Mental Health Bill [HL]

My Lords, I begin my brief remarks with an acknowledgment that the Government’s injection of funds into the health service over the past seven years has enabled some very significant improvements in in-patient services for children and young people. In east London, where I am the chairman of a mental health trust, we opened last year a purpose-built and beautiful new unit for children and young people, with 15 in-patient beds and six day places. We are very proud of the service that we can now provide, but my staff tell me how incredibly lucky we are. They are appalled at how children are treated up and down the country in places where, sadly, boroughs and trusts do not have the facilities that we have. The reality is that the number of general NHS CAMHS beds has increased by only 4 per cent between 1999 and 2006. The result is that many areas still admit children and young people to adult wards and rely on the private sector, where the young person may be many miles from home and the cost may be exorbitant. Until last year, we were in that position; we were placing children from the east end of London down in Sussex or Berkshire. Noble Lords can imagine how often parents could visit those children—and there was no chance of the children coming by day, which is very important for some categories of disorder, such as anorexia. We know from the Children and Young Person’s Inpatient Evaluation Study of in-patient care for eight to 18 year-olds that in-patient care is effective for very severe levels of disorder. In some of these cases, we can prevent the situation getting out of control and becoming absolutely chronic. In the study, the children showed considerable recovery, which was clinically significant, and family relationships, which are so crucial to a child’s well-being, improved—and the improvement continued over a one-year follow-up period. In supporting this amendment, I am mindful of the conclusion of the Department of Health’s Every Child Matters report that CAMHS, "““should expect to achieve by the mid-point of the NSF cycle the elimination of the use of adult wards for all but a few older adolescents who find themselves associating more readily with young adults””." This amendment seeks only to ensure that sufficient priority is given to achieving the objectives set out in the Government’s own report. The Minister for Care Services, Ivan Lewis, agrees with us. He said that, "““we should be seeking a situation where no child ends up in an adult ward environment””." He went on to say that, "““that should be our … mission””." It is our mission today. One of the central tenets of medicine is that health services should not do harm. But the Children’s Commissioner, Professor Sir Al Aynsley-Green, said he feared that children could be more damaged than helped by the experience of being on an adult psychiatric ward. As someone who makes a point of regularly meeting patients and staff on adult wards, I share that view. The reality of adult in-patient wards today is that staff are managing in-patients with ever more serious and complex psychiatric disorders. Anyone who can be managed in the community is managed by one of the community teams, even if that involves daily visits—three or four visits a day—and hours of every day being spent in that person’s home. The result is that any in-patient is likely to be severely disturbed. You do not have the sort of balance that you had 10 years ago where you had a number of reasonably stable patients and others who were a bit more disturbed. Today, everybody in those wards is a severely disturbed person. Thus, it is ever more urgent to avoid children and young persons being placed in a highly volatile adult in-patient environment. In Committee the Minister suggested that the Mental Health Act was concerned with the legal processes around mental health and that: "““It is much more difficult to move on from there to specifying services to be provided to a certain group””.—[Official Report, 15/1/07; col. 559.]" In fact, proposed new Sections 142B and 142C in the amendment refer exclusively to detained young people. The Bill is very clear about who will be involved in the assessment of adults under the Act. It seems entirely in keeping with the spirit of the Bill that it should specify that appropriately qualified clinicians must be involved in the assessment of young people. Proposed new Section 142A refers to voluntary patients under the age of 18. In view of the seriousness of the consequences of inappropriate placement of these young persons, it seems reasonable to extend the scope of the clause as proposed. I hope that the Minister will give the amendment sympathetic consideration.