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Lord Triesman: My Lords, I suspect that the fact that a large number of people are being held by the Israelis is not helpful to the peace process. I have said that from this Dispatch Box in the past. With reference
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Lord Howell of Guildford: My Lords, the noble Lord, Lord Steel, is right that the attack on Hezbollah by Israel to recover the three soldiers was particularly inept, and that several people have resigned, recognising that it was badly managed. It has left Hezbollah possibly as powerful as ever and still trying to undermine the Government of Lebanon directly.
The Minister said we are helping the Lebanese Government and Mr Sinora. Would he say how we are doing so? They are under considerable pressure from street violence by those who are attempting to overthrow a democratically elected Government.
Lord Triesman: My Lords, we are helping in a number of ways. We are strong supporters of the United Nations force that is attempting to clear paramilitary and militia detachments from parts of Lebanon, which is not easy; we well understand the extent to which they are embedded in that part of the country. We are trying to ensure that there are discussions among the factions in Lebanon to try to produce a means of sustaining the Government of Lebanon. But, first and foremost, we are trying to ensure that the route map for the Middle East peace process is resuscitated. Without that happening, I doubt we have the preconditions for anything else to succeed.
Business
3.24 pm
Lord Grocott: My Lords, with the leave of the House, a Statement will be repeated this afternoon on force levels in Afghanistan. It will be repeated by my noble friend Lord Drayson, and we will take it at a convenient time after 3.30 pm.
Local Authorities (Contracting Out of Anti-social Behaviour Order Functions) (England) Order 2007
Baroness Morgan of Drefelin: My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the draft order laid before the House on 9 January be approved. Considered in Grand Committee on 21 February, 5th Report from the Statutory Instruments Committee and 8th Report from the Merits Committee.—(Baroness Morgan of Drefelin.)
On Question, Motion agreed to.
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Mental Health Bill [HL]
3.25 pm
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move that the Bill be now further considered on Report.
Moved accordingly, and, on Question, Motion agreed to.
Lord Williamson of Horton moved Amendment No. 25:
In the case of an application for admission for assessment and treatment for a mental disorder, whether voluntary or not, in the case of any child or young person under the age of 18 years, a clinician with specialist training in child or adolescent mental health shall assess the needs of the child or young person and a PCT or equivalent health board shall provide for such services and accommodation as are sufficient for the particular needs of that child or young person.
142B Medical assessment by a CAMHS specialist prior to imposition of compulsion for a child or young person
In the case of a minor under the age of 18, who is admitted for assessment under section 2 or admitted for treatment under section 3, one recommendation as specified in these sections shall, except in an emergency where no child or adolescent mental health specialist is available, be made by a qualified child and adolescent registered medical practitioner.
Wherever under any provision of this Act a responsible clinician is to be appointed if the patient is a minor under 18 that clinician shall, except in an emergency where no child and adolescent mental health specialist is available, be a child and adolescent mental health specialist.””
The noble Lord said: My Lords, as this is the first amendment I have moved at this stage of the Bill, I should like to say that I appreciate the efforts the Minister has made to respond to the many points which rained down during Committee. I think we can say that there are at least some rays of sunshine—I hope we will see them on this amendment and on others. The Minister knows, however, that I and other noble Lords who have put their name to the amendment attach much importance to it, which concerns children and young people exclusively.
The first part of the amendment deals with the requirement to treat children and young persons under the age of 18 in a way appropriate to their needs. The public might think that this is so self-evident that we should not have to debate it on the Floor of the House. However, we know that despite the very great improvements in mental health care and services in recent years, in practice children and young persons with mental health problems and disorders are not always treated in an age-appropriate setting. My noble friend Lord Patel of Bradford gave some shocking examples when he spoke in Committee, and the very recent report by the Children’s Commissioner, entitled Pushed into the Shadows, has some more.
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In presenting this Bill, the Government have given Parliament the right opportunity to improve the present situation for children and young people. We know that many mental health problems come about in the teenage years and that the best assessment and care at this time and the confidence of the patient in his or her treatment can give longer-term benefits, and perhaps help to reduce the revolving-door phenomenon under which mental health patients go in and out of hospital, which it is one of the Bill’s objectives to reduce.
More specifically, the amendment requires first that for children and young persons under the age of 18, when there is an application for admission and treatment for a mental disorder, there should be an assessment by a medical practitioner with specialist training in child or adolescent mental health; and secondly that the health authority or equivalent health body,
- “shall provide for such services and accommodation as are sufficient for the particular needs of that child or young person”.
We find this quite appropriate to the Bill, as did our Scottish colleagues when they included the same words in Section 23 of the Mental Health (Care and Treatment) (Scotland) Act 2003, thereby setting an excellent precedent.
