, although it may not be appropriate for the Bill. An advance directive allows the patient some dignity; when they are well they can say, “This is what I would like to happen if I am ill again.” That is a positive step forward for mental health services.
It is distressing that sometimes police cells have to be used as place of safety accommodation, although I understand why it is necessary. I hope that the Government will reconsider that practice and think more creatively, especially in light of the massive NHS building programme; for example, some of the local improvement finance trust buildings or provision in the acute sector might be used as places of safety. The police need training. I was shocked to find that most police officers do not receive substantive training in dealing with people with mental illness.
Finally, we need to try to remove stigma. An important development in schools in recent years is the national healthy school standard, a key aspect of which is promoting emotional health and well-being in our youngsters. We should try to raise the issue of mental well-being with our children early on, so that they do not think of mental illness as a frightening, distressing condition to be backed away from. I remember a nurse telling me that if a person has a broken leg the general public will always help; when they see that a person has a physical injury they do everything they can to help because they can see the problem, but if someone has a mental illness, people run away—they do not want to help. We have to try to address that issue with our youngsters in school, by saying that we should not be frightened of mental illness; it is treatable and we can do things to help people. Let us treat it like any other illness and not see it as a distressing, frightening condition.
9.23 pm
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