Mental Health Bill [HL]

moved Amendment No. 14: 14: After Clause 8 , insert the following new Clause— ““CHAPTER 1A Treatment safeguards Capacitous patient’s right to refuse electroconvulsive therapy ( ) In section 58(3) of the 1983 Act (treatment requiring consent or a second opinion) after paragraph (b) insert ““; or (c) subject to section 58A (as inserted by section (Electro-convulsive therapy: children)), in the case of electroconvulsive therapy a registered medical practitioner appointed as aforesaid (not being the responsible medical officer) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment but that, having regard in particular to the likelihood of its alleviating or preventing a deterioration of his condition it is necessary for the treatment to be given.”””” The noble Baroness said: My Lords, I shall speak also to Amendments Nos. 15 and 16 and address the government amendments in the group. Your Lordships may wonder why I am speaking to the ECT amendments first. I do so because other noble Lords have decided that I am a fan of ECT. It is an inaccurate assessment of my view of ECT but, as I am one of the few people who have prescribed ECT on very rare occasions for elderly people, I am well aware of its problems. I am very keen that we should have greater safeguards and a recognition of the fear and the problems that have surrounded ECT. I believe that if ECT were no longer available it would not make a great deal of difference, but there are one or two instances where it needs to happen, and it is still a useful part of the armamentarium. I am well aware that at this stage in our deliberations on Report Ministers may be in need of some supportive psychotherapy themselves. I am delighted to welcome the Government’s amendment on the capacitous refusal of ECT which cannot now be overridden for adults. The government amendments in response to our amendments tabled in Committee have gone further than I expected. They ensure not only that capacitous patients who refuse ECT cannot be forced to have it, but that the wishes of those who have said in an advance directive that they do not wish to have ECT in the future cannot be overridden. That sets a marvellous precedent. I am very grateful, as other noble Lords will be. The issue of a second opinion for all young patients for whom ECT is proposed unfortunately has not been addressed. The 2004 draft Mental Health Bill would have introduced tribunal or court authorisation of ECT for all patients under 16, whether or not under formal powers. The amendment provides for a second opinion under the SOAD system for both formal and informal patients which goes some way to matching this safeguard. The amendment also requires that either the young person's own doctor or the second-opinion appointed doctor is a child or adolescent practitioner. A similar amendment has been tabled in relation to the use of compulsory powers over young people to ensure specialist involvement specifically before treatment with ECT. In his response to the amendment in Committee, the noble Lord, Lord Hunt, indicated that for informal patients who have capacity and have consented to ECT, a statutory second opinion would mean a young person being interviewed and examined by a second doctor, whom they would probably not know. With such serious treatment it is essential for a young person to be subject to a second opinion, regardless of whether they are a formal or informal patient. Far from undermining a capacitous voluntary patient, provision for a second opinion on a treatment with such far-reaching consequences can be only a support to the young person and the clinician and offer them reassurance that the decision is in the best interests of the patient. Due to the nature of the relationship between a young person and their clinician, the young person may find it difficult to voice their concerns. A second opinion will provide an automatic safety net where the young person is less likely to feel that they are undermining their relationship with their primary clinician. The young person will encounter a number of professionals they do not know while they are being treated. It is an unavoidable consequence of being a patient. Young people should have the sort of safeguards that older people have, and their wishes should not be overridden by parental consent. The amendment allows for patients who are not capable to have treatment on the basis of a High Court order, as there may be occasions when parents may not want to make, or will not make, decisions in their children's best interests. We need to include greater safeguards for young people. I would also like to address the issue of emergency ECT. Here again, we must ensure that capacitous patients do not have emergency ECT if they refuse to have it. As I said on a couple of previous occasions, I cannot envisage a clinical situation where Section 62 emergency treatment should ever be given to a patient who has capacity. Such treatment exists to treat profoundly depressed people who have usually stopped eating and drinking and who are seriously at risk of dehydration and death before the treatment takes effect. As the British Psychological Society has pointed out, evidence from Northwick Park studies shows that if a nurse can sit with that patient day in and day out over the course of a three or four-day weekend and get liquid into him one way or another through a drip and so forth, ECT can usually be avoided. But sometimes it is necessary. Sometimes the circumstances are not right and the patient may pull out the drip and refuse treatment. But I cannot understand how such a situation could arise with a patient who had full capacity. The nature of the illness is such that it would not happen. The amendment would provide safeguards for a capacitous patient not to be subjected to ECT without his consent, if it was outlawed as an emergency treatment. It would lead to better practice. There is nothing in this amendment that would not be welcomed by psychiatrists. It is certainly welcomed by the Mental Health Alliance. I beg to move.