Ms
Winterton: Can the hon. Gentleman give me an example of
how somebody who smokes a lot of cigarettes will be captured under the
Bill because of the changes that we have
made?
Tim
Loughton: We debated that issue the other day. Somebody
with a severe lung condition who smokes a lot of cigarettes could be
construed as wanting to hasten their own death. That could be construed
as some form of mental disorder. However, I would concur that that is
an extreme
example.
Mr.
Walker: On the exclusions relating to religion, some
religious sects or organisations—for example, a Christian one
called Opus Dei and certain Islamic faiths—believe in
self-flagellation as a way of atoning for sins and for penance. Would
they potentially be caught by this legislation if the religious
exemption put in by the Lords were
removed?
Tim
Loughton: That is another interesting line of thought:
self-harm for religious aims. However, potentially, because of the
wider definitions that now apply those people could be caught in the
net of sectioning. Whether Government Members like it or not, that is
the implication of the proposed legislation. More worryingly, that
implication is perceived by people who have what we might describe as
slightly odd religious, cultural or political beliefs, who may be
deterred from approaching mental health services for help because they
fear that they may be caught inthis
net.
Ms
Winterton: I am also interested in the hon.
Gentleman’s example of the person who smokes a lot of cigarettes
potentially being detained because of the changes that we are proposing
to the 1983 Act. Which of the exclusions that the hon. Gentleman wants
to see would prevent such a person from being
detained?
Tim
Loughton: Well, it is dependency, isn’t it? The
Minister is unclear about the difference between misuse and dependency.
Her amendment is not as inclusive as the Lords amendment that she is
seeking to replace and it mentions
only “dependence
upon...alcohol or
drugs”, and not misuse.
Substance abuse is being covered here.
Mrs.
Madeleine Moon (Bridgend) (Lab): Does the hon. Gentleman
accept that the climate of fear and anxiety that exists has been
generated solely by the Opposition? There is absolutely no suggestion
in the Bill that a climate will be created and set for a future agenda
in which people who do not have severe mental health problems will be
locked away. An insult against the Government is implicit in all of the
discussion that has taken place this afternoon, but an insult more
especially—I find this most fearful as a previous representative
of it—against the mental health profession of this
country. 6
pm
The
Chairman: Order. An intervention should be relatively
brief and a question should be posed. I hope that the hon. Lady is
about to reach
it.
Mrs.
Moon: I apologise, Lady Winterton. Perhaps I have spent
too long holding myself in. I should have intervened
earlier. Does the hon.
Gentleman agree that a number of people demonstrate their mental health
problems through delusions that have a religious basis? I have double
checked and found evidence of people who confirmed that their delusions
included religious delusions when thought that they were God or
Mohammed. Including such delusions as an exemption would, in fact,
create a situation in which lawyers would become
involved.
Tim
Loughton: Such matters are not fears and hypotheses that
have been dreamt up by Opposition Members to entertain or alarm the
Committee. They are the real concerns of 80 members of the Mental
Health Alliance and countless thousands of mental illness sufferers
whom they represent. Whether or not legally it turns out to be the
case, the perceptions that have been created by the Bill for those
people are deeply worrying. In no way are such matters trying to
denigrate the mental health profession. What it wants is clarity. It
needs that above all. The medical opinions of members of the mental
health profession need to be based on clarity in the legal system about
what they are entitled to do and the remit of the powers that they will
have. They are saying that the provision will create an enormous lack
of clarity and that it will undermine the therapeutic relationship
between a practitioner and the patient, which is perhaps more important
in mental health care than in physical health
care.
Mr.
Boswell: As for clarity, my hon. Friend will recall that
we had exchanges some time ago about addiction to tobacco. Does he
agree that the clause, as drafted, would include that addiction, which
would be embraced generally within the term “substance
misuse”? The examples of dependence on alcohol or drugs are not
exclusive and would not exclude tobacco, whereas conversely the
Government’s amendment makes no reference to dependence on
tobacco. Therefore, it would be open to a clinician to section someone
for that dependence, which would not apply if they were dependent on
alcohol.
