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Baroness Ramsay of Cartvale: I made clear--though obviously not clear enough--in my opening remarks on this amendment that one of the reasons why the Government do not favour the Bill is that we do not favour piecemeal changes to a complex piece of legislation such as the Mental Health Act. In our view, significant changes should be made as part of a review of the whole Act. I confirmed to the Committee that we are considering the need for a review of the Act and in doing so will take account of the views of all interested parties.
Lord Rowallan: I am delighted to hear the noble Baroness indicate that the Government are giving this matter very serious thought. After all, it is an extremely serious matter. There are an enormous number of mentally ill and mentally handicapped people, as my noble friend indicated, in the world today. However, we cannot wait, as was suggested at Second Reading, until 2004 or 2010. Something needs to be done much sooner.
I am delighted that the Minister's right honourable friend is looking at the matter seriously and carefully, but legislation is required now. Mental health has always been the Cinderella service, historically under-resourced and neglected. Many patients remain in anti-therapeutic and wholly unacceptable environments. The law compels many patients to reside in such places and therefore the law should offer protection for those to whom its sanctions apply. Primary legislation is necessary now; we cannot wait for a new Act.
As I am sure the noble Lord, Lord Alderdice, agrees, morale in the profession is rock-bottom. Recruitment is falling. Professionals elect to take early retirement, in part because they cannot bear the working conditions. Section rates are increasing year on year, partly because patients fear hospital admission and because of the disturbed anti-therapeutic environment which exists. Because of the Bournewood ruling, more and more people are liable to be put into necessary 24-hour care.
We cannot wait any longer. It is for that reason that I have introduced the Bill in the hope that, although it does not embrace the whole problem, we can sort out a small part of it. In-patient care is only about 10 per cent. of the problem, 90 per cent. relating to care in the community and out patient care. If we can sort out this small part of the problem first, we shall at least be doing something to help those who are afflicted by this terrible illness and for whom, unless we do something, there is not much hope.
On Question, amendment agreed to.
Clause 1, as amended, agreed to.
Clause 2 [Privacy and physical security for in-patients]:
Lord Rowallan moved Amendment No. 2:
The noble Lord said: Again, as a result of Second Reading, it became obvious that not only women but also the young were in danger and required single-sex ward areas. The young often find themselves in the very unsavoury position of being next to an adult who poses a danger to them. It can be a very frightening world for the young in a mental ward. I have seen it and it is not something I would wish on anyone. All the main mental health charities support this clause and the amendment.
Keeping the young in a safe, therapeutic ward area can only help them if they are in an area separate from adults. It is our duty to ensure that young people suffering from mental illness have every opportunity to recover from their illness. The amendment seeks to do that by giving them the same chance to enjoy a therapeutic environment as adult women and men in which to receive the care and attention which they so desperately need in order to recover. I beg to move.
Lord Alderdice: I first became aware of the difficulties faced by young people as in-patients in psychiatric units when in Northern Ireland in the early 1980s no psychiatrists were specifically allocated to deal with the problems of adolescents. It was not hard to see why that was the case. The key thing about being a young person is that it is time-limited. After a few years one grows out of being a young person and becomes an adult, who may be just as disturbed or even more so but for whom responsibility moves to different authorities.
I may say--I take some encouragement from this--that when we were enabled to debate the matter in the Northern Ireland Assembly, which had no legislative powers but simply gave us the opportunity to debate matters, within a short time there were changes because it became a matter of public concern and an adolescents' psychiatry unit was established.
A number of developments have created further anxiety in this regard. First, as I mentioned, as more people are being cared for in the community, the concentration of increasingly disturbed people within psychiatric units has increased and made them more difficult places in which to work for staff and in which to be for patients. That is particularly a problem for young people.
Secondly, in recent years we have become aware that many young people develop psychiatric difficulties not least because of abusive experiences that they have suffered. That was something with which we were less familiar a number of years ago but we are becoming increasingly familiar with the fact that many young people become profoundly disturbed in their behaviour and in themselves because of abusive experiences early in their lives. Indeed, when young people cut themselves, overdose and in other ways attempt to damage themselves, we now always pay attention to the possibility of abuse and particularly of sexual abuse.
Many young people who become disturbed and are taken on for treatment can be dealt with in an out-patient context or in day-patient facilities. But it is commonly the experience of those working with such young people that a period of containment is sometimes necessary in order that the work with them can continue. Sometimes it is only for a short time--perhaps a few days--but it is nevertheless critical to the work with a young person.
As I said, many of those young people have experienced sexual or physical abuse from adults. They find themselves frequently--I say this not out of speculation, but out of my certain knowledge--having to be admitted to relatively secure facilities in which there are adults who in some cases have perpetrated violent or sexual abuse. Of course there may be concerns as to whether some repetition of the experience may occur, but even setting that to one side, how can one believe that it is not disturbing for a young person who has experienced such abuse and been so disturbed by it that he or she needs psychiatric treatment and who, during that treatment, has become sufficiently disturbed to need to be admitted to a containing atmosphere, to find themselves contained in precisely the same context as those who, with other young people, have been the perpetrators of abuse? They may be perpetrators for a whole series of reasons that we may or may not understand; that is not the point. It is clearly profoundly antitherapeutic.
I appreciate and find encouraging the fact that the Government are looking at these matters. It was suggested that it is not appropriate to deal piecemeal with them but that we need something that is broad-ranging. I accept that there is force in the Minister's argument in that regard. However, is it appropriate that young people should have to wait for a number of years for all the manifest and manifold problems of the service to be addressed and all the different legal requirements to be dealt with? Is it appropriate that they should have to wait or is it the case that, even if the Government do not allow this Bill to pass through the other place, some kind of regulation may be introduced to ensure that young people, particularly disturbed young people, are not continuing to be cared for in a context that is profoundly, and obviously, not in their best therapeutic interests.
In advance of the Minister being able to give us such enlightenment, I strongly support the amendment. I look forward also to seeing whether the Minister can find some other way in which the Government, through
Earl Howe: Once again my noble friend presented the argument for the amendment most cogently and I support him. The need for separate in-patient facilities for young people is important for two reasons. The first is that young people, especially if they have been abused, need protecting from those who may be potential abusers. That is a principal reason and the noble Lord, Lord Alderdice, laid out that argument clearly.
The second is that early diagnosis and early treatment are essential to a successful outcome in cases of severe mental illness. Where a youngster suffers mental trauma, breakdown or something of that kind and needs to go to hospital, the process of treatment and recuperation is immeasurably assisted if the environment in which care is delivered is as conducive as it can be to recovery. The proximity of disturbed adults in a ward where a youngster first arrives to be looked after can pose an unhelpful barrier to the adjustment which that youngster needs to make if he or she is to be given a better chance of being successfully treated.
I hope that the Minister is able to accept at least the principle of the amendment, which addresses itself to the needs of some of the most vulnerable of mental patients, and can give us cause to hope that action will be taken to provide facilities of the kind the amendment seeks to promote.
Lord Swinfen: Although I support the amendment, I wish to ask the Minister a question in relation to line 27 where the provision states,
Does that mean that it will not be necessary in new psychiatric units? It may be that at Report stage we will need to remove the word "existing" from the Bill. Perhaps the Minister will consider the point.
Page 1, line 25, after ("units") insert--
("( ) the provision of in-patient facilities for young people, separate from those for adults;").
11.45 a.m.
"the fitting of appropriate security devices to all room and ward doors in all existing psychiatric units".
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