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Angela Browning: This could be the last intervention that I make on the Bill. One of the amendments that the Minister did not accept in Committee was the request to have people with autistic spectrum disorders added to the exemptions in the Bill. The National Autistic Society, of which I am a vice-president, writes today about the Report stage, saying that people with autistic spectrum disorders continue to be detained inappropriately, and the society believes that their situation will be worsened by the Bill, not improved by it.
Ms Winterton: We discussed autism not only in Committee, where the hon. Lady tabled a number of amendments, but when I attended the all-party group on autism. In addition, in discussions that I had until Friday last week, my hon. Friend the Member for Burton (Mrs. Dean) put forward arguments from the National Autistic Society. The meeting of the all-party group showed some of the divergence of opinion, even among those representing people with autism. I am thinking particularly of one of the Opposition Members who questioned why we were even considering some of the changes that the hon. Lady suggested. It is a complicated subject but I was glad that we were able to have the debate in Committee. I am more than happy to continue to look at how we can assist on issues such as the code of practice, to make sure that services are developed appropriately. As I said, I hope that the amendments that I tabled on supervised community treatment, the conditions that can be applied and how they will be applied will give some reassurance to those who are concerned about SCT.
Where we have not been able to accept amendments, we are trying to use non-legislative means to tackle the issues raised, such as the nearest relative provisions, which were mentioned by my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones), and places of safety, which were also mentioned today. We will continue to work on those matters, although it was not necessarily right to include them in the Bill.
I thank the many organisations that have worked with us in developing some of the Government amendments. In particular, I thank YoungMinds and the children’s commissioner—an office that, as I have said, is now called 11 Million.
Ms Winterton: Indeed. We have also had some very constructive dialogue with the new coalition of mental health organisations, particularly about the role of the responsible clinician.
We have tried to continue to engage with Members of the other place throughout the discussions. I pay particular tribute to Lord Williamson for his help in developing the age-appropriate services. As I said, our discussions in this House have followed on from many of the discussions in the other House, which have informed our debates. I believe that although we have not been able to respond to all the concerns raised there, we have been able to respond to very many of them.
I should like quickly to mention the Making Decisions Alliance and all that it has contributed to the development of the new safeguards for those deprived of their liberty
in their best interests. We sometimes forget that the Bournewood changes are a very important part of the legislation, about which I know that two Opposition Members are particularly concerned.
I should also mention all the work put into the analysis of the Bill by the Joint Committee on Human Rights and my hon. Friend the Member for Hendon (Mr. Dismore). Of course, I should also thank the officials who have supported me so effectively throughout the Bill’s passage. I hope that hon. Members would say that the officials have been open to discussion and approachable to Members of the House if they have been needed to give other information. I also thank all members of the Committee. We had an excellent debate with participation from all sides, and we were able to explore many of the issues very thoroughly.
I want to stress how much we want to continue to work with a wide range of stakeholders in implementing the Bill once it receives Royal Assent. I know that many have already been involved in developing the code of practice, and we would certainly like further input from all those with an interest, including Members of the House. Many have also been involved in drafting the secondary legislation, such as measures on new professional roles. Again, we want to work with all concerned to make sure that we get this right.
All told, I think that the Bill that we are—I hope—about to send back to the other place is a significant improvement on the one that came to this House, although we have been able to reflect some of the discussions there in the amendments that we have been considering over the past two days. I hope that Members of the other place will feel that we have taken on board their concerns and responded to the points that they made, as well as to the points made in Committee. I have no hesitation in commending the Bill to the House and wishing it a speedy completion.
9.24 pm
Tim Loughton: I echo the Minister’s words in saying that the Bill has provoked much debate and controversy, which I think is probably something of an understatement. It has been a long haul; as she said, nine years have gone by. I think that I have been responsible for the matter on the Opposition Benches for five of those nine years, and that she has had responsibility for a little longer. [ Interruption. ] It feels like we have been at it for a long time on the Mental Health Bill. We have been through two draft Bills, the pre-legislative scrutiny Committee, this Bill, the Richardson expert committee and countless meetings, briefings and debates with various members of the Mental Health Alliance and others.
I pay tribute to the hon. Members on both sides of the House who have contributed. We had a lively debate in Committee—it was described as “helpful and superb”—and I also thank the Bill team, who were helpful.
The Mental Health Alliance is a big alliance that formed because of the Bill. Whether or not we agree with everything that it has said, it has had an enormous input into the Bill. We must remember the enormous amount of good work that many of the organisations
that form the Mental Health Alliance do on behalf of thousands of people up and down the country every day of the week. We need a Bill that helps those organisations, because they look after some of the most vulnerable members of society.
