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Session 2006 - 07
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General Committee Debates
Mental Health

Mental Health Bill [Lords]



The Committee consisted of the following Members:

Chairmen: Frank Cook, † Ann Winterton
Boswell, Mr. Tim (Daventry) (Con)
Browning, Angela (Tiverton and Honiton) (Con)
Bryant, Chris (Rhondda) (Lab)
Coffey, Ann (Stockport) (Lab)
Duddridge, James (Rochford and Southend, East) (Con)
Gibson, Dr. Ian (Norwich, North) (Lab)
Gidley, Sandra (Romsey) (LD)
Gwynne, Andrew (Denton and Reddish) (Lab)
Hillier, Meg (Hackney, South and Shoreditch) (Lab/Co-op)
Iddon, Dr. Brian (Bolton, South-East) (Lab)
Kidney, Mr. David (Stafford) (Lab)
Loughton, Tim (East Worthing and Shoreham) (Con)
McCarthy, Kerry (Bristol, East) (Lab)
Moon, Mrs. Madeleine (Bridgend) (Lab)
Naysmith, Dr. Doug (Bristol, North-West) (Lab/Co-op)
Pugh, Dr. John (Southport) (LD)
Rosindell, Andrew (Romford) (Con)
Walker, Mr. Charles (Broxbourne) (Con)
Ward, Claire (Lord Commissioner of Her Majesty's Treasury)
Williams, Hywel (Caernarfon) (PC)
Winterton, Ms Rosie (Minister of State, Department of Health)
John Benger, Committee Clerk
† attended the Committee

Public Bill Committee

Tuesday 24 April 2007

(Afternoon)

[Ann Winterton in the Chair]

Mental Health Bill

pm

Clause 2

Learning disability
Amendment proposed [this day]: No. 40, in clause 2, page 2, line 4, after ‘disability’, insert ‘or an autistic spectrum disorder’.—[Angela Browning.]
4.30 pm
Question again proposed, That the amendment be made.
The Minister of State, Department of Health(Ms Rosie Winterton): May I first say what a pleasure it is to see you in the Chair, Lady Winterton, not least because of your surname?
Tim Loughton (East Worthing and Shoreham) (Con): That won’t help you.
Ms Winterton: I can try.
Returning to the amendment, the point that I made earlier is that there is very little case law that would help us to say precisely what abnormally aggressive or seriously irresponsible would mean.
Ann Coffey (Stockport) (Lab): My hon. Friend’s remarks are also pertinent to the clause as a whole, which deals with learning disability. In view of that, I find it difficult to understand why it is in the Bill at all.
Ms Winterton: My hon. Friend makes a good point. However, as I explained earlier, the reason we have kept in clause 2, on learning disability, is that there has been a historic attachment to saying that learning disability should be included in the Bill in this way, and I am afraid that there is no getting away from that. We took the clause out of the 2004 draft Bill, but there was heavy pressure to reinsert it, not least from the pre-legislative scrutiny Committee. In view of the points that were made, and the fact that hon. and right hon. Members and peers felt that we needed to be responsive to them, we said that we would agree with the pre-legislative scrutiny Committee on learning disability, because that meant that when we were considering amending the Mental Health Act 1983, we would be able to leave it as it was originally.
However, my point today is that to go further than that would, I am afraid, cause the difficulties that we have discussed, not only by creating the potential for uncertainty and the possibility of people not receiving the treatment that they need, but over and above that, because people suffering from hyperactivity or obsessive compulsive disorder could make a very reasonable case for doing exactly the same thing.
That is why I am afraid we cannot agree to the amendment. I understand completely the sentiments of the hon. Member for Tiverton and Honiton and I know that she feels extremely strongly about the issue. However, at the same time as saying that we do not believe that the amendment is the right approach for this particular Bill, we want to ensure that we take on board all the issues that she raised regarding early diagnosis, and proper care and treatment. Nevertheless, I am afraid that I must urge the Committee to reject the amendment.
Angela Browning (Tiverton and Honiton) (Con): May I say what a pleasure it is to serve for the first time on a Committee under your chairmanship, Lady Winterton?
I should like to pick up on the Minister’s final considerations of the clause, not least her remarks immediately before the Committee rose this morning. Clearly, she prayed in aid in support of her decision not to add autistic spectrum disorder as outlined in the amendment. She said that there was confusion, and she prayed in aid the case of a young man with an Asperger’s diagnosis who was apparently minded to light fires. Whether he has an ASD diagnosis or not, I think that we all understand such activity to be arson. She described how difficult it would be for the court to decide whether to send him to prison or to hospital. I have to say to her that the confusion and lack of clarity is with the existing legislation. It is quite clear that if the words “seriously irresponsible” are used and if a court believes that someone is an arsonist, that court has a duty to identify an appropriate determination of that case. It is up to the court to determine whether that person, regardless of their diagnosis, is sent to prison or hospital. Therefore, by identifying seriously irresponsible conduct, the provision actually clarifies the situation of a person with an ASD diagnosis who is before a court in those circumstances. I cannot agree from the Minister’s example that that would confuse people. I think that it would clarify the current situation.
Ms Winterton: I admit that it is an extreme example. I was trying to make the point that because there is little case law, the court would have to look at each case and decide whether the action was serious and irresponsible. By adding ASD in those circumstances, we are putting another hurdle in the way of getting treatment to people.
Angela Browning: I do not want to pursue that individual case too much, but I think that the example the Minister gave before lunch made my case for me more succinctly than anything I had said in my hour-and-a-half-long presentation to the Committee. The Committee was extremely tolerant, and I am grateful to everyone. However, the Minister’s pointis that if somebody was before a court in those circumstances, the court would have difficulty deciding whether the action was seriously irresponsible. If it even considers prison to be an appropriate sentence, then by definition the action is seriously irresponsible. If it was not seriously irresponsible, the option of a custodial sentence would not come into the court’s considerations. I have heard the Minister’s answer, but I must ask her to revisit that case. What is being proposed would clarify matters and not obscure them.
In conclusion, I fully understand why the Minister does not want a large pick-and-mix list of other conditions that might be appropriate to tag on. I hope that in the report of my submission this morning, I will have outlined many cases in which treatment and consideration of ASD is also appropriate for people with learning disabilities and vice versa. The conditions are different and it would be wrong in many circumstances to lump them together. For the purposes of the legislation, we know from what we have learned in recent years—how the condition presents itself and its appropriate management—that that is an area that is not being addressed at the moment.
The Minister has said that learning disabilities are included because there is an historical reason fordoing so. That is quite true; it is a matter of record. Instead of looking at history, the Minister now has an opportunity to make it. There comes a point when people must say that there is sufficient evidence to change in legislation what has changed around us. What has changed around us in recent years is the recognition and management of treatment of ASD.
I do not intend to press the amendment to a vote, not least because the Minister has been incredibly generous in agreeing to a meeting on Thursday, after the clause has been debated, with me and representatives from the National Autistic Society, including a doctor with a lot of experience in managing such cases. I hope to have another opportunity then, perhaps in a slightly quieter environment, to talk her through the more salient points. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 2 ordered to stand part of the Bill.

