Ms
Winterton: I am not clear whether sex addiction is a
mental disorder. I suspect that it probably is. [Interruption.]
I can see that we are getting into deep water. However, to return
to the point about sexual deviancy, the problem has been that although
various things, such as homosexuality, are not considered a
mental disorder, nevertheless things such as
paedophilia and paraphilia are considered a mental disorder. The danger
is that it has previously been possible for a paedophile to argue, for
example, that they were excluded from the Mental Health Act, as some
might prefer a prison sentence to a hospital order. We wish to get rid
of that in order to prevent such problems from
arising. James
Duddridge (Rochford and Southend, East) (Con): It is a
pleasure to serve under you, Lady
Winterton. What
consideration did the Minister give to excluding paedophilia and any
other acts that would be encompassed, instead of entirely removing
proposed paragraph (b) to section 1(3) to the 1983 Act? Alternatively,
instead of considering sexual identity and orientation, homosexuality
could be specifically mentioned so that it was
exempt.
Ms
Winterton: I will come to that point. The Lords amendment
does not restore sexual deviancy. I was trying to explain the
background to our changing the exclusions. I was explaining why,
because of the issues that I have just mentioned, we decided to exclude
sexual deviancy. The amendment does not reintroduce it. There are
different reasons why we believe that that is necessary. That is the
background to the previous exclusions. I shall now deal with why we
disagree with the exclusions that we are currently
discussing. Unfortunately,
the other place introduced a new set of exclusions into the Bill. As
hon. Members can
see, “sexual identity or
orientation...commission, or likely commission, of illegal or
disorderly
acts” and “cultural,
religious or political
beliefs” would be
excluded. However, those exclusions have never been included and, as
far as we can see, theyhave never been needed. Although I use
the word “exclusions”, I am probably using it
incorrectly, because the things that are listed are nothing of the
sort. They are about conditions, behaviours and beliefs, but none of
them are mental
disorders.
Mr.
Boswell: On a more substantive point thanmy
earlier one, does the Minister appreciate that the background to this
matter inevitably concerns not necessarily the practice in the United
Kingdom, the good faith of Ministers or the system, but the fact that
in certain countries there are chilling experiences of persons being
singled out for mental treatment because
their face does not fit? That may be because oftheir sexual
identity or because they happen to hold political beliefs, which we
might all find thoroughly objectionable, or they may be regarded as
morally disreputable, but none of those things constitutes a mental
illness on its own. Some other evidence would be
required for compulsory treatment to be appropriate. If that evidence
were available, these tests could reasonably be set
aside.
Ms
Winterton: I hope that as I go through the arguments I
might be able to address some of those points. I understand what the
hon. Gentleman is saying. If we want to guard against something
happening in future, where clinicians suddenly wanted to lock people up
because of their political beliefs, for example, we can say that that
is an issue. However, being realistic, we have to say what such
exclusions are meant to do. They are meant to be exclusions from
provisions dealing with mental disorder, but as I said, the items are
not considered mental disorders in the first place. As I said, the
exclusions are
unnecessary. If
somebody felt that they had been detained and given compulsory
treatment because of their political beliefs, they would first have to
get two doctors to sign up to the fact that they had a mental disorder.
They would then be able to appeal to the mental health review tribunal
and say, “I have been detained because these two doctors think
that my belief in x, y or z is a mental disorder, but in my view it is
not.” Even in the first appeal process that a patient would go
through, we have built in safeguards in order to give a
personthe ability to appeal if the basic criteria on which
compulsion works have not been fulfilled. Somebody can say, “I
do not have a mental disorder; therefore it is extraordinary that I
have been detained simply because of my particular political or
religious belief”. On the other side, having said why our
safeguards make such exclusion unnecessary, there is immense potential
to create confusion about the operation of the legislation and
therefore to prevent people from getting the treatment that they need.
It is not an enormous risk, yet it is there; we cannot avoid talking
about that possibility.
It is also important to
recognise that we particularly need to look at whether the amendments
that have come from the other place contribute anything in making the
Bill more effective in usage for clinicians. I understand that the
Royal College of Psychiatrists has argued that it will make
psychiatrists think twice. Well, I would have hoped that they were
thinking twice in the beginning and that the approach was not,
“Well, let’s really think this through” after the
event. We have always said that psychiatrists should examine whether
they are judging somebody else from their particular cultural stance;
they should make sure that they understand them. If they do not agree
with someone, it does not mean that that person is mentally disordered.
