Mental Health Bill [HL]

My Lords, I declare an interest as president of Mind which has been working for better mental healthcare over the past 60 years. Much has been achieved in mental health awareness and in mental healthcare over the past few years. The stigma is finally showing signs that it will slink away. The taboo is starting to lose its dread. The understanding that mental illness can be just as harmful as physical illness, that it needs just as much attention and that, like physical illness, it can be overcome has deepened, especially over the past four or five years. Even newspaper language, which in certain quarters used to be almost an incitement to lynch or to ostracise, shows signs of achieving some reason and sanity. Despite this Government’s laudable track record in areas of illness and disability, those to whom I have spoken in Mind and the Mental Health Alliance—a unique coalition of 78 organisations committed to better mental health legislation—are convinced that to let this Bill pass without serious amendments would be to fail an already disadvantaged section of our society and to miss a great opportunity. I share those views. I agree with my noble friend Lord Warner that the time is right for a major rethink and revaluation of mental health. Sadly, this Bill does not do that. At times, the Bill seems to be rooted in the stereotype that those suffering from severe mental health problems are likely to be threatening and dangerous. More than one in five of us will, at times, suffer from often grave mental health problems—one in five. Look around at those we know and know of. This alone makes a mockery of the murderous stereotype. There is a growing culture of alarm in this country. The fact that it comes at a time when crime is falling does not make that perception less influential, but this does not mean that we can therefore tolerate witch hunts. Yet the few high profile cases of people experiencing severe mental ill health who kill receive lurid and disproportionate media coverage. They leave the impression that tragic deaths have occurred because of a failure of the law to protect us. Yet the clear message from official inquiries into these incidents is that the key to avoiding them is not to reform mental health law but investment in mental health services. There is, for instance, no evidence that extensions in powers to allow compulsory treatment in the community will improve outcomes for people experiencing mental distress or increase public safety. As that is the case, are we not in some way talking about an unfortunate short-term reaction—even a snatch and grab at a problem—and not a detailed address to the realities involved? There is a definition of mental illness in the Bill. It is a useful starting point, but only if accompanied by exclusions to that definition. It would be absurd, for instance, to claim that there is merely one definition of physical illness. Yet, as those of us in Mind and other like organisations continue to say, the afflictions of mental illness are just as varied as physical illnesses, from the temporarily disabling to the crippling, in both cases. For compulsory treatment, the Bill removes a current stipulation that treatment should have a therapeutic benefit and requires only that treatment is available as ““appropriate””. This is surely too vague a basis for coercive powers and is not based on therapeutic value. In effect, it would allow the incarceration of mentally ill people who have committed no crime. It would also, many psychiatrists say, turn them into jailers. Furthermore, it would allow curfews to be imposed on patients in the community, which the Royal College of Psychiatrists fears would dissuade people coming forward to seek help. Research suggests that compulsory community treatment is not effective. It even deflects attention from the real issue of providing high quality aftercare and support. If the Government are looking at what can be achieved in the community then, as well as aftercare and support, they should be looking at tackling those factors that contribute to the social exclusion and isolation of people who have experienced mental distress. It is those factors, as well as lack of care and support—as much as any failure to comply with treatment—that contribute to people relapsing after they have been discharged. To do all this is extremely ambitious, but the ambition to serve the needs of the most fragile is a noble one. I believe that the people of this country will support it. There are points not in the Bill which should be there. Patients should have the right to a full assessment of their health and social needs before a crisis point, and a right to advocacy services to help negotiate their way through a complex system. Mind’s chief executive, Paul Farmer, said when this Bill was published: "““It’s quality health services that will protect people, not this legislation, opposed by mental health experts across the board. We hope that the widespread concern in Parliament will lead to the essential changes that must be made to give any chance of providing an effective mental healthcare system. It is vital that health legislation is focused on benefiting and treating health problems. Treatment that cannot improve or treat a person's health should not be forcibly given to them””." The Bill must also address the distressing over-representation of black and minority ethnic people in the mental health system. Again, this is difficult, but essential for individuals and, in the round, for society. The Scottish mental health Act includes measures to provide services and accommodation for mothers, of children less than one year old, with post-natal depression. Surely there should be similar measures for women in England and Wales. All in all, treatment for those with a mental illness must be on the same basis, wherever possible, as with those with a physical illness. Finally, the Government have a fine record in tackling the difficulties in our overall national health. They have lacked neither courage nor patience. But I hope that this debate will persuade them to reconsider this Bill and their position in this too long underserved part of our health provision.