Tim
Loughton: My hon. Friend makes an interesting point, which
is not limited to tobacco. We could be looking at solvent and petrol
abuse, too. Coming
back to the Minister’s point about where such matters would be
covered under the amendment, surely she is aware that all addictions,
including tobacco, are covered by ICD10 as a mental disorder. They are
already caught up in those things. Such addictions would be regarded as
a mental disorder, whether or not they are mentioned explicitly. She
needs to do a bit more homework on the amendment’s
implications. On the
implications and perceptions for the black and minority ethnic
community, we have received submissions from the BME groups. One brief,
which refers to National Institute for Mental Health in England
documents,
states: “Extensive
literature confirms that racism can apply in the practice under the
current law and is even more likely under the broader definition of
mental disorder. Research in cultural psychiatry demonstrates how hard
it is to diagnose when issues of culture and belief get involved in the
mix.” As for the point
made by the hon. Member for Bridgend, the brief
states: “The
difference between delusional behaviour and hallucinations and
culturally or religiously appropriate beliefs, such as belief in an
interaction with gods, witchcraft and spirits, is often difficult for
psychiatrists to
define.” It
comes down to the issue that the pre-legislative scrutiny Committee,
the Richardson committee and all the other committees made absolutely
clear. People should not be subject to sectioning solely on account of
their problems with substance misuse, sexual identity or cultural,
religious or political beliefs, but on the basis of a mental illness
that can then be treated bythe appropriate professionals. By
rejecting the amendments, we run the risk that people could be subject
to coercion within mental health services on the basis of something
that is not primarily a mental illness and will not be subject to
treatment as such. Equally bad, if not worse, is the perception that
that would create. The Government’s aim to remove the clear,
understandable exclusions that we are seeking to keep in the Bill would
cause a great deal of concern and angst among those who might not then
present for the help and treatment they
need. This is one of
the first big-issue debates about the changes to the Bill. The
Government are determined to bulldoze through their own amendments in
defiance of the vast majority of those involved in mental health, be
they practitioners, service users, service providers, charities or
others. The cross-party alliance in the Lords did not just conjure up
the amendments to alarm people, or pluck them out of the air to inflict
some defeat on the Government. After an extensive, well-informed debate
by some seriously skilled, expert and knowledgeable people, they made
the amendments to clause
3. On that basis, it
will be very bad news indeed if the Government—on the basis of
muddled logic, I must say, and factual errors from the
Minister—cajole Labour Members into overriding those precautions
and pushing through their amendments. The Conservatives will certainly
vote against them ifthey do.
Several
hon. Members
rose—
The
Chairman: Order. Before I call the next speaker, I think
that it is appropriate to let the Committee know that it is not my
intention to allow a stand part debate, as this debate is fairly wide
ranging, to say the
least. Dr.
Brian Iddon (Bolton, South-East) (Lab): Thank you, Lady
Winterton. I hope to be brief.
When I came to this House in
1997, almost 10 years ago, people misusing drugs—I am the
chairman ofthe misuse of drugs group, so I lay that on the
table—found it difficult, if they also had a mental illness, to
access mental health services. Our group launched an inquiry into the
problem and published a report in 1998 on comorbidity, or dual
diagnosis. At that time, an holistic approach to treating people with
comorbidity of that type was not fashionable. It has got a darn sight
better since, but in some parts of the country it is still not right.
People out there who have mental problems and misuse drugs still find
it difficult to access mental health
services. The Minister
will know that some people who misuse drugs such as amphetamine,
cocaine and even cannabis with high concentrations of
tetrahydrocannabinol —I am talking about 15 per cent. rather
than 5 per cent.—may become mentally ill, although there is some
doubt whether a predisposition is necessary. No doubt some people may
become mentally ill as a result of using certain, although not all,
drugs. On the other
hand, people who are mentally ill and tortured by their mental illness
also try to escape their problems by turning to the kind of drugs that
other people misuse, too. The terrible problem of diagnosed
schizophrenics using cannabis is well known, and tragically, in some
circumstances, it exacerbates their clinical symptoms. I support the
Government’s amendment, but I seek an assurance from the
Minister that she will do everything possible to ensure that people are
not turned away from mental health services when they are misusing
substances. Some of those people—I have met them—can be
extremely chaotic. The hospitals do not want them anywhere near,
because they are so chaotic. Their lives and behaviour are chaotic, but
obviously they need treatment for the drug misuse and the mental health
problems that they exhibit.
Dr.
Ian Gibson (Norwich, North) (Lab): Does my hon. Friend
agree that many of the drugs are not pure, and that the by-products in
some of the drugs causethe problems? There is no guarantee
that any drug is 100 per cent. chemically
pure.
Dr.
Iddon: That is true. There is also the considerable
problem of poly-misuse—the use of alcohol and drugs, or of
different cocktails of drugs. There has not been a lot of research on
how those affect the mind. We need much more research, but that is a
subject for another debate.
Mrs.
Moon: Does my hon. Friend agree that many of the people
whom he is describing often end up homeless because of their chaotic
lifestyle? Frequently, the people who work with homeless people, often
in the
voluntary sector, find it difficult to get support from mental health
services for people who suffer from severe mental health
difficulties.
