Mental Health Bill [HL]

My Lords, the Bill has had a spectacularly long gestation; it has been on the horizon for nine years, which indicates the degree to which it is difficult to legislate in this area. It is important for us to remember what the objectives of the Bill are. The first is to make the Mental Health Act 1983 compliant with the European Convention on Human Rights, which was incorporated into our law by virtue of the Human Rights Act 1998. The second is to deliver community-based treatment. The third is to address what I think of as the Cinderella of personality disorder, so as to provide at least some management of this condition. The Bill also provides for the protection of those who lack capacity and are compliant in treatment but who are not covered by mental health legislation. This is an increasingly necessary requirement given that one of the consequences of an ageing population is the growing incidence of dementia. Such people are in hospital or in care homes outside the ambit of the 1983 Act. In considering human rights it is important to remember that there is no hierarchy of rights. One person’s rights do not take precedence over another’s. It is important to seek a balancing of rights. In this area in particular, that balancing exercise is very difficult because, at its most extreme, it seeks to balance the liberty of some against the security of others. This first came to my attention in the early stages of the 1992-97 Parliament as a then new Member of the other place. One of my colleagues on the Labour Benches raised with the then Prime Minister, John Major, the case of a promising young musician, Jonathan Zito, who was minding his own business on a station platform when he was stabbed to death by Christopher Clunis, who had a personality disorder and could not be detained. Jonathan Zito’s widow, Jayne Zito, set up a trust in his name to campaign on these issues. That has remained with me as being the most intractable of problems because such people did not fall under the Mental Health Act 1983 and did not get treatment. Replacing treatability as a concept with the new appropriate treatment test, as envisaged in the Bill, will at last give some attention and recognition to a considerable social and health problem. This has been further reinforced for me because, in March of this year, I accepted an invitation from my noble friend Lady Scotland to conduct a review of vulnerable women in the criminal justice system. I have spent the intervening months visiting women’s prisons and talking to all manner of people who have an interest in or responsibility for their care. It is extraordinarily shocking how many women in our prisons are there because of personality disorder. Such women are assessed and the people caring for them are told, ““This person is not treatable””, so prison staff—who have no training at all in such conditions—have to try to cope. The levels of self-harm and self-inflicted death among those women are truly shocking. While we may talk about revolving-door patients, these are revolving-door prisoners. Prison staff will say, ““She will be back soon””, because no one has a responsibility to give her any help. Treatment does not necessarily mean drugs or a chemical cosh, to use a common expression. It can involve anger management, cognitive therapy, behaviour therapy, counselling, rehabilitation and independent-living skills. During my review, I met a woman who is a magistrate on a Bench in the north-east of England whose daughter was diagnosed with a personality disorder. The woman believed that its roots were a combination of chronic alcoholism and the use of non-prescription drugs. She recounted to me in a moving way the difficulty she had had in getting anyone, anywhere, to take any notice of what was wrong with her daughter. She finally found a counselling service, which spent a considerable time with the young woman dealing with the addictions that her mother felt were at the root of her disinhibiting behaviour. Her daughter is now what her mother calls a normal young woman with a family. I have always rejected the notion that such people are beyond any kind of treatment. They might be beyond the kind of conventional treatment that has been offered until now, but that does not mean to say that nothing can be done. This treatment has the potential to be of enormous benefit for people who lead chaotic lives and are consequently in and out of prison. Other noble Lords have referred to the lobbying of another place on this Bill today. I have been talking to my right honourable friend Rosie Winterton, the Minister of State, about her experiences in that lobby and I was struck by the fact that a woman said to her, ““Rosie, I have a personality disorder. I would love treatment but I cannot get it””. I welcome the fact that that will be possible under the Bill. As to community-based treatment, the provisions in the Bill are also designed to cater for those people who are called revolving-door patients by mental health professionals. They are detained; on discharge they feel no more need for prescribed medication; they lose touch with the professionals; they can become homeless—and they end up being detained. I support the principle of supervised community treatment, which is the norm in countries such as New Zealand and Canada. It is important to emphasise the safeguards. Community-based treatment will not be suitable for everyone. It must be appropriate to the person’s needs, and clinicians must be confident that appropriate services are available. I also welcome the provisions that give patients the right to appeal to the county court to discharge and replace the person statutorily designated as their nearest relative. This is because there may have been a breakdown in the relationship or the nearest relative could even have been a past abuser of the patient. I am pleased to note that a draft code of practice has been issued with the Bill and that interested parties have been invited to make suggestions as to ways in which the code could be strengthened and improved. One gap that I have identified in the Bill relates to the provision for children and young people, for whom mental illness is a growing phenomenon. No doubt these matters can be debated in Committee. Finally, as a Second Reading debate is about principle rather than detail, I laud the principles behind the Bill and its attempt to balance public safety with private treatment and care.