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Ms Winterton: My hon. Friend is right. I invite her to come to Doncaster to look at the pilot there, which has been incredibly successful. To date, about 4,000 people have benefited from access to psychological therapies. The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), and I would be more than happy to entertain her in Doncaster and to show her all the good things there.
Norman Lamb: The Minister referred to the pilots. Will she tell us whether she is fighting to speed up the process to ensure that the NICE guidelines, which have been in place for some time, can be met? At the moment, progress seems very slow.
Ms Winterton: It is a great step forward that we have the NICE guidelines. Computerised cognitive behavioural therapy is also coming on stream. We still need to make progress, however; there is no doubt about that. The important thing about our approach is that we are demonstrating through the pilot sites that these methods can quickly have a real effect. In such circumstances, we often need to convince commissioners that this is a good approach and that it will help to get care to a large number of people. That is why we are pushing in that direction. There is certainly a commitment; indeed, that was in our manifesto.
It is also right to say that there are some very real issues that we need to tackle, and we are doing so. Those include the experiences of people from black and ethnic minority communities when using and accessing mental health services. However, our national director for mental health, Professor Appleby, recently gave his summary of the progress made in the past 10 years, and he concluded that removing the inequalities of patient experience between ethnic groups through more responsive services, community engagement and staff training was a central part of the agenda and a key priority for the coming years. We are making progress with implementing the “delivering race equality” programme. We now have 160 community development workers in post and we are working with local services to employ the full complement of 500 workers as planned.
I also recommend the very good work in the focused implementation sites, which are looking particularly at why people do not come forward to access services, the experiences of people from BME communities when they get into the services, and what problems are involved in ensuring that people receiving those services are treated with respect for their cultural background. That work is about looking at how we can deliver our race equality programme in practice.
The Government have spent 10 years improving the mental health service and rescuing it from being the Cinderella service that it was during the Conservative years. As the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), pointed out, there has been a great deal of talk from the Liberal Democrats about all the changes that are necessary, but very little illumination of where all the money would come from. On the Mental Health Bill, they have turned fence-sitting into a fine art.
As part of our changes to the delivery of high-quality mental health services, we must ensure that we
update our mental health legislation so that it not only reflects current service delivery but deals with problems involving human rights and court judgments. That is why we decided to update the legislation. Our work has not been helped by scaremongering from certain organisations and, indeed, from the hon. Member for East Worthing and Shoreham (Tim Loughton). One of his more bizarre comments was that the Bill would make lobotomies more widespread. He also said that anyone addicted to cigarettes could be detained under the Bill. Such depictions of legislation are the one thing that puts people off using services. The aim of the Bill is to ensure that people are treated; to paint it as some have painted it is quite wrong and unfair to some very vulnerable people.
The Opposition parties now claim to be the champions of mental health, but time and again they vote against measures that would ensure provision of treatment for those who desperately need it in order to prevent harm to themselves or to others. As I have said, I am not sure that the hon. Member for North Norfolk is aware of everything that his party is voting for, but I can give an example.
The Opposition parties want to introduce an impaired decision-making test. That would mean that the use of detention was no longer determined by a patient’s needs and by risk to self or others. The first question would be whether the patient’s capacity to make decisions about treatment was impaired. If their capacity could not be shown to be impaired, detention would be forbidden, however much the patient needed treatment and however much the patient or others would be at risk without it. The hon. Members for East Worthing and Shoreham and for North Norfolk argue that we are wrongly detaining people who have the ability to make a decision about their treatment. The hon. Member for East Worthing and Shoreham said that many people under section retained the capacity to determine their treatment. The implications of the impaired decision-making test are clear, however. Not all suicidal patients have impaired judgment.
The Opposition parties have taken a very libertarian view. If someone has been through all the options and, although seriously ill, understands the treatment and does not pass the impaired decision-making test, who—they ask—are we to ensure that that person is treated? Given that people can refuse physical treatment, why should those with a mental disorder be given treatment? I have been given examples of young women suffering from borderline personality disorder—women who are suicidal and have had a terrible time in life as a result of physical, emotional or sexual abuse, but who, when all the options are explained to them, will still say, “I want to commit suicide.” The impaired decision-making test would mean our saying “That is okay. You go and do that.” I do not think we are helping anyone by not enabling clinicians to give treatment to such people.
Lynne Jones (Birmingham, Selly Oak) (Lab): Will my right hon. Friend enlighten the House as to the precise definition of impaired decision making? If somebody has gone through traumatic experiences and wants to commit suicide, that implies to me that they have impaired decision making.
Ms Winterton:
One of the problems in this respect is that there is no definition of impaired decision making.