Dr.
Iddon: I accept that point, too. It is true.
I want my right hon. Friend the
Minister to assure me that she will do everything possible to ensure
that people who deal with people with comorbidity are properly trained
in the medical schools, and that we will try to get more people to work
in a more holistic manner and even to take social problems into
account.
Sandra
Gidley: I note that a number of hon. Members hope to
speak, and I want to add my support to many of the comments made by the
hon. Member for East Worthing and Shoreham. Indeed, as he said a lot of
what I was going to say, I shall be brief. However, it is worth
repeating a few points.
Opposition Members cannot say
often enough that we do not raise these matters only for the sake of an
argument or to prolong the debate, but out of genuine concern. There is
such a consensus in the Mental Health Alliance, and given the disparate
nature of some of the members of that alliance, it is telling that
there is such agreement on many of the problematic aspects of the
Bill. As has been
said, Richardson recommended in 1999 that a new mental health Act
should contain a broader definition of mental disorder. She also stated
that that needed to be balanced by some exclusions. It is not only us
who say that: our stance is supported bythe Royal College of
Psychiatrists, the British Psychological Society, the British
Association of Social Workers and the Royal College of Nursing. They
are all people with everyday contact with service usersand the
very people who will be responsible for ongoing care.
It was mentioned that Scotland
and New Zealand have introduced a range of exemptions. A number of
states in Australia have done the same, despite the fact that in all
those countries the definition of mental disorder or mental illness is
narrower than ours. I hope that the Minister will tell us what note has
been taken of the experience of other countries and why that line has
been disregarded by the Government. I take her point, to a certain
extent, that people have so far not been detained, for some of the
reasons mentioned today. That does not mean that we should waste this
once-in-a-lifetime opportunity to make it crystal clear that this will
not be tolerated in the
future. 6.15
pm The Royal
College of Psychiatrists and others seem to be asking for clarity to
help them in their jobs. The Minister seemed to think that it was
insulting to suggest that they could not do the job already. They seem
to disagree with that and would prefer stricter guidelines, so I do not
think that it is a case of insult. I think that, particularly in a
litigious climate, that they want to be absolutely clear about what is
possible and what is not. They probably also want to safeguard
themselves and rogue members from allegations of social control. The
hon. Member for Bristol, North-West (Dr. Naysmith) pointed out earlier
that any such transgressions should be dealt with by professional
bodies. However, those of us who have looked into
professional regulation will have noticed that it can take a prolonged
pattern of aberrant behaviour before it comes to the attention of the
authorities. One has only to look at the case of Harold Shipman to
realise that malpractice can go undetected for a long
time. Dr.
Naysmith: I think that the hon. Lady is misquoting what I
said. I did not talk about discretions and someone coming before a
regulatory body, but about the high quality of clinical practice that
we should expect and which should be automatically available. I know
that she is making the point that we do not always get that, but it
should not be something that needs to be written on the face of a Bill
that patients will never
see.
Sandra
Gidley: One always hopes that certain matters do not have
to be written down on the face of a Bill, but, sadly, we have seen too
many examples of legislation that has been introduced as a reaction to
problems that would not have happened had every member of the
profession adhered to those high standards. I do not think that this is
the place for that debate. However, I acknowledge his point.
This morning, the hon. Member
for Tiverton and Honiton (Angela Browning) described how people with
autistic spectrum disorder can exhibit behaviours that, on the face of
it, can seem quite strange, but which become logical and understandable
in the context of ASD. To some extent, a parallel can be drawn with the
reasoning behind what the House of Lords was trying to do with its
amendments. The hon.
Member for Broxbourne (Mr. Walker) introduced a subject that
I was going to touch upon. I once visited a school where there was a
young man who had autistic spectrum disorder but who was also of
Iranian dissent. There was a practice which involved a very large
stick. It looked as though he was beating himself with it quite
severely. This was alarming behaviour to see in a school. What was
strange was that all the other children were ignoring this child and
the teachers were quite happy for this lad to have the big stick. In
that environment, people understood his behaviour and his problems and
he was quite happy. He did not need treatment, he just needed
tolerance. One can imagine a situation in which that lad grows up into
a hulking great 18-year-old and goes out into the community, which does
not understand the situation, and it is thought that there may be a
mental disorder. In fact, there is not and he should not be treated as
having such a disorder. I cite that as one fairly unusual example,
which, taken in the wrong context and without the safeguards in the
House of Lords Bill, could result in an inappropriate
sectioning.
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