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Equally, if we are concerned to uphold the human rights of everyone in the community, not just the person with the mental health problem, then we need a statutory framework that maximises the likelihood of people with mental health problems making a positive contribution to society through work and learning, successful parenting and cultural and community activities, and at the same time minimises the impact of mental disorders on families and the wider community. As we know only too well, mental ill health can have an appalling impact on carers, family and society. Not only are carers at greater risk

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of developing mental health problems themselves and experiencing major social and economic inequalities, but families may also have to face the loss of a loved one when someone with a mental disorder, who has failed to get the treatment and support they need, becomes violent.

Lesley Savage, mother of Daniel Gonzales, who was convicted of killing four people in September 2004, said in her statement following her son’s conviction that the family had made 100 attempts to get help at various times. She said that they could not list every phone call that went unanswered and every contact with a professional who told them they could not help. Daniel had been in contact with support services from his school days up to his conviction at the age of 24. But in all that time he received the help he needed—help that saw him begin to get well—for just one period of six months, between 1998 and 1999. The rest of the time his family was left to fend for itself. His family and the many concerned professionals were failed by a system that his mother describes as under-funded and incapable of providing joined-up care over any period of time.

Secondly, I want to focus on the practical and economic need for this amendment. Current evidence tells us that most people with mental health problems receive too little help, too late. According to Rethink, 50 per cent of people who end up being treated without their consent have previously asked for help and been turned away. Yet treatment that people ask for is known to be much more effective than treatment given without someone’s consent. We know too that most mental health problems go untreated. In 2000, less than a quarter assessed as having a neurotic disorder were receiving treatment of any kind.

The Healthcare Commission recently reported that 51 per cent of mental health service users do not have access to crisis care out of hours. According to figures from the Department of Health, around 10 per cent of five to 15 year-olds have a diagnosable mental health disorder. Of those, 40 per cent are not in touch with specialist services. That is but some of the evidence of a system in crisis, and the resulting human, social and economic consequences are dire. They can be seen not only in reduced life expectancy and the staggering 80 per cent unemployment figure among people with mental health problems but also in the situation of carers who experience poorer health, lower earnings and pensions as a result of struggling without adequate support.

The Sainsbury Centre for Mental Health has estimated that the current system generates a bill of £70 billion a year in costs of compulsory treatment, economic losses and premature deaths. That is how much we currently spend—or, rather, waste—because we have failed to provide support to people with mental health problems when they need it. The solution lies precisely in providing that timely and effective support. In order to ensure that that happens uniformly and that the investment is provided, we must quite simply legislate for it.

There is plentiful evidence that the right to get treatment and support in the critical early phase of illness would have a profound effect on outcomes. As

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the organisation Rethink points out, early treatment has been shown to improve the long-term course of psychosis. It says:

Much research is available, highlighting that investment in early intervention—investment which would be required by this amendment—can deliver substantial economic benefits. For example, my noble friend Lord Layard and distinguished colleagues at the Centre for Economic Performance at the LSE have shown that making effective psychological therapies such as CBT—cognitive behavioural therapy—available to all those who need them would pay for itself in reducing expenditure on incapacity benefits and people being able to get back to work.

We urgently need these provisions if the Government’s ambitious targets in welfare reform, child poverty, health and social care reform programmes are ever to be achieved. I hope the Government will recognise that this amendment is the best way to build on their achievements in mental health services and that it would deliver a powerful legacy in independent living and equality for some of our most excluded and unequal citizens. If we are seeking in the Bill to extend the powers for compulsory treatment, it is essential to balance that with a reciprocal right that people with mental health problems can access treatment and support at a much earlier stage, when they first need it. In that way, the Bill might begin to win their support. I beg to move.

6.30 pm

Lord Williamson of Horton: I support Amendment No. 7 and to shall speak to Amendment No. 55 tabled in my name and that of my noble friend Lady Meacher. These amendments are rightly grouped together as they have broadly the same aim. Indeed, the amendment moved by the noble Baroness, Lady Wilkins, is the Rolls-Royce of these amendments and mine is the Mini, but we are both driving steadily in the same direction.

