Mental Health Bill [HL]

My Lords, I am sure that the whole House has listened with enormous interest to the Minister’s very clear explanation of the somewhat complicated contents of this important Bill. As I listened, I found myself reflecting that occasionally, though mercifully not often, legislation is clearly needed but it is difficult to know precisely what changes to the law should be made or even what the alternatives are. This Bill is an example of that. It has a long history: seven years of careful and skilled consideration, including two previous draft Bills, two reports and much consultation. Yet there is still considerable anxiety and disagreement about whether what the Government are now proposing is right. Unlike a number of noble Lords due to speak later in the debate, who know a great deal about the subject matter of the Bill—I have a former Secretary of State for Health sitting beside me, which is somewhat unnerving—I am a complete layman in these matters. I have not been formally involved in the previous consideration of the Bill, but I have a particular interest for three reasons. When, many years ago, I served as the chairman of a medical research ethics committee, we had within our area of responsibility a large hospital for people with severe mental health problems. Inevitably, some research proposals that came before us, such as trials of certain drugs, could be carried out only by involving patients in that hospital—patients unable themselves to give their assent to participate. The committee gave each proposal careful consideration, centring on the potential benefits for such patients of the drug, the safeguards and issues of assent. Difficult decisions had to be made, but I believe that they were not entirely dissimilar from those that have to be made on this Bill. I have a personal interest in the Bill because of contact with mental disorder problems through cases among my own friends and family. I am sure that I share that experience with many other noble Lords. I do not believe that that contact is at all irrelevant to our discussions. I am interested in the Scottish dimension to the Bill. It applies mainly to England and Wales, but there are cross-border arrangements in Schedule 5, under Clause 32. In addition, the Minister touched on the fact that the Scots Parliament has recently legislated on these matters and useful comparisons may be possible. Quite a lot of the Bill is completely incomprehensible without the Explanatory Notes, due to how it is drafted in terms of amending other legislation. Having read the Explanatory Notes, I should like to make one general point on what lies at the heart of the main provisions of the Bill. I refer to rights—those of patients, children, their families and the rest of the community. The briefing I have seen—some of which I received only an hour or two ago—and the problems met by predecessor Bills centre mainly on deep anxiety about the rights of patients and of those suffering from a mental disorder, and what the Government propose for them. That is not surprising. This is, after all, a health Bill; it is about patients and of course Parliament must take those rights very seriously. It is always when the most vulnerable appear threatened that Parliament must be at its most vigilant. We must be very careful in our considerations. Other people have rights, too, not just the most vulnerable. Parliament exists to protect the rights of all people and to balance them when they conflict. It is so easy, in our concern to protect those who cannot protect themselves, to forget the major threat those self-same people can be to others in certain circumstances, as well as to themselves. The court cases which have been discussed often in relation to the Bill illustrate this graphically and disturbingly, as did a moving article which some of your Lordships may have read in the Observer two Sundays ago. The father of a 17 year-old with schizophrenia described in simple, factual, unemotional detail how the system as it exists, operating with the best will in the world, handled the young man and his family, to the young man’s great danger and suffering, and who knows what fate. The status quo will not do—the Minister has said that. It must be wrong in extreme cases, in the name of rights and freedom, to allow someone to fail to take his medication if that means he becomes dangerous to other people or to himself. It must be wrong, too, in the name of rights and freedom, to allow someone with a caring family to become homeless, unprotected and out of that family’s reach. It must be wrong, in the name of rights and freedom, to forget that sometimes, for some people, compulsory detention is salvation. Subsequent treatment in the community, if it can be made to work, may be able to be designed so as to be a salvation, too. My simple point—your Lordships may think it is too naïve but I believe it is important—is that, as we work our way through these proposals, it must be possible to maintain a proper balance of consideration. This may be a health Bill about patients but it is also about families, friends, communities and public safety. The problems confronted by the Government in the Bill are difficult but they are real problems; they affect the freedoms and rights not only of the weakest but of us all. At the same time, let us remember that the system as it is cannot continue.