I pay tribute to the work that was done in the Lords. I disagree with the Minister about whether this Bill is better than the one that came from the Lords. An enormous amount of professional expertise was applied to the Bill in the Lords, and I think that Members of the other place may have a few things to say when it returns to them.
I pay tribute to the many professionals who day in, day out do a difficult job looking after people with a mental illness. Again, our duty is to make their job easier and to clarify the law under which they work, which has always been our intention. I agree with the Minister that there is a need to update the legislation. The 1983 Act was largely based on the 1959 Act, so it is almost 50 years since the underlying principle of the legislation was updated.
There have been advances in mental health treatment, mental health law and the flexibility with which we deal with patients. Rightly, we must respect people’s lifestyles: we have moved away from the asylum system; the professions involved have changed; and there are human rights incompatibilities. All along, we have said that we need a Mental Health Bill, but we need the right Mental Health Bill.
I welcome the Minister’s success in getting the Government to move a substantial distance in a number of areas. She took note of the record six defeats in the Lords on substantial points of great principle. We welcome what we have seen on Report in the past two days on age-appropriate treatment. I also echo the Minister’s tribute to Lord Williamson’s amendments, which started the process.
As I have said, we have made good moves on introducing victims’ rights into the Bill. I welcome the compromise on treatability and pay tribute to the hon. Member for Rhondda (Chris Bryant) for the intelligent, balanced and assiduous way in which he introduced it. We have removed some of the more objectionable and unworkable parts of community treatment orders, not least the provision on abstaining from particular behaviours, and we have linked CTOs to medical treatment.
However, we have not gone far enough. The Bill still fails to take into account the international evidence, which the Government commissioned. It is still far too open-ended, and as such we think that it provides too much of a deterrent for people to engage with mental health services. We are still at odds with the Government about the roles of various “responsible clinicians”, which may be open to legal challenge. Furthermore, inconsistencies remain with the Mental Capacity Act 2005 and the renewal of detention following initial sectioning. We still have serious problems about the definitions and the exclusions. It is unfortunate that the debate on that was truncated, because those are substantial points of disagreement that go to the heart of the Bill.
Unfortunately, we have had no movement on impaired decision making. The new clause was meant as an antidote to the stigma that surrounds mental illness, which concerns us all. Some of the Minister’s
references to high-profile cases, such as the Michael Stone case, were unfortunate. She mentioned the Michael Stone case today and in Committee.
Ms Winterton indicated dissent.
Tim Loughton: If the Minister reads the record tomorrow, she will see that she mentioned the Michael Stone case. Without trying to single out one case, what happened in that case, as in so many other such tragic incidents, is that the system fell down—
Tim Loughton: Before I give way to the Minister, I should say that if she did not mention the Michael Stone case, I may have confused it with the John Barrett case. She has mentioned the Michael Stone case before. What is common to all those cases is that they show a failure of the system and the services in not being there to pick up those people when they needed to be picked up.
Ms Winterton: The hon. Gentleman is quite wrong to say that I have mentioned the Michael Stone case—I have not. I mentioned the Michael Barrett inquiry—I am sorry, the John Barrett inquiry—because one of its conclusions was that the only way that it would have been possible to ensure that John Barrett complied with treatment as an out-patient would have been through supervised community treatment, which was not available at the time. That is why we believe that supervised community treatment is important.
Tim Loughton: I entirely take the Minister’s point. I think that we are confusing Michaels and Johns; if that is my fault, I apologise. Nevertheless, whatever reference has been made to community treatment orders, there was in both cases a failure by the system in relation to somebody who tried to engage with it, and a failure by the services to provide a safety net and to move in at the appropriate time.
In the debate on impaired decision making, I was particularly concerned about the fact that the definition of “untreatable” involves people being turned away from services. That suggests that the Bill is being used as a substitute for the lack of appropriate services and deficiencies in the mental health service as it stands. It confuses availability and access to services with the need for coercion in order to ensure that patients accept services that are offered. As Dr. George Szmukler, dean of the Institute of Psychiatry has said,
“The government has objected that this amendment might leave out people who need treatment. It is alarming to think that the state has reached the point that everyone who is deemed to ‘need treatment’ should be detained if they disagree.”
Access to treatment seems to have become entirely entwined with the legislative ability to subject to section and compulsorily treat a patient. Is not that a rather terrible indictment of the state of mental health services?