That should be part of best clinical practice. We should not be using
legislation to say to people that they must think about
someone’s cultural beliefs, when that should be part of how they
work.
Dr.
Doug Naysmith (Bristol, North-West) (Lab/Co-op): It is a
pleasure to serve under your chairmanship, Lady Winterton.
Does the Minister not agree that
all the things listed by the hon. Member for Daventry are examples of
abuse of psychiatry and mental health legislation? I understand exactly
why the hon. Gentleman is making these points, but if such things
happened in this country, we should have sufficiently well regulated
medical and psychiatric professions to ensure that they stop. I agree
with the Minister that it is much better not to have all these things
outlined individually; for a start, we do not want to put ideas into
people’s heads.
Ms
Winterton: I agree absolutely with my hon. Friend; to go
down such a line would almost be dangerous for us, because we would be
taking away the expectation that the clinician should be making a
proper judgment. The idea that this is somehow an excellent thing,
because it would make them think twice, is deeply
worrying.
Ann
Coffey: And
offensive.
Ms
Winterton: As my hon. Friend says, I am sure that it is
quite offensive to a number of rather good
psychiatrists.
Mr.
Boswell: On that point, while I understand the purity of
the Minister’s argument, can she explain something that is
puzzling me? Why is it necessary to effectively ring-fence substance
and alcohol abuse? If she really wants to stand by her conviction, why
does she not simply strike out all exclusions and leave the matter to
the clinical judgment of
practitioners?
5
pm
Ms
Winterton: Again, that goes back to the long-standing
agreement that we must be careful in saying that we could detain
somebody solely on the grounds of their addiction to drugs and alcohol.
It has been said that someone who is an alcoholic has a mental
disorder. However, there has been a desire not to want to detain
someone who, for example, might get drunk on a Friday night and as a
result becomes violent. We have said that there would have to be an
underlying or resulting mental disorder for that person to be
detained. The
treatment of the person simply for their alcohol problem should
probably be the responsibility of the addiction services. However, if
we want to treat someone who has an alcohol problem and underlying
severe clinical depression that makes them detainable, that is why have
said that, in those circumstances, alcohol and drug dependency are
mental disorders. The other conditions are not mental disorders, which
is why we must have the exclusion provision for drugs and alcohol
unless we decide to detain people for drug and alcohol addiction alone,
which is something that Parliament has never said that it would
do.
Chris
Bryant: The Minister has referred almost
exclusively to alcohol dependants. Clearly, no
psychiatrist in Britain will want to detain someone for getting drunk
on a Friday night. It would be a very big job detaining everyone who
did that. The Lords amendment referred to substance misuse, including
dependence, whereasthe Government amendment refers only to
dependence,
not misuse. If they want to stick with that idea, wouldit not
be more sensible to refer to misuse
anddependence?
Ms
Winterton: Until fairly recently, it was not clear to us
what was meant by misuse. I now understand that the Royal College of
Psychiatrists has clarified the meaning. Apparently, the idea is to
cover what might be called binge drinking. I referred to someone who
drinks every day, but on a Friday night may become very drunk and
violent. At the same time, certain people might get very, very drunk
and, for a few days, hallucinate and become delusional because of the
extent of their drunkenness. That might be an appropriate point at
which to detain them because they had become so severely delusional
that the Act would be necessary for a limited time. That is why we have
not covered that situation by “substance misuse”, but as
dependency. Hywel
Williams (Caernarfon) (PC): It is a pleasure to see you in
the Chair, Lady
Winterton. The
Minister suggested earlier that it would be patronising to the
practitioners to draw their attention to certain things. I draw the
Committee’s attention to the fact that, in other aspects of law,
such as child-care law, it seems to be entirely appropriate to draw
practitioners’ attention to the need for them to give due regard
to children’s background, ethnicity, language, culture and a
whole long list of matters before taking children into care. Should we
be arguing against such provisions in that other context? Would the
Minister apply the principle
across?
Ms
Winterton: I am not sure that I caught everything that the
hon. Gentleman said. I think it important for clinicians to operate in
a non-judgmental way, while looking at people’s background or
culture. The viewpoint should be that people do not have a mental
disorder just because their ideas might not seem absolutely
normal—to use a phrase. Our reason for thinking that such people
should not be in the clause is because everything listed there, apart
from dependence on drugs or alcohol, is not a mental disorder.
