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.
Tim
Loughton: The Minister was unable to gauge the difference
between misuse and dependence, and she said that only recently had the
Government been made aware of problems with the definitions of
misuse
and dependence. I agree—we considered this in the pre-legislative
scrutiny Committee, and somebody referred to the Sainsbury
report—that there might be a disincentive for people to seek
treatment, but similar considerations could apply to the other
exemptions that the Lords have added on sexual identity and on
cultural, religious or political beliefs, so I struggle to understand
the consistency in her
approach. 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.
| 