The Minister has admitted that under her mental health system she would turn people away if she could not subject them to compulsory treatment. We seem to have reached a stage analogous with somebody who has heart disease, with blocked arteries, presenting at a hospital and being told, “You must either have a heart transplant or no treatment at all.” It should not be all or nothing; it should be coercion and sectioning only in the most extreme circumstances. The Minister seems to
be proceeding under the highly flawed and worrying premise that if someone cannot be sectioned he will not get the treatment. That is wrong—it should not be the case under mental health law—but the Minister is labouring under that misapprehension.
It is interesting to note that the Minister dismissed out of hand the situation that will pertain, for example, in the constituency of Kirkcaldy and Cowdenbeath—that of the incoming Prime Minister. Under her assumptions and analysis, the constituents of Kirkcaldy and Cowdenbeath are being allowed to commit suicide because of impaired decision making, yet she has no evidence to support it. Has the incoming Prime Minister said, “Under impaired decision making, there is a serious problem with my constituents being more susceptible to suicide”? I very much doubt that there has been, yet the Minister is going to create a difference between mental health law on either side of the border. Clearly, Scotland has produced much more enlightened mental health legislation, and that will throw up serious differences between how patients are treated on either side of the border.
Ms Winterton: The hon. Gentleman has consistently failed to answer one question. He says that there will be people who would not need to be detained because they did not have impaired judgment, but he has never given the figure for how many people he thinks it acceptable to turn away from services saying, “We’re not going to treat you either because you are a danger to yourself or a danger to others.” What is that figure?
Tim Loughton: The Minister is trying to repeat our previous, truncated debated. Her logic and analysis imply that, in the incoming Prime Minister’s constituency, under the Mental Health (Care and Treatment) (Scotland) Act 2003, which contains impaired decision-making provisions, people are much more susceptible to suicide. There is no empirical evidence for that.
We are worried because there is a significant risk that the Bill will undo much of the good work in improving mental health services and the relationships between service users and providers. There is a genuine risk of investing in a new regime of compulsion, which will have a counter-productive effect, alienating rather than engaging with people with mental health problems and possibly increasing rather than reducing patient and public safety. Patients could well slip under the clinical radar, and we do not want that to happen. We want a Bill with which we can work, with which clinicians can work and with which patients can work and engage. We want a Bill that reassures the public that their safety is being protected, and balanced with the liberty and medical care of others.
We need a Bill that is fit for the 21st century. We are almost there, but the measure, which now returns to the Lords, still contains too much that is objectionable and will deter people from presenting. We cannot, therefore, support it as it stands. I urge my colleagues to vote against it, but in doing that, I hope that the Government will take our concerns on board, engage constrictively with the Lords and go that bit further so that we can have a Mental Health Act 2007 of which we can all be proud. I look forward to considering the measure again when the Government have taken our concerns on board and it returns from the Lords.
9.36 pm
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op): I agree with the Minister that we have held a series of excellent discussions on Second Reading, in Committee and yesterday and today. Every member of the Committee took part in the debate to a greater or lesser extent—I believe that that is unusual. In my admittedly limited experience, the contributions from hon. Members of all parties in Committee were of an extremely high standard.
Opposition suggestions and amendments have brought about changes and Back-Bench amendments have also been adopted. That has improved the Bill. Unlike the hon. Member for East Worthing and Shoreham (Tim Loughton), I believe that the measure is an improvement on the current position. It is not perfect and other improvements can be made, but it is better than the Bill that was introduced a few weeks ago.
The measure will return to the other place and I hope that their Lordships will at least recognise that it has not been rammed through the House—far from it. Careful consideration has been made of every point—some might say ad nauseam. I hope that their Lordships will pay some heed to that.
On a final, personal note, tonight marks the end of some five years’ involvement with scrutinising the Bill’s predecessor and serving on the Committee that considered the current measure. There is therefore a sadness, but I believe that we have produced something better than we had previously. I recognise that there has been much constructive working among many people who are in the Chamber this evening to achieve that.
9.38 pm
Dr. Pugh: After a long journey, we have reached an interesting juncture. The Bill arrived in the Commons surrounded by controversy, heavily amended and cloaked in colourful rhetoric. Some said that it was simply a Home Office measure, which was intent on coercing the mentally ill, an open charter for compulsory medication or a means of handing out psychiatric ASBOs, likely to terrify and worsen patients’ conditions. Others claimed that it was the last chance to prevent an epidemic of killing by deranged people and the only way to stop psychopaths freely walking the streets.
Some peopled the world with psychiatrists twitching to incarcerate the vulnerable, the eccentric and the politically deviant. Others spoke of a profession turning its back on the troublesome and the homicidal. However, in the Commons, the Committee stage, secluded in a Committee Room, reduced the temperature. Points were probed and some small progress was made. Subsequent off-stage meetings accelerated the process and I hope that Report has moved things on further.
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