Mental Health Bill [Lords]

Once again, the Secretary of State is making our argument for us. It is perfectly clear that far from resorting to CTOs, the Government should have been trying to work out how supervised discharge arrangements can be used more effectively. [Interruption.] Compulsion is not the same as supervision. What is required in order to promote patient compliance is, wherever possible, to achieve close supervision in circumstances that do not involve compulsion. [Interruption.] The Secretary of State has said, ““Well, they cannot be recalled.”” Of course it is possible for a section to apply, which could happen to any patient in the community. That may be for assessment in the first instance, but if the patient has been sectioned before, it may be for treatment. The Secretary of State seems to be making our argument for us, but I do not want to go on for too long, because I know that many hon. Members want to speak. Even more dangerous than the risk of non-compliance by patients would be if the use of CTOs were extended as an alternative to in-patient treatment, where that is desirable. Over the weekend, I published figures from the Department on the number of formal admissions under the Mental Health Act 1983. The Secretary of State has said that the Government want a shift out of hospitals and into the community. Well, the number of formal admissions has increased since 1997, while the number of in-patient beds has decreased by 20 per cent., including by 5 per cent. in the last year for which figures are available. With 63 per cent. of finance directors of mental health trusts saying that they are reducing their spending plans, the risk is clear. For financial reasons, rather than for reasons involving patients’ interests, early discharge from hospital will involve community treatment orders. Early discharge should never occur because a CTO is cheaper; it should occur only in circumstances in which patients should not be in hospital. Cost saving by limiting in-patient detention is another potentially serious risk. I do not understand why the Government oppose the Lords amendments to clause 24 on age-appropriate assessment, services and accommodation. They have said that that would not be available in an emergency, but clause 24 is perfectly clear about assessment in an emergency, when it might not be possible to provide such facilities. It is clear that what is required in terms of accommodation is what is sufficient for the needs of children and young people and that what is sufficient for the needs of children and young people might be different in an emergency from what might be available when there is more time. As I said to the hon. Member for Birmingham, Selly Oak, Ministers must accept that Parliament wants to make it clear that it is unacceptable for three children and young people a day to be admitted to adult in-patient facilities. That must stop, and we must find not only the means but the will to make it happen. I have mentioned the safeguards on revolving-door patients, and I find it astonishing that Ministers will not accept the Lords amendment, which seems to deliver precisely the kind of safeguard that Ministers have called for. On therapeutic benefit, the Secretary of State and I had an exchange on the issue of personality disorder. That comes down to the question of medical necessity—is it necessary for somebody to be admitted under compulsion? In another place, the Liberal Democrat Lord Carlile, who cannot be accused of treating lightly the protection of the public, quoted Professor Eastman, who is professor of law and ethics in psychiatry at the university of London and head of forensic and personal disorder psychiatry at St. George’s medical school. Professor Eastman has said:"““Therapeutic benefit to the individual is of crucial importance in terms of protecting the boundary of what is the business of mental health professionals. I am not at all against protecting the public, of course not, but it must be in conjunction with some benefit to the individual that goes beyond simply stopping them offending. If you adopt a definition of treatability which is simply the reduction of risk or the avoidance of offending, that means that locking somebody up is treating them.””" We do not agree with the proposition that locking somebody up is treating them. This is a health Bill, and it must be about treating patients successfully. We have to protect patients from harm and we have to protect the public, and improving access to and the effectiveness of mental health services is the best way to achieve that. In specific circumstances, compulsory detention and compulsory treatment in the community will be necessary. We have a responsibility in Parliament to define those circumstances with the greatest possible care. I have no doubt that those circumstances must be determined by the therapeutic benefit to the patient as well as the necessity of compulsion to prevent harm to others. We must not widen the scope of compulsion to such an extent that it threatens patients and drives them away from access to services and compliance with treatment. Conservative Members welcome the Bill as introduced in this House, and unlike the Government, we will vote for it on Second Reading while agreeing with its principles.