Mental Health Bill [HL]

My Lords, as the Minister said, the Government are making enormous strides in the development of mental health services. They are spending £1.25 billion more on mental health services now than in 1999, an increase of more than a quarter. Most importantly, access to mental health services is improving with the provision of new outreach teams and crisis-resolution teams aimed at providing care in patients’ homes and early intervention. Outcomes for people are beginning to improve and suicide rates are the lowest since records began. It is completely appropriate for the Government to be concerned to get the balance right between public safety and patients’ rights to mental healthcare and to endeavour to update mental health legislation to keep pace with the growth of modern community-based patient services. I think it was UNISON that, in its briefing on the Bill, said, "““progress towards reform of the Mental Health Act 1983 has hitherto been arduous””." Members of your Lordships’ House who have taken part in the debate so far have echoed those sentiments. It has been a long road that has brought us to this point. As this is going to be an involved debate, I shall not focus on areas that I know others are likely to cover. However, I would like to add my voice to concerns about the question of treatability by having a broad definition of mental disorder and a wide definition of treatment. I am concerned about the ethical position with regard to the use of treatment without specific or potential benefit to the patient for the purposes of control. I understand that there is a balance to strike in the interests of public safety, but I do not yet understand the safeguards in the Bill well enough to put my mind at rest in this regard. I am also concerned about the detail underpinning the new community treatment orders, particularly issues about the nature of the conditions of residency and behaviour as well as questions about information sharing and confidentiality. Are we, for example, going to involve landlords in the making of these orders? Will neighbours be aware of these orders? A lot will depend on the trust that we place in mental health professionals to supervise the orders fairly and effectively. I want particularly to focus on the missing word ““advocacy””, to which the noble Lord, Lord Rix, has already briefly referred. Advocacy is key to promoting the rights and needs of those detained under mental health law. In a mental health context, an advocate is someone who supports another person in expressing their views and concerns; who helps to access information and services; who defends and promotes their rights, and explores choices and options. An advocate can reduce a person’s anxiety and promote a constructive relationship between the service user and the psychiatrist. Being detained under mental health legislation can be an overwhelming and distressing experience. The support of an advocate can help service users to negotiate the complicated mental health system. For people in crisis who may feel that they have little control over what is happening to them, an advocate can be an invaluable source of support, representation and information. Experience shows that the early and ongoing support of advocates reduces the need for admission to hospital and involvement with other agencies such as the courts and homelessness services. Advocates can help by limiting the escalation of financial, housing, personal and medication problems. During episodes of hospital care, tensions can be eased, misunderstandings resolved and a constructive approach to recovery established through an advocate. As a result, the use of compulsory powers can on occasion be more short-lived and patients may be less fearful of compulsory care. The Government have a duty to promote race equality and reduce racial discrimination underthe Race Relations (Amendment) Act. It is well documented that people from black and ethnic minority groups have a significantly worse experience of mental health services. They are more likely to be treated under the Mental Health Act, to be sectioned, to receive higher doses of medication, as well asbeing more likely to be restrained or secluded while in compulsory care. I believe that introducing a statutory right to independent advocacy would be a positive step in promoting race equality and reducing discrimination. For example, an advocate can improve communication and the flow of information between parties, ensure that social, cultural and racial factors are appropriately considered during the consideration of care and treatment options, and ensure that the rights of the service user are upheld. Having access to an advocate can save time and even costs spent on tribunals and appeals because conflicts can be resolved without recourse to legal action. As I understand it from the charity Mind, there is also emerging evidence that advocacy is linked to a reduction in cancelled tribunal hearings, suggesting that advocacy can reduce hold-ups in the system and improve efficiency. The Government have decided not to include a provision for advocacy services in the Bill. I want to question the merits of that approach, particularly as I understand that the Government are looking very seriously at how advocacy services can be improved and made more accessible. The Joint Committee on the draft Bill, to whose members I pay tribute for their amazing work in considering the proposals, came up with strong and thoughtful recommendations on advocacy. The Joint Committee said that there should be a duty in the Bill to provide independent mental health advocates to meet the reasonable requirements of patients as soon as any statutory procedure is commenced. It went further, recommending that there should be a duty to ensure independent advocacy for all patients with a mental disorder who should have an opportunity to use such services right from the start of an initial examination. The Government responded positively to the committee’s recommendations, saying that they are keen to ensure that patients are given adequate support at all times when the new legislation is in operation. There was even talk about how codes of practice should be used. But now we find that there is no mention of advocacy in the Bill. This, as I am sure noble Lords will agree, is a missed opportunity that could easily be put right. As I understand it, staff are very supportive of the idea of working with advocacy organisations. There are many parts of the country where best practice is already established. I am particularly concerned that advocacy services should be made available to people who are being considered for community treatment orders with conditions to which I have alluded. Such conditions, if breached, can put someone back in hospital; they can affect where people live and their behaviour. Would they, for example, cover how loud someone’s music should be played? Surely a vulnerable person in this situation is extremely likely to benefit from automatic access to an advocate. If the Bill is to be a progressive strand in the Government’s already successful mental health strategy, perhaps the extension of control should be matched by the introduction of new rights of access to independent advocacy for the most vulnerable members of our society.