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Looking at our debate as a whole, a bystander might wryly note the fact that each side quotes the Scottish Act from time to time like scripture, but only the bits they really like; that each side quotes experts, but only the ones they really like and dismisses the others as so-called; that each side demands evidence for opposing claims, but not always for its ownas, for example, with our discussion of compulsory treatment orders; and that each side quotes opinion surveys, but only the ones that suit. Personally, I have difficulty in
any case involving complex matters in believing that the majority are necessarily right. I sometimes have difficulty in believing that even the Liberal Democrats are necessarily right[Hon. Members: Hear, hear.]
Suspicion about intentions and fear of professionals abusing power have been persistent traits in this debate and in the briefings, which perhaps indicates that there is more widespread paranoia around than hitherto. Unusuallythe Bill has been unusual in this respectthe vast bulk of Opposition amendments tabled both in this and the other place have been skilfully drafted by a few but very influential external hands, who helpfully handed many ready-framed amendments to MPsa kind of Blue Peter model of legislation.
As a result, we have got concessions from the Governmentvery welcome concessions, but possibly not enoughon children, advocacy and treatability. In other areas, the Government have stood their ground and we will have to go a little bit further. Where our arguments are goodthey will be put in the other placewe would expect concessions and not stubbornness. Ultimately, this is not for any of us a political issue. It is about putting good legislation in place on a very difficult subject, which will last for decades. Whether it is done through truculence in the Lords or Socratic questioning in the Commons, we can secure better legislation [ Interruption. ] Any philosophical reference will usually do for me.
The reality is that the Bill has had a poor birth and a rather troubled adolescence, but it might just mature into stable legislation.
Chris Bryant: I thank the Minister and congratulate her on two things. First, she has brought the legislation forward in an open and transparent manner. She has sought to work with people from all backgrounds who have wanted in good faith to contribute to producing a better Bill. She has done a very fine job on that. Secondly, she has done a good job by listening to Labour Back Benchers. It is very rare for the Government to accept amendments from their Back Benchers, and it is quite nerve-racking when an amendment has been tabled, but one is not sure whether the Minister is going to accept it, because it makes one think of having to vote with the Opposition against the Government.
It is an important point for parliamentary democracy and how this House works with the other place to note that it is right for the Government to seek to put things right in this House rather than wait for the other House to do business down the other end of the building. I pay an enormous tribute to the Minister and to the whole team who have contributed to that.
The Minister was right to say that the Bill team has been magnificent. I confess that I sought its advice on many occasions and it was always forthright with me. I would also like to pay tribute, as would many of my hon. Friends, to my hon. Friend the Member for Bristol, North-West (Dr. Naysmith), who over the past few years has steered many of us on the Government side in the right direction and has personally devoted a great deal of time and energy to the Bill. The quality of the Bill tonight is in no small measure due to my hon. Friends contribution.
I personally believe that the Mental Health Alliance, with which I have had some sturdy rows on occasion, has provided a very helpful service to the House. I have not agreed with it on everything, but I believe that it has sought to introduce amendments to improve the Bill according to their lights. We often forget that the lobbyists who come to our doors are every bit as important a part of the political and democratic process as are we who have been elected to sit here. We would simply not be able to do our work without them.
I pay a sort of tribute to Mr. Grumpy, commonly known as the hon. Member for East Worthing and Shoreham (Tim Loughton). Perhaps he should be known as Mr. John Lewis, as he is never knowingly understated. He has on occasion been non-partisan, however, as well as being conciliatory and generous to the Minister and, for those moments, I am enormously grateful to him.
Mental health and mental ill health are still barely understood by the public, and the stigma is enormous for many people. We still find it too difficult to intervene early enough to prevent some people from getting to the stage of detention; we need to do far more in that regard. I am proud that we have a Government who have put a significant amount of extra cash into mental health services so that we can start to do that, but much more needs to be done. In particular, there is a shortage of talking therapies, especially in working class constituencies around the land. We need to put that right. We also need to do more work on the relationship between the criminal justice system and the mental health system, because there are too many women and men with mental health problems in prison who should probably be receiving mental health service support.