The purpose of these amendments is to put into primary legislation a right to a comprehensive assessment of the need for support and treatment for those who have or have had a mental disorder and are not in hospital. I draw attention to the fact that the assessment would be the responsibility of the local authority and, I believe for the first time in this form in statute, of the NHS body. The responsible authorities, having regard to the results of the assessment, then have to decide whether the requirements of the person call for services of support and treatment and, if so, to make the necessary arrangements. We think that this is highly reasonable. It is after all not so different from what

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might happen in the case of physical illness. It is a straightforward way of approaching the system, and it can be summed up as meeting the objectives of: get in early, do not wait for compulsion and do not leave a condition untreated. That is what happens now and what we want to avoid in the future.

The Minister will not be surprised to hear me say—and not for the first time—that this proposal is in line with the Scottish mental health Act. If Scotland can produce one Prime Minister after another, I am sure it can produce good legislation as well. In addition to the evident value of assessments, in the case of mental disorder we also believe that it could remove or reduce the number of cases where people are turned away from services when they seek help. We all know that this is a tragedy which happens quite often, and the results are unforeseeable and usually bad. A survey undertaken in 2003 by Rethink—I declare my interest as a patron and long-time supporter—showed that up to one person in four was turned away by services when they or their family sought help.

There are some differences between Amendments Nos. 7 and 55. For example, the proposal by the noble Baroness, Lady Wilkins, has a much fuller statement of treatment and support in subsection (10), while Amendment No. 55 includes a specific provision requiring the health authority and the local authority to give reasons in writing if they do not intend to carry out an assessment. This is intended to avoid an unwanted silence, which as we know sometimes happens in the treatment of mental illness. Amendment No. 55 also specifically refers to the possibility of requests by the person himself or herself, the carer, the nearest relative or an approved mental health professional. It is a little more specific in that respect. However, it is fair to say that if the Government accept the amendment proposed by the noble Baroness, Lady Wilkins, all will be well. If not, and the issue comes back on Report, it is probable that there will be a single amendment and not two, as we have before us today. But the objective, of course, will be precisely the same.

Lord Carlile of Berriew: I support both these amendments. As the noble Lord, Lord Williamson, has said, they aim to achieve the same purpose. In so doing, I should like to reflect for a few moments on my experience when I was a Member of another place. I recall being involved in two non-mental health areas or schemes which were extremely successful. One concerned raising money for a CT scanner to be based in a hospital in the region in which my then constituency was situated. It was what I think the press would call a rather sexy scheme. It was possible to raise the money quickly; it was a large amount of money—a seven-figure sum was put together, and the scanner was installed. Afterwards it transpired that not enough staff were available to operate the scanner at all the times when it was needed. That was a managerial problem which left one feeling a little disappointed with one’s achievement.

The other organisation I was involved with was a truly wonderful place, a children’s hospice of which I

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was a trustee for a time. The hospice in question, perhaps like all children’s hospices, had no statutory funding at the time, but it appealed strongly to the local community. I recall going to one meeting of the trustees on a Saturday morning and being told that we had a serious problem. The serious problem was that we had raised so much money during the previous two months that other charities in the region were complaining bitterly and we had to put a brief moratorium on the raising of funds for the hospice.

I move on to mental health provision. I was at one time involved in the starting-up of a small regional mental health charity which continues to provide services very expertly for a small number of mainly young people recovering from serious mental illness. When it started we were unable to obtain any statutory funding, and when I ceased to be a trustee at the beginning of last year it was still unable to obtain statutory funding and depended entirely on voluntary contributions, most of it raised from families with some experience of mental illness themselves. It was therefore a very different area for fundraising from collecting the money for a CT scanner or for a children’s hospice. That experience confirmed my view, when comparing it with the others I have described, that mental health provision, particularly that for children and adolescents, remains a Cinderella service.

Of course I accept, and no doubt the Minister will tell us, that the Government are doing what they can in many areas to provide better mental health services, particularly for children and young people. But as we heard the other day in what perhaps I may say with respect was an extremely eloquent speech by the noble Lord, Lord Ramsbotham, there are areas, particularly custodial settings, which remain not merely Cinderella areas, but almost completely unclothed. The possibility of those suffering from poor mental health in prisons, especially young people in custodial institutions, reaching the relative ball of a decent child and adolescent mental health ward is still remote, as I am sure the noble Lord would agree.

