Mental Health Bill [Lords]


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Ann Coffey: Surely, the way of reassuring people from ethnic communities who might feel that their way of thinking about things is different from that of the wider community is to ensure that when they come into contact with mental health services they feel that professionals understand the differences of their cultural beliefs. The only way to reassure such people is to improve the standards of service that we offer; we cannot do it by introducing an exclusion that will not reassure them. This exclusion will send out the message that psychiatrists will section such people because they have culturally different beliefs. That is way of driving such people from the service, rather than helping them within it.
Ms Winterton: I agree that, in a sense, this matter draws attention to something and creates fear whereas we are striving to have the best clinical practice that says that people need to be understood in terms of their cultural beliefs. This debate has been ongoing. I do not believe that people are not trying to improve the situation, because a lot of good work is being done to say, “Let us be clear that we are not judging people on the individual psychiatrist’s belief; we are trying to understand others at the same time.” It is important that the debate takes place, but it would be wrong-headed to think that we can somehow pat ourselves on the back because we put something in a bit of legislation that confuses things and does nothing to sort the situation. We are talking about service provision. For all the reasons that I have outlined, there is no way that this measure does not get in the way of getting treatment to people, so I ask the Committee to support our amendment.
Tim Loughton: I welcome you to the Chair, Lady Winterton, and in doing so issue a blanket welcome from the entire Committee rather than the continuous gratuitous oleaginousness we have had since half-past 4. We very much welcome you here, Lady Winterton, and may we also say how very nice we think you are as well?
Chris Bryant: Just to add to the oleaginousness.
Tim Loughton: Which was started by the hon. Gentleman.
I have desperately tried to follow the debate for the past hour, and I have to say—I hope that I am not alone in this—that I feel more confused by the Minister’s explanation of what she is trying to do at the end of it than I did when we started. She constantly goes on about some terrible future Government wanting to lock everybody up. However, we are more concerned about this Government, whose legislation could end up with more people being locked up, and we are not the only ones who are concerned. Many hundreds and thousands of mental illness sufferers are also concerned. That is why there has been such a strong and concerted lobby over so many years in defence of their liberties, which are being undermined by the Minister’s proposals.
The Government and the Minister seem to be in denial about what the definitions that we have discussed do. Clause 1 and schedule 1 extend the definitions of mental disorder. In clause 1, several definitions that are in the old Act are scrapped in favour of a much wider mental disorder definition. The explanatory notes to schedule 1 explicitly say that the effect of this
“is to widen the application of the provisions in question to all mental disorders, not just those which fall within one of the four categories (or the particular category or categories to which the provision applies). Practical examples of disorders which would now be covered by those provisions are forms of personality disorder”,
and so on. In my book, in most people’s books and certainly in the book of the Richardson expert committee and most of the people who have been scrutinising the Bill closely, that amounts to an extension of the definitions of mental disorder, which de facto means that potentially more people can be scooped up in that net. That is the basis on which we start.
Ann Coffey: We have just had a debate about mental disorder, and the hon. Gentleman appeared to support the new definition that brings all those things under mental disorder. Is he now saying that he is concerned about it. If he is concerned about it, why is he supporting it? He was perfectly at liberty to propose an amendment to clause 1 to narrow the definition if he felt that it was too wide.
Tim Loughton: Very simply, as the hon. Lady will know, we are supportive of the changing of the definitions of mental disorder if that is balanced bythe exemptions. That was exactly the line taken by the Genevra Richardson committee, which concluded that
“a broad definition of mental disorder in the draft Bill must be accompanied by explicit and specific exclusions which safeguard against the legislation being used inappropriately as a means of social control.”
That is the quid pro quo that the Lords put into the Bill, which has been supported by the Opposition, the pre-legislative scrutiny Committee, the Richardson expert committee and most other sensible-minded people. There is no changing of positions.
5.45 pm
Ann Coffey: In that case, if the exclusions that the hon. Gentleman wants are not included in the Bill, will he still support the new definition of mental disorder, or will he withdraw his support?
Tim Loughton: We will then have a serious problem, but the hon. Lady should remember that it is for her Government to overturn amendments to the Bill, while Opposition Members are seeking to defend what we believe are the improvements and extra safeguards that the House of Lords has put in. We are therefore in no position to amend something that has not yet been amended. That would be pre-empting what the Government are trying to do. I hope that the hon. Lady and her colleagues will not be duped into following the Minister, who seeks to get the Committee to do so. That would weaken the Bill, reduce the safeguards and not be in the interests of people suffering from mental illness. At the end of the day, we will see how many Labour Members follow the Minister in defiance of80 members of the Mental Health Alliance and cross-party support for these amendments at all stages in the House of Lords.
The Minister’s response to some potential anomalies, which were first pointed out by the hon. Member for Rhondda, was also worrying. It is quite important that the reference to “solely” that was in clause 3, as amended, has now been dropped. That is an important consideration for how we regard dual diagnosis, yetthe Minister responded that she “envisaged” that the reason why it had been changed was whatever had then been proposed. Well, this is her amendment; it is in her name. I would have hoped that she was better informed than to be in a position merely to envisage why Government amendments to a Bill had been tabled, whoever has actually written them for her. She must support such amendments and account to the Committee for why they are being put into the Bill now, seeking fundamentally to overturn what the Lords have done in another place.
May I also correct the Minister on some other factual matters? The Lords amendments on sexual identity are in accordance with the Joint Committee on Human Rights report on transsexualism and gender dysphoria. She was also mistaken in saying that homosexuality is not included in the ICD10; it still is, whatever we may think of that, albeit that it says that it is not a mental disorder. She specifically said, as the record will show, that homosexuality is not included in the ICD10, which is wrong. Also, paedophilia is not excluded by the Lords amendments; it is not included in ICD10 under sexual identity or sexual orientation. So we have problems with some statements that she has made. These are important issues that go to the heart of this Bill, and one of the big six areas that the Lords added to it, with cross-party support and by a large margin. We are seeking to support their amendments today.