We also need to do a great deal more to ensure that the culture of our mental health services does not exclude those who were not born in this country or whose cultural and religious references are not the traditional ones on which this country was founded. We need further to explore improving our mental health services so that they can cope with the many people arriving here who want to work, who do work and who contribute a great deal to our economy, but who sometimes find that our cultural milieu does not help their own mental health.
Mr. Boswell: The hon. Member for Rhondda (Chris Bryant) paid me an entirely unmerited compliment in Committee. I should like to reciprocate by paying him an entirely merited compliment on the general tone of his comments tonight and on his perspicacity and persistence in putting through his amendment on treatability. The amendment has wide support and is a great credit to him, and I am glad that we have got that one secured.
If I do not vote for the Bill tonight, it will not be because I oppose changes in mental health legislation, but because I regard the Bill in the form in which we are now delivering it to another place as work in progress rather than work completed. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) has detailed our continuing objections to it, and I would like briefly to remind the House of them.
The first relates to people with impaired decision making, and I must point out the anomaly not only between English and Scottish law but between the treatment of physical and mental illness. The treatment of a person with a physical illness who has mental capacity and who withholds consent for treatment would, in law, constitute assault, but such treatment of a person with mental illness will be sanctioned by legislation. However strong the arguments for administering such treatment might be, this is a difficult principle to breach.
I am also concerned about the excessive scope of community treatment orders and the nature of the exclusions that we have debated over the past two days. Functionally, my concern is for the people who are not represented among those joining the debate, namely, people from different cultural and ethnic backgrounds, or with different levels of sophistication or differing abilities to stick up for themselves. The hon. Member for Rhondda touched on this issue a moment ago. Such people might find themselves enmeshed in the system. All the conventional measurements in relation to the involvement of people from black and minority ethnicBMEbackgrounds suggest that they are clearly being very badly served.
I am also worried about the absence or patchiness of treatment facilities in some parts of the country. We cannot necessarily legislate to put that right, although we have done so in relation to age-appropriate treatment. I want to pay tribute to the Minister, who made some good changes in Committee. I would not wish to caricature the Governments position at all in this regard, but I do have those outstanding reservations.
Behind those reservations are two considerations. The first is that there is some kind of ghost in the machine that we have not yet fully eliminated. It is the ghost of control systems, as opposed to the treatment, support and protection of minorities and people with real difficulties and sensitivities in their lives. My strong feeling is that if we are worried about people with mental health problems in the community, the best way to approach the issue is positively and at source through appropriate treatment, rather than seeking to get out of the problems by saying how toughly we can control them. That is not to say that there should be no controls. Of course there should be controls, and they have been hallowed in statute for many years, but they need to be weighed very carefully in each case.
Finally, let me make an appeal to the Minister. I think I can do that on the basis of the constructive relationship that we enjoyed during the passage of the Mental Capacity Act 2005, and subsequently in the context of some its implementation. The Minister has shown an exemplary readiness for dialogue. During the passage of the 2005 Act, with which I was more intimately concerned than I am with this Bill, progress seemed impossible at one stage. There was a time constraint, there were huge differences in views, and there were passionate concerns about such issues as euthanasia. Nevertheless, we somehow managed to work ourselves into an almost complete consensus by the end. We have not yet done that with the Mental Health Bill, which is why I shall not be supporting it tonight.
I think that we are nearly there. I think that if Ministers are prepared to respond to concerns expressed in another place, to respond again when they return to usas no doubt they willand to iron out the remaining issues, we shall have a Bill that reflects our power to debate and, above all, our power to engage with this most sensitive group of people, to whom we all feel that we have an obligation and whom we need to serve by getting the legislation right.
Dr. Iddon: I, too, congratulate the Minister. In some respects, this has been a very difficult Bill. Some of the arguments have been separated only by a thin line, which was exemplified by those that we heard today on new clause 12. It has certainly been a difficult Bill for the Minister to steer through the House, but she has done it with courage and professionalism, and has presented her arguments with great clarity.
I want to make it clear that the Committee was not full of people who were always going to agree with the Government. Some of the awkward squad were there. I include myself in that: I was prepared to challenge the Government, although on this occasion I have agreed wholeheartedly with the Government line. I am very pleased to be able to say that. I believe that the addition of the advocacy measure to the final Bill is a great step forward. I was a little surprised that it was not included initially, but I am very pleased that it is there now.