We recognise that in proposing including the appropriate treatment test in the criteria for detention, the Government have recognised that there is a problem and sought to provide a partial remedy. To that extent, there is common ground between us. But the effect could be that if the primary care trust did not provide care in a CAMHS unit and an adult unit was deemed not safe, the child or young person could not be detained and would not get the place of safety which might be necessary. Nor does the Government’s approach deal with children or young people to be admitted on a voluntary basis. Our approach is more direct and, in our view, more reliably effective.
3.30 pm
At an early stage, the Minister indicated that it is not appropriate to put services on the face of the Bill. We are frankly baffled by that argument. As a former civil servant, I feel tempted to say that it must have been invented by a civil servant. The Mental Health Act, as amended by this Bill, is littered with service provisions, which is a good thing. As Rosie Winterton, the Minister of State, made clear on 30 January in the all-party parliamentary group: “This Bill is about making sure that people get the care they need”. Good for Rosie. In any event, in this amendment we are not talking about a newly differentiated group of people, such as market gardeners, asylum seekers or circus artists, but proposing an amendment for children and young people. In almost every sphere of our society we differentiate services for children and young people—for example, children’s hospitals, school buses, young offender institutions, the Children Act and so on.
The two remaining parts of this amendment are complementary to the first. They deal with medical assessment by a children and adult mental health
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Finally, despite the Government’s good intentions, which we recognise, neither the code nor the Government’s policy guidance has protected the children who have been admitted to adult wards in past years and we are not convinced that a reiteration in the code will make much difference, which is why we invite the Government to put this provision in the Bill. I beg to move.
Earl Howe: My Lords, I cannot better the case put forward by the noble Lord, Lord Williamson, in favour of this amendment, but I should like to express my firm support for it and to add some emphasis to a number of the points that he has so ably made. I begin by saying how much I endorse his arguments in favour of an age-appropriate setting for children and young people under the age of 18. This seems a classic example of a win-win amendment. We are all aware of real horror stories involving children who are sent to adult wards for treatment, and who are then molested and traumatised by adult patients. The experiences endured by young people in such circumstances are often terrible.
However, it is not only those horror stories that this amendment is about. It is about that central, key issue which has surfaced and resurfaced throughout our debates on this Bill; namely, that fear of the mental health care system engendered by traumatic experiences of whatever nature carries with it the potential for wholesale disengagement from mental health services in the future. The moment we see that happening—it happens often—there is only one consequence. The child or young person will not wish to seek help from anyone—they are turned off. They will hide their symptoms and carry on in a state of acute mental distress until they have reached crisis point. The irony is that having reached that crisis point, they are more likely to be treated under compulsion—so the trauma repeats itself.
The acuity of need among some young people carried over into adulthood is a cause for grave concern. Recent research has shown that almost 78 per cent of adult service users receiving intensive services had received a diagnosis before the age of 18; 60 per cent had received such a diagnosis before the age of 15. Those figures underline the importance of making sure that children and young people with mental health problems receive the services that are appropriate to their needs and which make them want to trust and use those services in the future if they need to.
The Minister may well fall back on the standard response by saying that this is an amendment about service provision, but I hope he will see that it is not just about that. It is about doing the thing that Ministers have repeatedly said that they want this Bill to do; namely, to make sure that people get the care they need when compulsion has to be used. The Minister said in Committee that it was difficult to
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Nobody doubts the Government’s sincerity in wanting to see better mental health services for children and young people. We hear the right things being said, both in the code of practice and the children’s NSF, but we know from the royal college, the Children’s Commissioner and the noble Lord, Lord Patel, in Committee that neither policy guidance nor the code has delivered the desired results. Good practice is, regrettably, not the norm.
Research published in the BMJ shows that more than one-third of all young people admitted to hospital for a mental illness are admitted to a general psychiatric or paediatric ward. Something more needs to be done. We know that the implementation of standard 9 in the NSF is receiving what the Minister, Ivan Lewis, called unprecedented priority, and that resources are being put into that whole area with the aim of solving the problem over the next two years. That is what Mr Lewis has said—and, if it is so, there really should be no argument about giving statutory backing to the notion of an age-appropriate setting. For once, we are not faced by funding constraints, because the funding has already been allocated, so I hope that the Minister will be receptive and sympathetic to everything that the noble Lord, Lord Williamson, argued for.
Baroness Meacher: My Lords, I begin my brief remarks with an acknowledgment that the Government’s injection of funds into the health service over the past seven years has enabled some very significant improvements in in-patient services for children and young people. In east London, where I am the chairman of a mental health trust, we opened last year a purpose-built and beautiful new unit for children and young people, with 15 in-patient beds and six day places. We are very proud of the service that we can now provide, but my staff tell me how incredibly lucky we are. They are appalled at how children are treated up and down the country in places where, sadly, boroughs and trusts do not have the facilities that we have.
