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Lord Tebbit: My Lords, we gave this issue a great deal of thought in the Joint Committee, under the chairmanship of the noble Lord, Lord Carter, and we all agreed that the stigma which is attached to mental illness is still there. I am not against stigma in all circumstances—it can be a very valuable part of the way we live—but it is extremely unfair in the way that it affects people who have suffered mental illness.

As the noble Lord, Lord Carter, said, we considered going to the social model, on which a number of Members of the Committee were very keen. I was less so. I always have echoing in my head on these occasions the words of the late Enoch Powell:

I will leave your Lordships to brood upon that on your way home this evening.

So I was not attracted to that particular way of dealing with matters. I was attracted very much to the concept on which we settled, which virtually amounted to totting up. At the Committee stage, the Minister indicated that perhaps there could be, or should be, the concept of a continuous illness which had episodes with periods of calm in between, and one would then take the whole of the length of episode. I think that that is a very constructive approach—it may well be better than totting up—but we are still uneasy about how it will operate in practice. If the Minister could reassure us about that, it would make it easier for me not to support my noble friend's amendment. Otherwise, I might do so.

Lord Ashley of Stoke: My Lords, I do not agree with the noble Lord, Lord Tebbit, in his assessment of the value of stigma. I think it is wholly bad. However, I support him in the change of concept, which is a possible way forward. A simpler way forward is to accept the amendment because the noble Lord, Lord Skelmersdale, has compromised and is asking for only a small part of what we asked for in Committee. This is a wholly reasonable amendment because depression is the one disability that is made worse by discrimination. That in itself should encourage the Government to be sympathetic. I do not understand their stand because it is illogical. The Bill would be anomalous if they refuse this amendment. I hope that my noble friend will be able to accept it.

Lord Addington: My Lords, I shall be brief. Noble Lords who have been dealing with the Bill have been trying to square the circle on depression. There is clearly discrimination based on preconceptions about what depression means. It is thought that people will not be able to do things. The model that we are using does not fit depression, the most common of mental conditions. I hope that the Government will be able to move some way towards our position in Committee on the amendment of the noble Lord, Lord Skelmersdale. Something must be done. If this is not it, will the
 
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Government give us some assurance about how it will be done? There is a problem and we need to deal with it. This would seem to be the best time to do so.

Baroness Hollis of Heigham: My Lords, this has been a short but moving debate. I welcome the contribution of the noble Baroness, Lady Murphy, who has experience in this area. I wonder whether the division between the Government's approach and that of the noble Lords who have spoken this afternoon is more apparent than real. I welcome the opportunity to clarify the Government's thinking on this matter.

I do not think that this amendment does what it should do. However, there is a problem to be met by a social model or whatever. One only has to look at employment figures to see that people with what we might call quite mild depression have a harder time getting into employment—or back into employment—than people with severe physical disabilities. There is no dispute between us about the degree of continuing stigma associated with depression and the difficulty of addressing it in ways that work within the framework of the DDA.

I shall try to explain our thinking rather more fully than I did in Committee. Clause 17 deals with the definition of a disability. As it stands, this amendment would modify the definition of "long-term" in Paragraph 2 of Schedule 1 to the DDA by extending coverage to people with two or more episodes of short-term depression where the substantial effects of the first episode lasted at least six months and occurred within the previous five-year period. Behind this discussion lies whether those two episodes are the tips of an iceberg—an underlying condition—that have broken water or whether they are unconnected and discrete. For the most part, only a clinician can judge that. That is the discussion between us.

From where I stand, a person might have two instances of depression three years apart—I shall explain circumstances in which that might occur—that would not be evidence of an underlying condition and would not appropriately invoke the protection of the DDA. But a person could have two episodes of depression not three but five years apart that should invoke the protection of the DDA because both episodes are related to the same underlying condition. That is the distinction that I am trying to draw.

The DDA is intended to cover people who are disabled in the generally accepted sense of the term. That is reflected in the current definitions. In Committee, my noble friend described people who suffer short but profound episodes of severe depression. I am not trying to suggest that there is any direct physical analogy, but people can have a severe infection in a broken limb that has substantial adverse effects that do not last for more than a few months. As all of us will know from personal experience, such people may have problems with their employers because of absence records or the need for time off for hospital appointments or physiotherapy. But none of us would suggest that such a situation should come within the framework of the DDA.
 
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The DDA is intended to provide protection where an impairment has recurrent effects. Where an impairment ceases to have a substantial adverse effect on a person's ability to carry out normal day-to-day activities, it is treated as continuing to have that effect if the effect is likely to occur. That is the example given by the noble Baroness; I think that she said that there is a 75 per cent chance of a recurrence within five years. That is exactly the condition that is appropriately picked up by the Bill as drafted. I hope that the noble Baroness agrees with my reading of that. Therefore, conditions with effects that recur sporadically or for short periods qualify for protection under the Act provided that they are part of the same underlying impairment.

As the noble Lord, Lord Tebbit, said, we are not trying to tot up how often the symptoms of the impairment occur. If they occur more than once—or even just once, but it is regarded as belonging to an underlying condition—they are covered. That is the wise way forward. The mechanistic way—for example, doing arithmetic and keeping records of how long episodes lasted; when a patient visited the doctor; what the records say; whether the doctor less than frank about how severe a case was; and so on—is not sensible. Instead, we are taking advice from clinicians. If the episode is indicative of an underlying impairment, the person is covered whether another episode happens in a year, or in five, eight or 10 years, because that person will continue to have a propensity—I am not sure that I am using the appropriate language—and therefore needs to be protected in the situation as described. I think that that is the right approach.

If we take any other approach, we get a different dilemma. At any point in time, about 10 per cent of adults suffer depression. One in 10 new mothers suffers postnatal depression. One in two of those who marry is likely to divorce, which is likely to generate a period of grief or depression. Almost all of us are likely to lose our parents. That produces grief and depression for many of us. Very many of us—indeed, most women—will lose a spouse, often after a period of draining medical care. We should also bear in mind redundancy, bankruptcy and homelessness. All of these events can give rise to periods of quite severe depression. It would be unnatural for a woman who lost both parents within three weeks and a husband a few years thereafter not to grieve and to suffer from depression. But such events would be discrete episodes that could be dealt with by a rest, a good diet, supportive friends or medical support. In no sense would they be indicative of an underlying condition. They would be discrete episodes.

That is why I think that our approach is better. Let us say that someone—perfectly legitimately—suffers from depression as a result of losing a parent, for whatever reason, and then, five years later, loses his job in difficult circumstances and suffers from another period of depression, in the sense that he goes to the doctor saying that he is depressed and so on. Those are discrete, unconnected life events which have hit that
 
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individual hard, but they do not suggest that, in terms of the DDA, he has a "long-term impairment" for which he needs its protection.

We are trying to make a distinction between those separate life events, which we do not think should come within the protection of the DDA, and other episodes that belong to an underlying condition, where we believe the general practitioner is best qualified to guide and steer that person through. It does not matter whether those episodes are one, five or 10 years apart. They belong to the underlying condition and the sufferer will continue to receive protection—and rightly so.

What I am happy to do—and I will seek the noble Baroness's advice on this—is to see whether we need to do anything further to ensure that general practitioners in particular are well aware of the need to draw this distinction as appropriate so that they can give the necessary help. I will talk to the DRC. I am very happy to ask my honourable friend the Minister for Disabled People to talk to the Department of Health to see whether we can do anything further to promote understanding on the issue. But I would hope that your Lordships would agree that the Government's approach is appropriate.

3.30 p.m.


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