How do we remedy this? How do we, as a responsible society, show those who are mentally ill and their families that we are really taking this issue seriously? A simple and actually inexpensive way of doing it is to have some kind of charter of rights. What is set out in these amendments, taken together and separately, is in effect a very simple charter of rights. As has already been said so well by the noble Baroness in moving her Amendment No. 7, it represents good value for money. A comparison can be made here with the criminal justice system. In 1996, the Audit Commission produced a memorable report on crime committed by young people. It found that £1 invested in 1996 on preventing crime for young people saved approximately £7 later on, so that is money well spent.

Exactly the same applies to mental health provision. Beds in acute mental hospitals are extremely expensive. When I visited one of the leading psychiatric hospitals in the country, I was told that for the most acute beds—this is at 2006 prices—the

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annual cost was £140,000. Occasionally it was double that because of the intensive nature of the care needed. Were we to have this kind of charter of rights for those suffering from serious mental illness, it is self-evident that we would save money in the long term.

Are there precedents for this kind of charter? For those who are charged with crime, many of whom are guilty—statistically about half of them are found guilty if they contest their cases, and something like 95 per cent are guilty because most plead guilty in any event—we have the European Convention on Human Rights. This is a very simple document, a small pamphlet, which has been incorporated into United Kingdom law by the Human Rights Act 1998. Many of the people who commit crime have full control over what they are doing at the time they commit the crime. Although many are mentally ill, many are not. The wisest, cleverest, craftiest, most devious of criminals understand exactly what they are doing. In the area we are talking about, a very small number of people have a complete insight into what is happening to them. Some do, of course, but many do not. To introduce a charter of rights in this area is the least a civilised democracy should be offering to people who may be suffering from severe mental confusion.

Furthermore, how many people who are sectioned today really understand what their rights are at the time when they are sectioned? I suspect that the true answer is almost none. How many of their families understand what their rights are when they are sectioned? The families become very savvy after a time but, to begin with, the answer is probably virtually none. If we are going to take one opportunity in a generation to introduce amendments to mental health law in this area of serious mental illness, one of the biggest changes we can make, which would be entirely beneficial and would set a new standard for the future, would be to incorporate a short charter of rights into the legislation.

Baroness Meacher: In my view, one of the most cruel injustices in this country is the failure of our National Health Service to provide the same level of assessment and treatment to people with mental disorders as we take for granted for those with physical illnesses. This injustice, of course, affects both primary and secondary services. Either of Amendments Nos. 7 or 55, by providing a right to assessment, treatment and support for people with mental health problems in England and Wales, could ensure that progress is made to put right this wrong.

If we go to our GP with physical symptoms, whether a skin rash, breathing problem or pain, which our GP is unable to treat effectively, we can expect to be referred to a specialist for a skilled assessment and appropriate treatment. If, however, we go to our doctor with depression or anxiety, which may cripple our lives—these are not minor matters; they can destroy our family relationships, our friendships and our capacity to work and, indeed, may ultimately lead to suicide—we may be turned away with little or no help. Only one in four of those who suffer with depression or chronic anxiety is receiving any kind of treatment.

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This failure to treat is not only a waste of people’s lives, it is also costing a lot of money to employers and taxpayers, as has already been indicated. Many people with mental health problems are in work but their productivity is much lower than it needs to be. Employers are paying huge sums of money in sick pay for people who could work with a small amount of help. A million people are not working at all and are receiving incapacity benefits because of mental illness.

6.45 pm

One of the reasons for this costly and cruel state of affairs is, perhaps, that until recently we had little confidence that the treatments available could transform the lives of so many people. Now we have evidence-based psychological therapies that we know lift at least half of those treated out of their depression or chronic anxiety. We tend to think of psychological therapies as going on for years, but the new therapies are short-term, forward-looking treatments that enable people to challenge their negative thinking and function effectively. These therapies are supported by NICE guidelines, but those guidelines are not being implemented due to a lack of resources devoted to therapies within the NHS. Either of the two amendments would provide the impetus needed to ensure the implementation of the NICE guidelines.