The reality is that the number of general NHS CAMHS beds has increased by only 4 per cent between 1999 and 2006. The result is that many areas still admit children and young people to adult wards and rely on the private sector, where the young person may be many miles from home and the cost may be exorbitant. Until last year, we were in that position; we were placing children from the east end of London down in Sussex or Berkshire. Noble Lords can imagine how often parents could visit those children—and there was no chance of the children coming by day, which is very important for some categories of disorder, such as anorexia.
We know from the Children and Young Person’s Inpatient Evaluation Study of in-patient care for eight to 18 year-olds that in-patient care is effective for very severe levels of disorder. In some of these cases, we
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In supporting this amendment, I am mindful of the conclusion of the Department of Health’s Every Child Matters report that CAMHS,
- “should expect to achieve by the mid-point of the NSF cycle the elimination of the use of adult wards for all but a few older adolescents who find themselves associating more readily with young adults”.
This amendment seeks only to ensure that sufficient priority is given to achieving the objectives set out in the Government’s own report.
The Minister for Care Services, Ivan Lewis, agrees with us. He said that,
One of the central tenets of medicine is that health services should not do harm. But the Children’s Commissioner, Professor Sir Al Aynsley-Green, said he feared that children could be more damaged than helped by the experience of being on an adult psychiatric ward. As someone who makes a point of regularly meeting patients and staff on adult wards, I share that view. The reality of adult in-patient wards today is that staff are managing in-patients with ever more serious and complex psychiatric disorders. Anyone who can be managed in the community is managed by one of the community teams, even if that involves daily visits—three or four visits a day—and hours of every day being spent in that person’s home. The result is that any in-patient is likely to be severely disturbed. You do not have the sort of balance that you had 10 years ago where you had a number of reasonably stable patients and others who were a bit more disturbed. Today, everybody in those wards is a severely disturbed person. Thus, it is ever more urgent to avoid children and young persons being placed in a highly volatile adult in-patient environment.
In Committee the Minister suggested that the Mental Health Act was concerned with the legal processes around mental health and that:
“It is much more difficult to move on from there to specifying services to be provided to a certain group”.—[Official Report, 15/1/07; col. 559.]
In fact, proposed new Sections 142B and 142C in the amendment refer exclusively to detained young people. The Bill is very clear about who will be involved in the assessment of adults under the Act. It seems entirely in keeping with the spirit of the Bill that it should specify that appropriately qualified clinicians must be involved in the assessment of young people. Proposed new Section 142A refers to voluntary patients under the age of 18. In view of the seriousness of the consequences of inappropriate placement of these young persons, it seems reasonable to extend the scope of the clause as proposed. I hope that the Minister will give the amendment sympathetic consideration.
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Lord Northbourne: My Lords, I support the amendment. Noble Lords who spoke made the case clearly. It seems to me absolutely incredible and shocking that vulnerable children are put in the very highly disturbed atmosphere of an adult ward. I hope that the Minister can encourage us to think that that will not happen in the future.
Baroness Walmsley: My Lords, I wish to make it quite clear that these Benches support the amendment. Such was the enthusiasm of your Lordships for the amendment that there was no room to add my name to it, but these Benches enthusiastically support it.
The British Government are a signatory to the UN Convention on the Rights of the Child, which states that,
- “every child deprived of liberty shall be separated from adults unless it is considered in the child’s best interest not to do so”.
I know that the Government are doing their very best to implement that responsibility. In fact, great progress has been made within the criminal justice system to do that. We also know that it is the Government’s intention that children should be in age-appropriate settings when they have mental health treatment.
Like the noble Earl, Lord Howe, I am relieved to be able to support the amendment without having to make any additional spending commitment. It is clear from Ivan Lewis’s statements that the Government have earmarked the necessary resources to go that step further so that no child will need to go into an adult ward in future.
If we needed any proof that this amendment was necessary, we have only to read the report of the Children’s Commissioner, to which reference has been made. The Minister says that the amendment seeks to enshrine good practice in the Bill; the Children’s Commissioner’s report makes it clear that that is necessary.
3.45 pm
Baroness Murphy: My Lords, I have added my name to the amendment. I do not want to speak further about the humanity behind it because I think that almost everyone in the House is agreed on that and it was well exposed today. I want to talk about the practicalities.
I know that the Government are concerned about amendments that dictate how services should be provided and about the possible extra cost that might suddenly be imposed. In reality, however, we have imposed special legislation for, for example, high-security patients, maternity services and cancer services, so there is absolutely no reason why we should not dictate what services are necessary.
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