Chris Bryant: Is the hon. Gentleman really saying that paedophilia is not included in ICD10? It clearly is, as one of the paraphilias.
Tim Loughton: If the hon. Gentleman refers to the debate in the Lords, he will see the comments from Baroness Murphy on how paedophilia will be treated by this Bill. I suggest that he looks there.
Chris Bryant: Just to help the hon. Gentleman, it is item F65.4, and it is a disorder of sexual preferences. That is pretty straightforward; he can apologise to the Committee if he wants.
Tim Loughton: Well, like the Minister, I am happy to come back to the hon. Gentleman on that point. My point is that paedophilia is not included under sexual identity or orientation in ICD10. Does he agree with that?
Chris Bryant: The hon. Gentleman said that it is not in ICD10, but it is counted as a paraphilia there. That is pretty straightforward.
Tim Loughton: I am sorry if I am being misinterpreted. To read again the words that I used, it is not included in ICD10 under sexual identity or sexual orientation. I believe that that point is true; does the hon. Gentleman want to challenge it? If he does not, we can take that as read.
Chris Bryant: I think that it might be best if we were to reconcile this matter afterwards with an exchange of letters, but clearly that is not precisely what the hon. Gentleman said earlier.
Tim Loughton: I hope that it is clear, now that I have re-read my words, that that is what I said. I am not entirely sure why the hon. Gentleman wants to make such an issue of it. He did not seek to take the Minister up on what I believe was a factually incorrect statement in her address, so I do not know why he is taking it up now. As my hon. Friend the Member for Tiverton and Honiton has said, there is a move in the Bill from an emphasis on clinical diagnosis to an emphasis on behaviour, and that is why it is so important to have the relevant definitions.
I was a member of the pre-legislative scrutiny Committee and I want to refer to something that the Committee said to reinforce the point about why a balance is needed between a wider definition and the exemptions. The Committee said:
“Although we conclude that the Government should retain the definition of mental disorder contained in the current draft Bill, we believe that the scope should be narrowed by means of specific exemptions and by the conditions for the use of compulsory powers.”
I wholeheartedly concur with that, and that is what the Richardson committee said as well.
The Minister has referred to exclusions as arbitrary obstacles to the use of compulsion, which will cause uncertainty, yet she has conceded the necessity of including references to drug and alcohol misuse. She has conceded the principle, but not the scope.
Ms Winterton: The whole point about drug and alcohol dependency is that they are mental disorders. That is the issue, and that is why they should be included.
Lord Alderdice made what I thought was a very important contribution to the debate in the Lords. He said that
“we could end up dragging into the net all sorts of people who are not suffering from mental illness in a proper sense and it becomes a question of how we deal with people who are difficult, different or deviant in our society.”—[Official Report, House of Lords, 8 January 2007; Vol. 688, c. 82.]
Baroness Murphy referred to the many cases of people who in the old days would have been dumped in mental hospitals and asylums. She said that those institutions
“became repositories for all kinds of socially excluded people when there did not seem to be anywhere else to put them.”—[Official Report, House of Lords, 8 January 2007;Vol. 688, c. 76.]
Lord Alderdice also referred to the very interesting subject of auto-erotic strangulation in the debate on sexual identity and sexual orientation, on the backof which comments he was described by Baroness Murphy as a “wonderful tease”. The Baroness also raised the subject of the everyday rubber fetishist. They have some interesting debates in the House of Lords. The Bishop of Coventry mentioned the Syrian monk, Dionysius the pseudo-Areopagite, and referred to the Church of England submission that expresses concerns about the Bill being used as a means of social control.
The Government appear to revel in their condition of splendid isolation. For instance, the Mental Health (Care and Treatment) (Scotland) Act 2003 includes a list of exclusions that covers
“sexual orientation; sexual deviancy; transsexualism; transvestism; dependence on, or use of, alcohol or drugs; behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person”—
and—
“acting as no prudent person would act.”
The Government often refer to the New Zealand legislation, and that also includes a list of exclusions.
Mr. Boswell: Will my hon. Friend tell the Committee whether he is aware of any difficulties in the implementation—for example, a series of legal challenges—pertaining to either the Scottish or New Zealand legislation?
Tim Loughton: Those countries seem to be getting on with their new legislation rather well. It is early daysfor Scotland, but there are some good signs fromthe Scottish legislation. The pre-legislative scrutiny Committee modelled many of its recommendations on what had already been achieved in Scotland.
On exclusions, perhaps I could also quote the evidence given to the Joint Committee by Dr. Zigmond, from the Royal College of Psychiatrists:
“People who make life-style choices either to behave in a criminal manner, or to drink to excess, or to gamble, or to become addicted to cigarettes should not normally be forced to stop those by a health service. If a government feels that those behaviours are inappropriate, then they should legislate in relation to those behaviours, but they are not part of what is generally understood as people who are ill.”
That is right. Yet those people could potentially be caught within the remit of this extended mental disorder provision without the specific exemptions.
Even if that were not so and there was not going to be a field day for the lawyers, as the Minister seems to claim—it is usually those on the Opposition Benches who subject the Government to the claim that their muddled legislation will lead to a field day for lawyers—the perception among vulnerable people of what could happen to them if they submit and present to the mental health system would be that they will be forced quickly down a coercive route, simply because they have other issues that are not, strictly speaking, mental illness. That perception is deeply damaging.
 
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Prepared 25 April 2007