My hon. Friend should ask Opposition Members what they mean by that. If they are saying what they said in Committee and elsewhere, which is that many people under section retain the capacity to determine their treatment, then presumably those people will not get treatment if an impaired decision-making test is introduced.
Let me return to the case of young women with a personality disorder. Do Opposition Members feel that it is fine to say, “Well, you know all the options and you’ve still decided that this is what you want to do, but we cannot treat you now as you have understood all the options”? If Opposition Members are content to take that view, I am surprised, but that is their position at present. That is the position that the Liberal Democrats take.
Lynne Jones: What does my right hon. Friend mean by understanding all the options? Is it not the case that someone might understand their options—although I am unsure whether there is a great array of options in such circumstances—but that they can still have impaired decision making if they want to commit suicide?
Ms Winterton: They can have impaired decision making if they want to commit suicide, but it does not always follow that such people necessarily do have impaired decision making. I refer my hon. Friend to the comments of the British Psychological Society. It has said, “Yes, there will be people who do not pass the impaired decision-making test.” I wonder what is my hon. Friend’s position in respect of those people who, once the options and the effects of treatment have been explained, do not pass the test. It is important to remember that mental health measures currently have a simple test: is the person concerned a danger to themself or to others? Introducing another test trumps that, so that even if the individual is a danger to themself it still follows, if there is an impaired decision-making test, that that person may have to be let go without having treatment—indeed, that they must not be given treatment. That is the big problem with the impaired decision-making test. We should consider what the experts have said. The hon. Member for East Worthing and Shoreham said that many people will not pass the test. That means that they will not get treatment.
The Government also believe that people who need mental health care should be able to access it. That is why we will change legislation to cover the significant number of people who under the current legislation cannot be treated because of the treatability test. The hon. Member for North Norfolk mentioned women who had not received the mental health care that they needed ending up in prison. If he looks at Jean Corston’s report on women in prison he will see that many of them have personality disorders and have been turned away from having treatment. Jean Corston is very clear that an amendment should be made to mental health legislation to remove the treatability test, because there is no doubt that that has pervaded mental health services and has meant that people with
personality disorders have been turned away time and again. The Opposition know that that is the case, but they keep rejecting it.
The hon. Member for East Worthing and Shoreham said that it would be a better idea to have special legislation that comes under the Home Office for people with personality disorders. Those many people who have not committed a single crime and who are not necessarily a danger to others but might be a danger to themselves would suddenly be dealt with under criminal justice legislation. That is not the way to reduce stigma and discrimination. The hon. Gentleman should be aware that his party’s proposal to restore the treatability test would perpetuate the situation whereby people with personality disorders are refused treatment. I am surprised that he does not know that from his constituency experience, because I know it from mine.
The Opposition also want to introduce all sorts of exclusions into the legislation. They propose that people should not be detained for their political beliefs, for example, or for their religious or cultural beliefs. Of course, we agree with that. The exclusions under the Act, however, relate to people who have a mental disorder. Political and cultural beliefs, however, are not a mental disorder. The Opposition are creating a lawyer’s paradise. As for their argument that some terrible future Government—not the present Government or perhaps the next—might lock people up for their political, cultural or religious beliefs, one would be unlikely to wave the Mental Health Act at such a Government.
The Opposition also want to amend the Bill to restrict supervised community treatment to patients who have been detained as compulsory admissions at least twice. That will benefit fewer patients, restrict clinicians, exclude patients whose first compulsory admission has been preceded by several voluntary admissions, and make patients wait until a further crisis and a further compulsory hospitalisation have occurred. As a supporter of the Zito Trust wrote in March,
“What possible benefit can the mentally ill person gain by obtaining a CTO only after being hospitalised twice? Once is enough”.
It is beyond belief that the Opposition are supporting that— [Interruption.] Stranger still is the Opposition amendment to restrict supervised community treatment to those who are a risk to others—
Tim Loughton: We have not got on to that yet.
Ms Winterton: I am referring to what the hon. Gentleman said on Second Reading, and what his party supported in the other place. If he is resiling from what his party did in the other place, that is fine, but that is the current situation— [Interruption.]
Mr. Deputy Speaker (Sir Michael Lord): Order. We cannot have sedentary interventions. If the hon. Member for East Worthing and Shoreham (Tim Loughton) wants to intervene, he ought to do so in the usual way.
Ms Winterton: The Opposition’s approach is completely wrong and would deny patients treatment that they should get.
Dr. John Pugh (Southport) (LD): In the past 10 minutes or so, the Minister has been talking about the Mental Health Bill and various amendments to it. She has not been talking about the motion before the House. Will she get round to that?