I must tell all those who have deluged me, and other Committee members, with briefings that there has just been too much of it. It has jammed my e-mail inbox, and filled my sacks of mail. I have a confession to make: I have not read it all. I think that there is a message there. Why should we receive a briefing from the Mental Health Alliance and, at the same time, briefings from all its members? I am grateful for the briefings, but I ask those who sent them please to send us a few less in future.
During the Bills passage, I have detected a tension between psychiatrists and psychologists. The Government are trying to build a modern mental health service in which all professionals work in harmony and to the same endto help the patients who benefit from the service. I hope that the professionals will listen to that message.
At the beginning of the Committee stage I felt like a member of the Stasi, being accused of wanting to lock people up for having strange religious practices, political views or sexual deviancies of one kind or another. In fact, I feltand now believe wholeheartedlythat the Minister was trying to strike a balance between liberty and human rights on the one hand, and on the other the need to recognise that there are people out there who can benefit from modernised mental health services. People with serious personality disorders, for instance, can benefit from the application of appropriate treatment, with a consequent saving of lives that might otherwise be lost as a result of both homicides and suicides.
Ms Rosie Winterton:
My hon. Friend has clearly set out all the reasons why the Bill should be voted for. Does he agree that if the Opposition vote against it, they will be voting against advocacy, victims rights and
looking after people in the community, and thereby put at risk patients and public safety?
Dr. Iddon: The Opposition will vote against it, which is sad. As with all proposed legislation, this Bill will be proved to be successful or not when its provisions are put into practice. I hope that it will benefit the patients for whom it is intended.
Angela Browning: I thank the Minister for her generosity in spending time with me when I have asked to see her during the course of the Bills proceedings. I also particularly wish to thank the Mental Health Alliance. In my view, it did not send too much material, but put a lot of work into supporting Members who were dealing with the Bill. I also thank the Royal College of Psychiatrists and the National Autistic Society for helping me with my representations on the Bill.
I look forward to working with the Minister on the code of practice. There are still problems to do with people with autistic spectrum disorders. There is a problem in that people with autism are detained inappropriately in unsuitable settings and for far too long. I hope that the code of practice will address that.
Finally, let me raise again an issue that I mentioned at the end of my speech on Second Reading, and which has not been touched on today. Early intervention with appropriate levels of resources is the answer to mental health issues. It seems incongruous to me that the Minister should suggest that by voting against the Bill the Opposition will be responsible for putting patients at risk.
Ms Winterton indicated assent.
Angela Browning: The Minister is nodding her head, but apparently that is okay in Scotland.
Lynne Jones: I have no trouble in supporting the Government and voting for the Bill, as it is a substantial improvement on the current legislation. I thank Members of all parties here and in the other place, as well as those who have briefed and supported us in our discussions, for their work in helping to bring about the current state of play in respect of the Bill. I particularly thank my right hon. Friend the Minister. As other Members have mentioned, she has been very open and has bent over backwards to discuss the Bill frankly. I also thank her for her attendance at meetings of the all-party group on mental health.
The Bill has been much improved since it first appeared many years ago. Much of the angst that we have experienced in the past eight or nine years could have been alleviated had greater regard been paid to the expert committee that reported in 1999 or 2000. Too much emphasis was placed on public safety as a result of some tragic cases that were in the news at that time.
I tried to intervene on the Minister on the subject of impaired decision making. If we are to protect the public and reduce the tragically high number of suicides that result from mental illness, people must receive the
treatment that they need as early as possible. The effectiveness of our mental health services is judged not by the number of people who are subject to detention and sectioning, but by our effectiveness at getting services to them when they need them. I am still disappointed that the Government were unable to accept the new clause on impaired decision making.
Yesterday, there was some consternation when my hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) suggested that there might be more mental health Bills. However, we have not been able to discuss yesterday or today new clause 1, which would give people suffering from a mental health problem a right to assessment, and we still do not have rights to a comprehensive care plan on discharge. There are issues that we need to address beyond this Bill to ensure that we get excellent services to people when they need them. The Government have done much to invest in mental health services, but I am afraid that it is still a Cinderella service. That is the
It being Ten oclock, Mr. Deputy Speaker put the Question already proposed from the Chair, pursuant to Order [18 June].
Question put, That the Bill be now read the Third time:
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