Mental Health Bill [Lords]

It is interesting to hear the Secretary of State move the Second Reading of a Bill whose principles now diverge substantially from those that the Government proposed, but such is the nature of today’s debate. It probably will not be well understood outside that we will manage to have an argument while all agreeing that the Bill should be given a Second Reading, but we will carry on and do so anyway. The Government always say that the Bill is not about mental health services but, like the Secretary of State, I want to start by paying tribute to the people who work in mental health services. Hon. Members on both sides of the House will in a personal context, a family context and a constituency context have met people who work in mental health services, who do an often difficult job in difficult circumstances. People with psychological illnesses may present in similar ways to those with physical illnesses, but in some cases they can be very different—and very difficult to handle. The skills required of those who work in mental health services are remarkable, as are their forbearance and their patience in delivering those services. We should therefore start our debate by recognising what they do. The Conservatives think that, as a consequence, such people should be especially listened to. That has happened during consideration of the Bill in another place and, as it passes through this House, I hope—I know—that Members of this House will take a lot of trouble to ask people working on the front line in mental health services what they feel about the provisions. That may well change a few minds that might have started out a bit too set. I do not want to discuss at length the state of mental health services. You will recall, Mr. Deputy Speaker, that in February last year we had a debate in Opposition time in which we set out the issues in some detail. I hope that that will be taken as read. We acknowledge that additional resources have been provided for mental health services. Ministers often chide me, but I am prone to say that health services generally and mental health services have improved. From experience in my local area, I especially welcome the creation of crisis resolution teams and the introduction of early intervention and assertive outreach. Those are important innovations, as has been the development of the care programme approach. However, I hope that Ministers will be equally even handed and acknowledge that significant problems remain. Those problems include reductions in the number of in-patient beds and financial pressures on mental health trusts—even if they are not in deficit, they have to make savings as a consequence of deficits elsewhere. Despite the introduction of the care programme approach, only 50 per cent. of patients are subject to care planning. In addition, as the ““Count Me In”” census demonstrated, there are continuing problems relating to the discriminatory effects of the use of compulsion, especially in relation to black and minority ethnic patients. Those are all problems that we have to deal with, but as I am sure that Ministers would remind us, the legislation is not specifically designed to deliver services; it is designed to establish the legal framework under which people are brought under compulsion. We are discussing one of the less impressive tales of policy making of the last 10 years—and there is some competition on that score. It has long been acknowledged that the Mental Health Act 1983 needs to be brought up to date. A generation has passed since it was enacted, and as the Secretary of State rightly said, there are a number of issues that need to be dealt with, but let us consider the stages that we have been through. There has been a so-called blue paper, a Green Paper, and a White Paper—oh, and I left out Professor Genevra Richardson’s expert committee report in 1998. I should not have done so, because it would have been a jolly good thing if the Government, who received that report right at the start of the process, had actually listened to what was said in it, rather than trying to cherry-pick from it. There was a 2002 draft Bill and a 2004 draft Bill, and a subsequent Joint Committee on the Draft Mental Health Bill report. Finally, in March last year, a few weeks after our debate on mental health services, Ministers acknowledged the inevitable—the fact that the legislation would not fly—and moved to an amending piece of legislation, which is what is before us now. I did not find, in any of the recent stages in which I have been involved, that the Government appeared genuinely to listen to the independent expert consensus that is emerging on how the legislation should be framed. It is true in a literal sense that the Bill is about the legal process for bringing people under compulsion, but there is a clear relationship between service provision and the case for compulsion. Those two things do not live in isolation from each other, and there is an important document, which was published in December, that needs to be read in that context. It is the five-year report of the national confidential inquiry into suicide and homicide by people with mental illness, which for convenience is called ““Avoidable Deaths””. In that report, clinicians were asked to identify the factors that they believed would have made homicide less likely. Let us remind ourselves what the results were, starting with the factor that they were most likely to cite. They were: better patient compliance, which is not surprising; improved staff communication; closer contact with the patient’s family; closer supervision of patients; and better liaison between different services. In more than 20 per cent. of cases, those were cited as factors that might have made the homicide less likely.