Mental Health Bill [HL]

My Lords, it has been a long process in getting an amended Bill before the House to tackle the inadequacies of existing mental health legislation. I pay tribute to all those who have been involved in scrutiny, working with government to bring the Bill to a state which many Members who have spoken today have commended, in spite of the deficiencies they see in it. I also pay tribute to all those who work daily serving others in providing mental health services, including voluntary organisations, campaigning organisations, carers and all those who dedicate themselves to this very difficult area of care provision for some of the most vulnerable people in our society. I congratulate the Government on maintaining their priority of improving mental health services. It is a priority, and the intention is to achieve those improvements through the Bill. But will that happen? From what we have heard so far, unless substantial amendments are made to the Bill, that is unlikely to be the case. I am most concerned about the prospects for those groups of patients who have to date experienced substantial adverse discriminatory treatment. The Mental Health Act 1983 has been disastrous in its application to some of our resident African and Caribbean-origin communities. The Bill fails to address the evidence of institutional racism—it does exist—and the practice of psychiatry in its detrimental effects on the black communities. As drafted, the Bill is likely to compromise and deny their right to the appropriate services when needed. The irrefutable substantial body of evidence shows that black and ethnic minority communities are more often diagnosed as schizophrenic. They are more often compulsorily detained under the Mental Health Act; admitted as offender patients and held by the police under Section 136 of the Act; transferred to locked wards from open wards; not referred for psychotherapy; given high doses of medication; sent to psychiatrists by the courts; and they more often have unmet needs. Compulsory powers continue to be arbitrarily invoked against African-Caribbean people, who mistrust and fear the services on offer. A 2004 report from the Office of the Deputy Prime Minister called Mental Health and Social Exclusion acknowledged that black people have higher levels of dissatisfaction with statutory mental health services and are twice as likely to disagree with their diagnosis. Such dissatisfaction has been around for three decades or more, and it is getting worse. Knowing of such concerns and representations made by the African and Caribbean organisations and their advocates, it is very disappointing that the Government should bring forward the Bill in such a deficient manner, notwithstanding all the contributors who have sought to make it much more acceptable. It is deficient in a number of ways: it has failed to conduct a comprehensive race equality impact assessment; it has excluded black community organisations in meaningful discussions—for example, there were last-minute communications involving black church leaders who were previously excluded from consultations. It is deficient in its compliance with the race relations legislation as specified by the Commission for Racial Equality. It is deficient in tackling the realities of the disproportionate adverse effects on African-Caribbean communities through culturally insensitive and detrimental mental health practices. These deficiencies are best exemplified by looking at the race equality impact assessment, with its lack of data and its speculative analyses that fail to qualify and determine what adverse potential impact may arise from these measures other than assertions such as ““The Government are of the view that”” and ““The effect of such policies will be neutral”” without the necessary back-up, analyses and data to substantiate such statements. Black and minority ethnic stakeholders, including patients, are deeply concerned about community treatment orders and the likelihood of even more detention of black and minority ethnic people. Similar concerns are held about the competence of tribunals to operate with cultural sensitivity to achieve equality and fair outcomes for all. The composition of panels should reflect cultural and ethnic diversity, but we have little or no information about their composition. Race equality and diversity training should be a prerequisite for all tribunal members. It should not merely be tick-box training—it should be meaningful, with understanding of diverse needs paramount in the course content. That also applies to the proposal to widen the range of professionals who will be involved in the provision of mental health services. Furthermore, the black and minority ethnic stakeholder groups hold the view that people detained with a mental health condition should have the basic right to independent advocacy to ensure that they are adequately represented and that their needs and rights are protected. I fully back what has been well expressed by the noble Baroness, Lady Morgan. It is also critical that the Bill provides the right to request an assessment, as is the case in Scotland, so that people with mental illness and carers can have their needs assessed and responded to before a crisis point arrives. The Bill has the potential to be—to use the Home Secretary’s favourite phrase—““fit for purpose””, but only if the Government are prepared to consult, listen and be responsive to voices that have been ignored or marginalised to date and which can help contributeto it achieving meaningful, fair and appropriate outcomes for all, as intended. As we heard from my noble friends Lord Patel of Bradford and Lord Adebowale, their contribution in helping to shape the Bill and in bringing forward amendments offer optimism that the Bill can emerge from this House acceptable to all sides and to all providing mental health services and care for the most vulnerable people in our society.