Mental Health Bill [HL]

My Lords, I am more than happy to follow the noble Baroness and her call for advocacy. In a Bill where civil liberties are to be removed, we must make every possible effort to make sure that individuals have that right. It is a point made by many in the Mental Health Alliance. I do not think that anyone has so far paid tribute to the alliance. There was a time when 77 organisations coming together with a shared voice to articulate the needs of that group of patients so often overlooked within our health services would have been unthinkable. I warmly commend its work; I admire and respect all it has done, even though my conclusions are not entirely those of the alliance. I am sorry that the noble Lord, Lord Rix, is not here. My own background was in the subnormality world. As a girl, I looked after subnormal children—as they were then known—on holiday. I was horrified that these youngsters had no proper clothes, no proper toys, no care and no nurture. I then worked in some of the subnormality hospitals where children, just because they had learning disabilities, had no proper rights. They were not properly regarded in the education system and were treated like sick people, not citizens. The dramatic change we have seen in our generation concerns people with mental health problems and those with learning disabilities who used to be incarcerated— out of sight and out of mind—in simply appalling institutions, facing abuse and difficulties. There has been a dramatic change, and I want to register that. The great movement to get people out of long-stay institutions and into communities was enlightened. Dramatic new pharmaceutical products enabled people to live as decent human beings, without being a danger to themselves or others, and to improve their quality of life. What we have seen in the 10 years since I held ministerial office is a dramatic increase in psychological treatments. CBT is treated as an important port of call. I pay great tribute to the noble Lord, Lord Layard, and his work at the London School of Economics on The Depression Report. I am delighted that the report is from the Centre for Economic Performance as opposed to a health department. It will help us to remember that 1 million people are on incapacity benefit because of their mental health problems. What an appalling waste of talent. The noble Baroness, Lady Morgan, rightly said that the suicide level has been falling, which is extremely good. During my term in office we introduced a preventive strategy, The Health of the Nation. As is the way in changes of government, the new Government introduced a dramatically new preventive strategy called Our Healthier Nation. The targets were almost identical, although no mention was made in the subsequent strategy of the previous one, which I thought was a little mean spirited. Suicide was one of the targets identified and how welcome it is that there has been a turn. But let no one be under any illusion: the most common cause of death for people between the ages of 15 and 34 is suicide, at twice the rate for men as for children. The very eminent and distinguished Member of Parliament for Worthing West long ago used to be a transport Minister who worked hard to reduce driving accidents. But accidents on the roads are as nothing compared with the dangers of suicide. Therefore, as we discuss the Bill, let us remember that suicide is a critical cause of loss of life and contribution and that it causes great suffering to friends and family. Last week I spoke for the Charlie Waller Memorial Trust. Charlie Waller, a successful account manager, was 28 when he took his life. His parents, in the way that some parents are extraordinary and remarkable, set up a foundation to ensure that more families did not have to live through the savage, traumatic loss of a successful young person. Through that foundation they have worked to raise the profile; to fund a chair at the University of Reading; for CBT outreach programmes in schools; for depression helplines for students; and so on. This Bill is only a very small part of what we must do more widely to promote an understanding of mental illness. Of course, the mental health budget is always the easiest to raid because mental illness does not show so clearly on waiting lists; it is always the acute side that takes the glory and the priority. Our job, particularly in this House, is to speak for the inarticulate needy as opposed to the articulate greedy—whether they are the professions or the most forceful patient groups—who are always able to get to the front of the queue. Probably unlike any other Member of another place, my endorsement when I first became a Member of Parliament was by the noble Baroness, Lady Howe, and by a professor of child psychiatry at the Maudsley, where I was working. I have a professional background in this area and Professor Lionel Hersov gave me a clean bill of health and thought it was an excellent idea that I should pursue a parliamentary path. However, at the same time, I was also a magistrate and a juvenile court chairman. There is a similarity between what we have seen in childcare and what we see in mental health. There was a time when children were incarcerated in long-stay institutions because their families were thought not to be fit. In some parts of the world, you can still see, tragically, children in long-stay institutions. Then children were returned to their families but, time and again, there were appalling child abuse incidents. The story was always the same—Louis Blom-Cooper never stopped; he had a season ticket for writing reports—because in the community it is much harder to hold the pieces together. It is the same for mental health. It is also the same in alternatives to custody for people who are not in prison institutions. It is much more complex to organise the psychologist, the nurse, the doctor, the teacher, the social worker; it is much harder to have a co-ordinated approach. The murder of Jonathan Zito by Christopher Clunis was a classic example of what we saw in the childcare system: the different elements in the community had simply not co-operated and collaborated. What is more, some of the patients about whom we are speaking are not particularly loveable, endearing or engaging of the professional services when they are feeling ill, or when they may not be feeling ill but are being troublesome to the community. When a patient going through a psychotic episode failed to turn up at a clinic, they did not say, ““Oh dear, where is this needy patient?””. They said, ““Thank goodness for that, we can concentrate on the worried well, on other patients, on other areas””. So the moment when that patient most needed a co-ordinated approach was the moment they slipped through the net, and somehow it was no one’s job to go and search them out. After the Christopher Clunis case I asked for a judicial inquiry. I am not one who thinks an inquiry is the answer to every problem, but I felt that we could begin to learn the lessons we had learnt on childcare. Then there was Ben Silcock, the young man who walked into the lion’s den at London Zoo. The story was that he had been involved in a Mind day centre in the Roehampton area, but had proved too difficult. I think Mind is a brilliant organisation, and this is no criticism of it, its work or its campaigns. The fact was, however, that when he was suspended from the day centre no one thought it was their job to find out what had happened to him. I had a most moving meeting with his parents. In 21 years as a Member of Parliament, I came across more examples than I care to mention of parents saying, ““I know my son or daughter is failing to take their medication. I know they’re not complying with the treatment that is arranged for them. I am regarded as part of the problem””. They had read RD Laing, and they were the schizophrenogenic mother of all our pasts. They were perceived as the problem, not the answer. When all else failed, however, some other parents were supposed to cope. I became convinced that we needed to do more to identify those mental health patients who needed a more careful regime and someone to watch over them. As a result of that, we moved towards supervised discharge and supervision registers. Again, overpressed, underpaid, overworked care staff tend to do the work that is statutory. With the best will in the world, those who are not on a list or a register, if there is no statutory force, so often fall through the net. I understand why supervised discharge has not delivered the results, or been as useful as might have been anticipated. It is the reason why today I have sympathy with the Government’s approach, in so far as I believe there is a role for supervised community treatment orders, but with many more safeguards than are currently in the Bill. The noble Baroness referred to advocacy. That must be a requirement, and goodness knows why, when it was in the original draft Bill, we do not see it now. Many other groups have talked about the special needs of children. Again, they were to have a special mention, but they have been omitted; not only the needs of children and young people whose parents may be subject to orders, but children and young people who have their own difficulties. I fail to understand why. Still a fifth of those young people admitted to an institution under an order are in an adult ward. That cannot be right. In my view, we need to take this Bill extremely seriously. I will give it the benefit of the doubt, despite this Government’s history of endless punitive measures—50 Home Office measures and the appalling Jack Straw severe personality disorder legacy as an early response to these difficulties. Provided that this is a small element of a comprehensive commitment for us all to do better for people with severe mental health problems, I shall, with modifications, support the Bill.