Mental Health Bill [HL]

My Lords, the Bill before us is a very far cry from the first proposals for a new Mental Health Bill—a Bill which was to be comprehensive and would have started almost from scratch on mental health legislation. In 2004, a draft Bill was produced and widely considered. It was large, complex and not widely popular. Now, as a result of much comment and debate, this Bill—shortened, and somewhat simpler—is to be considered. It does not remove all previous mental health legislation; rather it modernises and builds upon it. No Bill will ever satisfy everyone, and, as we have heard, there are varying views on whether this Bill suffices. One of the challenges before us is to ensure that, when it leaves this place, it does. As the Secretary of State for Health, Patricia Hewitt, said during the Queen’s Speech debate in another place: "““For far too long, mental health services were neglected””.—[Official Report, Commons, 16/11/06; col. 149.]" This Government have invested in our mental health services and this Bill is a further stage of that process. The Bill contains some important new proposals. I welcome the introduction of treatment supervised in the community for those who have already had treatment in a hospital. It will, one hopes, prevent patients relapsing and having to be readmitted to hospital. I welcome such provision because there is no doubt in my mind that such care in the community is needed. I am familiar with the case of a man, now in his forties, who has suffered with mental health problems since his teens. He has been hospitalised on numerous occasions and then released without sufficient support. Needless to say, after exhibiting behaviour that was dangerous to his family, to the general public and, most worryingly, to himself, he has had to return to a secure hospital. I am sure that other noble Lords know of similar cases. As the Secretary of State for Health also said last week: "““Hon. Members are only too aware of the problem of those mental health patients who are treated in hospital and whose condition improves with care and medication, but who leave hospital and then fail to keep up their treatment. In a small minority of cases, involving some of the most seriously ill people, that can lead to terrible and tragic results””.—[Official Report, Commons, 16/11/06; col. 150.]" If the man who I know could be professionally supervised in the community, it would be good not only for him and his family but for society as a whole. The Bill has other positive aims: to expand the skill base of mental health professionals and, as a vital part of that, to ensure that they have the right experience and training; to improve safeguards for patients who are unable to decide for themselves about their care; and to provide speedier and more frequent mental health review tribunals. The latter would be of great assistance not only for those with mental health problems but also for those directly involved with them. Something I support, but which I recognise raises concerns in many quarters, relates to the current ““treatability test””. The Bill introduces appropriate treatment to replace the treatability test. This clause will apply to all the longer-term powers of detention. However, patients will not be detained compulsorily, nor will their detention continue unless they are able to receive the appropriate medical treatment that they specifically require. Any such restrictions willapply only when it is considered by those with responsibility for the diagnosis that patients may be a risk to others. I accept that such considerations are a fine balancing act, but there will always be some people who are not in a fit mental state to give their consent to treatment and they must be protected from harming themselves as well as others. It is also vital that appropriate treatment is available for all patients regardless of their label or diagnosis. I believe that that is more likely to be achieved under the new proposals rather than the existing ones. I know that other noble Lords think differently. I also welcome a debate on whether a relative is always the best person to have responsibility for those with mental health problems. I am sure that in the vast majority of cases a close and loving relative will have the best interests of their loved ones at heart but, by the nature of human relationships, there must be instances where others who are not relatives would be better able to reflect what the individual concerned would wish for himself or herself. Like other noble Lords, I have received a number of briefs from different organisations. A small number of them have been disappointingly negative. I do not think that it is of any help to send me or other noble Lords a brief that totally condemns the Bill. Constructive criticism is important and welcome, but negativity alone is of little use to the debate. A number of the briefs pointed to the Scottish legislation, which has already been mentioned in the Chamber, which is preferable to what the Bill contains. In particular, the Scottish community treatment orders are recommended, as they are confined to conditions regarding treatment and residence rather than the wider proposals contained in the Bill. That view is supported by the Law Society among others. Its chief executive, Fiona Woolf, believes that, "““the Government has tinkered with our mental health provisions, rather than introducing radical reforms””," and have thus missed a golden opportunity for advancement in this area. Perhaps the Minister could comment on this preference for the Scottish legislation in his summing up. A particular brief that raised matters of some concern for me was that from Barnardo’s, which concentrated on the mental health issues of children and young people. The noble Baroness, Lady Bottomley of Nettlestone, has already mentioned that. The Barnardo’s brief covered two angles: those younger people who have mental health problems and those who look after adults with mental health difficulties. Both those groups of young people are among the most vulnerable. Genuine worries are raised about the current treatment available for children and young people who develop mental health problems and whether the Bill’s proposals will tackle what Barnardo’s believes to be a ““national shortage of treatments””, especially among 16 to 18 year-olds. Barnardo’s hopes that the Bill will be amended to add emphasis relating to age assessment, treatment and aftercare for the younger folk who have specific problems. They believe that that should include care and treatment by professionals trained in child development and child psychiatry as well as aftercare support, which is so essential to bring back stability to their lives. The second element—parental or other adult care—raises stark issues indeed. Barnardo’s estimates that up to a quarter of adults with mental health difficulties are being cared for by young people.Such circumstances can place unbearable strain on those carers, who become old before their time from their burdens. Such youngsters must surely be able to access the widest possible range of support, and I hope that my noble friend will agree with that view. Finally, it seems to me that, for this Bill to succeed, above all, emphasis must be placed on providing enough properly trained staff and enough resources generally. Without those two basic requirements, the Bill will not do what it sets out to do. Can the Minister reassure the House that the relevant staff will receive the training necessary for their varied roles and that sufficient resources will be available to put the Bill’s proposals into effect?