Theyare being excluded from “mental disorder”
for the purposes of the
Act.
Ann
Coffey: It is a pleasure to serve under your chairmanship,
Lady Winterton. Does
my hon. Friend agree that there is a world of difference in talking
about what constitutes a mental disorder in terms of substance misuse
or dependency—because of the inter-relationship between alcohol
and drugs and mental disorder—and in terms of putting in
exclusions such as cultural, religious and political beliefs that have
nothing to do with mental disorder but with a state of society that
might or might not come about with the overthrow of the democratic
Government? If that happened, having that in would not help any of us,
because we would all be in
jail.
Ms
Winterton: I am glad that my hon. Friend makes that point.
I was wondering about hiding behind the Bill in the circumstances where
everyone was being
locked up for their cultural, religious or other beliefs. Holding up the
Mental Health Bill would not necessarily
help.
Tim
Loughton: There are many points on which I would be
grateful for greater definition between what the Minister regards as
misuse and what she regards as dependence. For example, what about the
person who goes out and gets drunk on a Friday night and then becomes
violent? What about the chap who gets severely drunk every Friday
night? Is the latter to be hauled off to a mental hospital or will he
be recommended to Alcoholics Anonymous and given hospital health
treatment or
whatever?
Ms
Winterton: We have been very clear about the legislation
continuing to operate as it does as the moment. We will have the status
quo when the new legislation comes in with respect to drug and alcohol
dependencies. There will be no difference in how the legislation
operates now. If somebody has drug and alcohol dependency, that is not
the only thing that they can be detained for. I want to come on to a
couple of other points, but I can go over the issue of misuse if the
hon. Gentleman did not pick it up the first
time. The Royal
College of Psychiatrists, which suggested an amendment, has said that
that interpretation of misuse is needed to stop binge drinking or the
casual consumption of illicit drugs being the basis of compulsion. As I
said, there is no such exclusion at the moment; it is simply in respect
of dependency. That is about a one-off misuse of alcohol or drugs. It
is true that, at the moment, we do not have wards full of binge
drinkers or casual drug misusers. That is anticipating something that
does not happen at the moment. There is nothing in the Bill that would
change the current position, but it is important to ensure that in
certain cases there is scope for dealing with people who might have
become extremely delusional for a time, and the Bill allows for
that. Sandra
Gidley (Romsey) (LD): I am confused. The reason for the
exemptions is that there is now a much broader definition in some
respects.
Ms
Winterton: No there is
not.
Sandra
Gidley: We can argue that point, but we have finished
clause 1 and I do not want to revisit it. If mental illness is
considered as a condition under ICD10, the definition covers acute
intoxication, harmful use of a substance, dependent syndrome and
withdrawal state, which is a whole range. It is difficult to try to
comprehend the precise circumstances under which alcohol and drug
misuse would be completely ignored, and those under which it could just
be convenient to use the new legislation to lock somebody up because
they were extremely drunk. There is potential for abuse in
interpretation of the
rule.
Ms
Winterton: I reiterate that, if there is an intention to
exclude binge drinkers, one would assume that lots of people are
already the subject of detention because
of binge drinking or drug misuse on a one-off basis. That is not the
case, so it is difficult to understand why there needs to be a new
provision, rather than retention of the existing practice that covers
dependence on drugs or alcohol.
I want also to make some points
on the exclusions themselves. We agree that sexual orientation is not a
mental disorder, and nor is sexual identity, if it is assumed to mean a
person’s own identification of their sexual orientation.
Breaking the law and acting in a disorderly manner are not of
themselves a mental disorder, nor are political, cultural or religious
beliefs, however curious or unpalatable they might be to some
people. Mr.
Charles Walker (Broxbourne) (Con): It is a pleasure to
serve in a Committee that is chaired by your good self, Lady
Winterton. I think
that the Lords inserted the exclusion on cultural, political or
religious beliefs, not to help guard against overbearing clinicians,
but perhaps to protect against overbearing Governments that might lean
on clinicians. Before the Minister dismisses my concerns, let me say
that I do not think that anybody in the room thought three years ago
that the prevention of terrorism legislation would be used haul off
from the Cenotaph a woman reading the names of soldiers fallen in
Iraq.
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