Mental Health Bill [HL]

My Lords, it is somewhat intimidating to follow the noble Lord, Lord Patel of Bradford, because he has great expertise. It is also particularly intimidating to speak at this position in the list because many of the points have been made. I shall try not to repeat them, although, as I know the Minister’s attention is not always long—that was not what I meant, but it woke us all up—I want to begin by congratulating the Government on the present mental health services. I have worked in mental health for nearly four decades, and the change that was described earlier by the noble Baroness, Lady Bottomley, has been outstanding. I worked in large institutions containing elderly people who should have been out in the community, young women who were incarcerated because they had had an illegitimate child and many people who seemed rather more normal than those in community, but we have moved on to a quite different place. It is clear from sitting on Committee G of the EU Scrutiny Committee considering the Green Paper on the EU mental health strategy that we are leaders in Europe. I am sure that there many other nations from which we can learn, but we have much to share with the rest of Europe. But we can do better. Like many previous speakers, I have some disappointment with the Bill. It is a curious mixture and arouses strong and deviant feelings. I think that the noble Baroness, Lady Gibson, is optimistic that we will all agree at the end of the day. Like others, I welcome the Bournewood provisions, but also, like my colleagues, would like to see that the principles of implementation are in the Bill and that there is greater clarification, including exactly how Schedule 6 will work in practice. Having been the deputy chair of the National Care Standards Commission, I have real anxieties about that implementation and who can make the application. However, I intend to spend my few minutes concentrating on a major gap in the Bill—the mental health service for children and young people—and then to raise some questions about definition and role. The only references I can find to child patients are those in new Sections 64E and 64F. I am unclear if these sections remove the confusion about whether parental consent can be used to admit 17 and 18 year-olds for treatment against their will. The provision clarifying this in the previous draft Bill appears to be omitted in this one Bill. On a more general note, it seems a lost opportunity not to address those issues of child and adolescent mental health that touch on containment and are at odds with the Children Acts and the frameworks for children. The Minister knows only too well that children are not the same as adults. They have different levels of development and dependency and they process and react to problems differently. Those aged under 18 need expert, age-appropriate provision, not—as is happening in significant numbers—to be treated on adult wards. YoungMinds, a charity which I admire and commend, is dedicated to promoting and improving the mental health of all children and young people. It would like to see an assessment of therapeutic benefit and safety of young people if they are admitted to an adult ward. The Minister will no doubt quote Ivan Lewis, who has made the welcome request to the health service to prevent children being held on adult wards as an ““unprecedented priority””. But where is the response and the implementation? What are the Government doing to enable that to happen when they do not, as we have already heard, have verified central statistics on the numbers? YoungMinds knows of young people who have witnessed and experienced verbal and sexual violence on adult wards, and been denied access to education. Drug abuse is a major problem. Wards have 30 to 40 patients and are often overcrowded. There is a reliance on sedation and drug treatment, rather than talking therapies. The welcome growth of crisis and other teams which can keep people in the community, means that the severity of illness of people on wards is likely to increase. These are not places in which to treat our young. If resources can be found for the supervision of adults in the community—a response to the media highlighting a few cases, although something I welcome—why cannot they be found for those with less voice; our children and young people? Will the Government consider legislation similar to the Mental Health (Care and Treatment) (Scotland) Act, in Section 23 which says that there should be provided, "““services and accommodation as are sufficient for the … child or young person””?" There was, after all, a recommendation by the 2005 Joint Committee on the draft Mental Health Bill that: "““There should be a duty on health authorities to provide age-appropriate accommodation for under-18s subject to the Bill or needing in-patient treatment””." Why has that provision been lost? We have already heard of children who live in households with adults suffering from mental health problems. Some of these adults may well be on the new community supervision orders. My concern here is about the focus and training of these officers, who will be there primarily, as I understand it, for the supervisee. Can we be assured that they will not lose sight of the family as a whole and, in particular, understand issues around child development and child protection? Like the Minister, my background stretches back to the days before the Seebohm reorganisation. Since then we have come full circle. The lessons learnt must make for a better holistic family service than we have achieved thus far. As has been mentioned, Barnardo’s has drawn our attention to the many children who care for a parent with a mental disorder. Will the new workers be able to give some help to those children? I now turn to Clause 3 dealing with the clarification of definitions of mental disorder. As the deputy chair of the Lucy Faithfull Foundation, an organisation that has led the way in understanding the treatment of child abusers—not all of whom would be described as paedophiles—it is helpful to see those whose distorted mental processes enable them to sexually abuse our young brought into the scope of the 1983 Act. Like many parts of the Bill, this takes us into the overlap between the role of the Home Office in dealing with offenders and that of the Department of Health in treating those with a mental illness or disorder. The foundation’s residential clinic was closed in 2002, although we have continued our work in the community with the support of government. The re-opening of the clinic has been hampered by a curious ruling that we can no longer lock in the men we treat in the institution, although we did so for many years—and very successfully. Through this Bill, we might find a way for the foundation to continue its important and renowned work of treating offenders and so protect our children. As we move through Committee, I am sure that we will begin to tease out the balance of compulsion and rights, so well outlined by the noble Baroness, Lady Carnegy of Lour, at the beginning of the debate. During those discussions, I hope that we will also understand the relationship between those who deliver care and treatment and cut through the silos that divide departments. The Bill seeks this continuity of care. After all, how many mentally ill people are in prison with little or no treatment? How many, simply by categorisation, do not receive the appropriate help? We have heard that this is particularly true of those from black racial backgrounds, but it is also true of adolescents. In my day, we had a great debate on the deprived and the depraved—whether you were deprived and therefore in trouble or really wicked and therefore in trouble. I suggest that there is not that demarcation and that somewhere in that spectrum, particularly with young people, there is a great need to look at how we incarcerate them and the kind of help we give to them. There are more developments in cognitive behavioural therapies for people with so-called personality disorders. I therefore contend that the divisions between containment and treatment are not so easily defined. The new community order will surely help to bridge that spectrum. But, no doubt, we will spend a great deal of time looking at these concepts. I only hope the issues around children and mental health services will have as much attention as those about containment.