Ms Winterton: I talked a lot about the motion, and made points relating specifically to it. Perhaps the hon. Gentleman was not in the Chamber at the time.
I have addressed the points made about deficits, employment and the need to ensure a multidisciplinary approach. That brings me to the point made about teamwork in mental health care being essential, with which the Government obviously agree. But when we introduce legislation that will improve the working of mental health teams and help to ensure continuity of care for patients, the Opposition consistently vote against it. In relation to professional roles, the Opposition fundamentally undermine the role of the responsible clinician by expecting a doctor to be involved at key points, and requiring the responsible clinician to get permission from the doctor. That would keep mental health services rooted in the past. Their approach is about paternalism and protection.
I am astonished that the hon. Member for North Norfolk can talk so freely about psychological therapies and the importance of getting more psychologists to work in mental health, given that the reality of the amendments to the Mental Health Bill that he supports, which are against the role of the responsible clinician, mean that psychologists will be unable to have such powers and responsibilities. I suggest that he talk to organisations such as the British Psychological Society, the Royal College of Nursing and Unison, which represent 85 per cent. of staff working in mental health services and which vigorously oppose those amendments.
Norman Lamb: I have made it clear that I will talk to all those organisations, but this is a completely different point. The amendments to the Mental Health Bill have nothing to do, as the Minister knows, with the case for increasing the number of therapists available for psychological therapies.
Ms Winterton: The hon. Gentleman does not understand that we have spent 10 years devising new ways of working and a multidisciplinary approach, the point of which is to allow people other than psychiatrists to take responsibility for patients. We are trying to reflect that in legislation, so that this House sends a clear message about ensuring that we can recruit more psychologists, for example. The hon. Gentleman has obviously set his face against that, and I suggest that he think about the real implications of his position, which does not help and would set back all the work that has been done in achieving a multidisciplinary approach to delivering health care and in encouraging more people into the profession of psychology.
We are updating the Mental Health Act 1983 because the world has moved on in the last 24 years. The Mental Health Bill is relevant to the Liberal Democrats’ motion, in that it is important in ensuring that the people who need treatment get it. The Liberal Democrats, however, are supporting amendments that would prevent that from happening.
Let me finish by reminding Members of a recent statement by Dr. Matt Muijen, the World Health Organisation’s head of mental health in Europe. Dr Muijen, who spent many years in the UK mental health sector, pointed out that England has the best mental health services in Europe and that this is acknowledged in other countries. Interestingly, despite having spent quite a long time in the campaigning part of mental health services, he also said that we had a “culture of criticism” that prevented that fact from being acknowledged here. I know that there is still more to do, but I invite Members to free themselves from that culture and to join me in paying tribute to the many thousands of people who work in mental health services. Without them, we would have been unable to make the improvements that mean that high-quality services can be, and will continue to be, provided under this Government to some of the most vulnerable people in our society.
8.43 pm
Tim Loughton (East Worthing and Shoreham) (Con): Forty-eight minutes later, it is safe to come out from behind the sofa. What a bizarre speech by the Minister! She has been re-running debates that we have had, or might still have to come, in Committee, and has tried to make up for the paucity and confusion of her logic there by resorting to complete caricature and rather bizarre claims, in response to a motion that does not actually mention the Mental Health Bill anyway and is supposed to be about mental health services. I shall not discuss what she said in detail, other than to say that I shall be fascinated to see the record of where I have said that the Mental Health Bill will lead to an increase in lobotomies, because that is news to me. I seem to recall raising with her the subject of whether lobotomies are still permissible under certain circumstances, regardless of the Mental Health Bill.
I also challenge the Minister on the hoary old chestnut that she has trooped out for some months now about the prevention of suicide by community treatment orders and other provisions of the Mental Health Bill. She has not provided a shred of evidence to back that up, but she is already going on about how suicide rates have fallen. Even so, she still requires, apparently, some of the most coercive mental health legislation of any country in the world.
I was delighted to receive so many mentions by the Minister—rather more than by the Liberal Democrats whose debate this is, and five of whom remain in their places. I am glad that they did not all head for the door when I started to speak, unlike the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint).
The arguments I make are not just my arguments or those of my colleagues in the House of Lords. They are the arguments of 80 members of the Mental Health Alliance, occasionally including members of the British Psychological Society and a couple of others that the Minister mentioned several times. I welcome this debate. I am glad that the Liberals are following the Conservative example of trying to raise the profile of mental health issues at Westminster. I have to say, however, that this is the only debate that the Liberal Democrats have had on health matters in this Parliament and only the second since the last election. However, converts late to the party are welcome.
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