We are not seeking an overall increase in government spending—far from it. Money spent on evidence-based psychological therapies will pay for itself, as the noble Baroness, Lady Wilkins, indicated. Evidence-based psychological therapies cost a mere £750 per person. This would be fully offset if, on average, incapacity benefit claimants worked for just one month as a result of a treatment. The productivity of those in work would improve; the tax take would be enhanced; the numbers who finally break down completely and need costly in-patient care would fall; and, most importantly, millions of people would be healthier.

I want to focus on the significance of the amendment for people with more severe mental health problems. A major concern expressed by the Royal College of Psychiatrists and others is that the Bill will add to the number of patients under compulsion and will thus take away resources from voluntary patients. The college, rightly in my view, fears that mental health services will be directed away from services such as early intervention, assertive outreach and other developments which are designed to reduce the need for compulsion.

The Government have begun to change the focus of the psychiatric services through the national service framework. The new early intervention teams and the idea of bringing psychological therapies and other help to young people in the early stages of a developing psychosis are the right way forward. But these teams are not yet fully developed; trusts have not devoted sufficient resources to this crucial area of work. The result in my own area, the east end of London, for example, is that generally no help is provided until the young person has had a psychotic breakdown and

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already has been detained in hospital. Surely this is already too late. That young person’s life will never be the same again with the stigma of a psychiatric admission on their record, and the use of a costly in-patient bed could perhaps have been avoided with earlier help. By making it less likely that resources will be devoted to early intervention, the Government are undermining their own excellent policies.

Section 117 of the Mental Health Act 1983 imposes a duty upon the primary care trust or health authority and upon the local social services authority to provide aftercare for people who have been detained in hospital under a six-month order. These authorities have no duty, on the other hand, to provide help to those people in the early stages of their illness. As the noble Baroness, Lady Wilkins, noted, Rethink has established that 50 per cent of people who end up under a detention order in hospital had asked for help and been turned away at an earlier stage when they could have co-operated with treatment and remained at home. This makes no economic sense and it is cruel to the individuals affected. Yet the amendment Bill repeats the pattern. It envisages compulsory treatment in the community, again for people who are under a six-month detention order. But again no duty is envisaged to offer treatment to prevent the trauma and cost of a full breakdown and hospital detention.

Either of these two amendments would support all the principles espoused by the Government’s own Social Inclusion Unit. They would uphold the principle of the least restrictive alternative, encourage preventive care and early intervention, reduce dependence on medication, support carers and combat unemployment. Either amendment deserves the Government’s support.

Lord Soley: I come to Amendment No. 7 from a very different position from those we have heard about so far. I have heard the arguments about patients’ rights, and I agree with those. I have a history of supporting patients’ rights, and I will go on doing so. One of the things that make this area so incredibly difficult to legislate on, however, is that there is a balance of rights. Rights are not a one-way street. There are also the rights of the people immediately affected by the patient and the rights of the community in which they live.

I shall say a little more about that, not only because it is relevant to the nature of this clause, but also in the context of my criticism that the Government’s approach on this does not go far enough. We are not facing the difficult question of what you do when an individual, whether through a personality disorder or other problems, is frightening and difficult for the community to deal with and yet there is no willingness to treat them. That is what this is about.

I want to take the Committee back a bit. I touched on this when I made a relatively short contribution on Monday. In the period prior to the 1959 Act, our hospitals acted in a way as containment centres.

Lord Hunt of Kings Heath: I think the noble Lord is speaking to the next amendment. The amendment

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we are discussing at the moment is on the issue of the provision of services, not the issue of treatment.

Lord Soley: My apologies if that is right. I was reading Amendment No. 7 and some of the subsections of the new clause deal with treatability. Is that not right?

Baroness Royall of Blaisdon: This amendment is about rights to support and treatment.

Lord Soley: My noble friend is absolutely right. I apologise; I was looking at Amendment No. 7.

Baroness Murphy: If the speech of the noble Lord, Lord Williamson, was a Mini, and that of the noble Baroness, Lady Wilkins, a Rolls-Royce, mine will be a tricycle. I was just beginning to agree with everything the noble Lord, Lord Soley, was saying. I am disappointed that he stopped.

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