Clause 3

Changes to exclusions from operation of 1983 Act
Ms Winterton: I beg to move amendment No. 15, in clause 3, page 2, leave out lines 22 to 30 and insert—
‘“(3) Dependence on alcohol or drugs is not considered to bea disorder or disability of the mind for the purposes of subsection (2) above.”’.
The amendment will remove the exclusions added in the other place. Again, it might be helpful for me to give some background to the history of exclusions. The Mental Health Act 1959 contained only one exclusion, stating that nothing was to imply that anyone could be dealt with under the Act as having a mental disorder by reason only of promiscuity or other immoral conduct. Such a provision is quite understandable in the context of the times, as there was still a recent history of the law being used—or, as I am sure we all agree, misused—to detain women, in particular, not for health care reasons but for moral ones, such as having a child outside marriage.
When the 1959 Act was overhauled in 1982, two more exclusions were added—one for alcohol and drug dependence and one for sexual deviancy. The latter was agreed with virtually no debate, but we think that its main target was homosexuality. It is probably worth remembering that even as late as 1982, homosexuality still appeared in the international classification of diseases as a mental disorder. Today, of course, we do not think of it as a disorder at all, nor as sexual deviancy.
When we came to the current reform of the legislation, our starting point was that the needs of patients and the risks posed by their disorders should determine whether powers of compulsion should be used where there is no other way of getting people the treatment that they need. I am afraid that exclusions get in the way of that principle. They are essentially arbitrary and do not necessarily say anything about the needs of the individual. However, we listened carefully to what was said to us, took account of the recommendations of the Joint Scrutiny Committee and agreed that we should keep an exclusion for alcohol and drug dependence.
4.45 pm
There is no doubt that such dependence causes a lot of harm, but we do not have a history of using mental health legislation to force treatment for dependence alone, and we were persuaded that there was no compelling case to start doing so now. By contrast, we remain convinced that the exclusion for sexual deviancy should go.
Chris Bryant (Rhondda) (Lab): I am sorry that I have caught the Minister a sentence after she said the word “alone”. She will note that in the exclusions that the House of Lords has given us, the emphasis is on the word “solely”. For example, there is an exemption for people who might be detained solely on the grounds of substance misuse. There is no such word as “solely” in the Government’s amendment. Would she consider changing that?
Ms Winterton: That is an interesting point. I suspect that, because of the way in which the reference to dependence on alcohol or drugs is phrased, we will have been advised that the use of the world “solely” is not necessary. However, I take on board what my hon. Friend has said and I will look into whether it would clarify the point that we are trying to get across, which is, as he has said, that treatment should not be forced on people for dependence alone. I take on board the point that I think he is making about the way in which the Bill reads, and I shall come back to him about that.
As I said, we remain convinced that the exclusion for sexual deviancy should go. Paedophilia and various other paraphilias can constitute mental disorders and there may well be treatment that can be offered. If a person with such a condition meets the criteria for detention under the Act because of the risk to themselves or to others, we believe that it is important that the Act is available. The fact that a mental disorder that can be treated happens to be related to sexual deviancy, or whatever one wants to call it, does not render it somehow not a real mental disorder.
Mr. Tim Boswell (Daventry) (Con): As the Minister will know, I am a comparative newcomer to some of these areas, but can she consider the case of sex addiction, which I suspect is a term of art rather than necessarily a precise term, and whether someone canbe addicted to committing sexual acts in the sameway as to alcohol or other substances? If so, and if somebody’s dependence is of that nature, what is the criterion for their inclusion when the alcohol or drugs addiction is excluded?
 
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Prepared 25 April 2007