Mental Health Bill [Lords]

Occasionally, I read the notes that I have prepared beforehand, and my next page says that the ““Avoidable Deaths”” inquiry identified what it regarded as the potential for prevention, and it mentioned 56 cases a year of suicide and—a figure that the Secretary of State did not mention—eight cases a year of homicide, because those cases related to the criteria for community treatment orders. Of course, the ““Avoidable Deaths”” inquiry was also clear about the lack of evidence, so we have to be understanding. In precisely the paragraphs to which the Secretary of State refers, it says:"““We have no reliable way of calculating how many suicides would be prevented by a community treatment order””," and it says precisely the same thing about homicides. That brings me back to my point about the Bill being about service provision as well as compulsion. If we are concerned to ensure that suicides, homicides and violence to others are minimised, what really matters, first and foremost, is the availability of services and the degree of appropriate supervision available to patients. The care programme approach and the availability of enhanced CPAs seems, on the face of it, and indeed on the basis of the ““Avoidable Deaths”” inquiry, to be the factor that is most likely to mitigate the risks. The Government ought to know that, because they went out looking for evidence to support their argument. They looked for evidence on community treatment orders, and that evidence was published just after the Bill’s Third Reading in the House of Lords, so it was too late to be of any benefit to those proceedings, but I think that it would probably have reinforced their lordships in their conclusions. The review of evidence, by Churchill et al, which was published in 2007, said:"““It is not possible to state whether community treatments orders…are beneficial or harmful to patients.””" It went on to say that there was"““very little evidence of positive effects of CTOs in the areas where they might have been anticipated.””" The result is that the Government last week announced a further research project, which is to be undertaken by the university of Oxford and others. The Government have been proposing supervised community treatment orders for several years, and now they think it necessary to undertake research into their potential effectiveness. The Secretary of State was perfectly open about the Government’s objective. She wants the Bill to complete its Second Reading, but then she wants to change most of it and overturn the amendments made in the Lords. I suggest to Members wishing to participate in our debates that they read the debates in the Lords carefully. Those debates lasted for 45 hours, so I know that that takes a long time, but I urge them to do so, as they will find that powerful arguments were made and a great deal of expertise was brought to bear on the issue. I pay tribute to my colleague, Freddie Howe, to Lord Carlile, Lord Williamson, Baroness Murphy, Lord Rix, Lord Adebowale, Baroness Barker, Baroness Neuberger and all those who contributed their considerable weight of expertise and authority in the Lords. The Government tried to represent the argument as one between the rights of patients on the one hand and the protection of the public on the other, but that is a false dichotomy, as we can secure the rights of mental health patients and protect the public better than we have done until now. The Government, however, want to propagate that false dichotomy, because they want to force the argument in the direction that they want to take. Their attitude that they should have unrestricted access to powers is best seen in the assertion by the Minister of State, Department of Health, the right hon. Member for Doncaster, Central that"““Every restriction is a patient untreated””." That is both illogical and misleading. Compulsion is not the only route to treatment. Thousands of patients access services without compulsion. In the case of Michael Stone, the fundamental issue was not whether he was placed in a hospital under detention and regarded as not treatable but whether the services were available to provide the treatment that was regarded as necessary. Ministers go round talking about those cases—they do not do so openly; they do it privately—and if that does nothing else, it propagates the stigma experienced by mental health patients, which must stop. Thousands of patients access services without compulsion. Supervised discharge arrangements are available, and an enhanced care programme approach does not require compulsion. Discharge into the community should not happen earlier because CTOs are available. The principle should be straightforward: if patients need to be in hospital, they should be there; if they no longer need to be in hospital, they should be discharged. It does not require the legal establishment of a community treatment order for that to be the case. We are not against CTOs in principle, but they should be deployed as a means of securing compliance under strict conditions, and the Lords have put such measures in place where there is a history of relapse after treatment, where there is a history of refusal of treatment, or where there is a clear benefit from treatment if subsequently recalled.