I am grateful to the hon. Lady for that intervention, but my point was that, under the existing regime, black and minority ethnic communities are treated disproportionately severely, and that if there is any increase in compulsion as a result of the Bill, there is every likelihood that those groups will be disproportionately affected by it. It is a question of logic. We must take the opportunity of this mental health legislation coming before Parliament to address the concerns about the way in which black and minority ethnic communities are treated, so as to ensure that mental health services do not discriminate against people from those communities.
I want to deal with the amendments passed in the other place which, in the view of the Liberal Democrats, must be preserved. First, there are the exclusions from the definition of mental disorder. The right hon. Member for Sheffield, Brightside talked about exaggerated language being used by those who oppose the Bill, but some of the exaggerated and misleading claims made by the Government have been enormously damaging to what should be a good, high-quality debate.
At the Local Government Association conference last month, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) said that"““by adding a range of unnecessary exclusions, the changes forced through by the Lords will inevitably open up new avenues for patients and their lawyers to use to try to secure the premature discharge for some of the most dangerous patients.””"
That is scaremongering. The exclusions are about making sure that the powers are not used inappropriately. Similar exclusions exist in most comparable jurisdictions, including Scotland, and there is no evidence of dangerous people roaming the streets as a result of those exclusions being put in place in the Scottish legislation.
I want to deal next with the amendments on impaired decision making. The Bill, as amended, prevents the compulsory treatment, including detention, of people who are fully able to make their own decisions about the provision of treatment. The Government claim that this will result in people who need treatment not being detained, putting them and others at risk. First, the Scottish legislation contains a similar provision and, again, there is no evidence of it causing a danger to individuals or to the public. Secondly, if someone with a physical health problem has the right to refuse treatment, should not the same rule apply to someone with a mental health problem? I think that the hon. Member for South Cambridgeshire (Mr. Lansley) made that point earlier. Thirdly, the Government’s own expert Committee, the Richardson Committee, supported an impaired decision making test, as did the Joint Scrutiny Committee. Fourthly, mental health clinicians advise that a person with a mental disorder who is suicidal or who poses a risk to others because of their condition would inevitably be found to have impaired decision making, and so come within the scope of the legislation. So the amendment is a safeguard of real importance to the citizen’s human rights, and does not leave individuals or the public at risk.
Next, I want to deal with the treatability test. The Minister made an extraordinary claim on this in her speech to the Local Government Association. She said:"““This safeguard has, on occasions, been misrepresented as meaning that patients can only be detained if they can be cured, rather than treated. This confusion has led to too many patients with personality disorders, which can be treated but not cured, being turned away from services.””"
If that is the case, the answer is surely to ensure that professionals interpret the law correctly, not to change the law in a fundamental and dangerous way. The amendment addresses the Government’s concern to ensure that someone with a personality disorder is covered by the Bill. It is a balanced amendment, and it should stay.
The Richardson Committee said that a health statute should authorise overriding patient autonomy only if there are"““positive clinical measures included within the proposed care and treatment which are likely to prevent deterioration or secure improvement in the patient’s mental condition””."
Again, the Scottish legislation uses the same therapeutic benefit test, and there is no evidence of disaster in Scotland.
The amendment on the renewal of detention is intended to provide a safeguard that is hard to dismiss other than on cost grounds. A medical practitioner would be required to examine the patient and to agree to their continued detention. Other health professionals have argued that the amendment goes too far, and we will take account of their arguments in Committee.
I join in the criticism of the Government for publishing research on the international experience of community treatment orders the day after the Bill completed its passage in another place, which I thought was extraordinary. We know that the report had been available for a considerable time. Why did the Government wait until the deliberations in another place had finished? Surely it is better to allow informed debate than to deny us valuable information.
The research revealed that there is little evidence of the positive value of CTOs. The Institute of Psychiatry concluded"““there is no robust evidence about the effects of CTOs on key outcomes, such as hospital readmission, length of stay, medication compliance, or the patients' quality of life.””"
The report advised that enhancing community services was a better way of improving compliance and reducing the incidence of relapse. Surely it makes sense to accept the argument for CTOs in a limited number of cases, along with the safeguards introduced by the House of Lords.
The Minister claims that CTOs are intended to apply specifically to those dubbed ““revolving door patients””: people who leave hospital, relapse because of failure to take medication, and go back into hospital. The amendment was designed to ensure that CTOs would apply to precisely those patients. CTOs can impose wide-ranging restrictions on patients—many have described them as ““psychiatric ASBOs””—and further amendments are needed to make them proportionate. It is important, for instance, to give patients the right to appeal to mental health review tribunals against conditions that have been imposed on them.
Amendments that give health bodies a positive duty to admit children and young people to age-appropriate settings, and to provide specialist assessment and supervision for detained children, are fundamental to a civilised society. The Secretary of State said that it was not possible to ensure that something happened by passing legislation. I wish that the Government had taken more note of that principle during the past 10 years, but in this instance we should surely set a standard. We must all accept that children should not be admitted to adult psychiatric intensive care units. It is nothing short of scandalous that one child or young person has been admitted to an adult mental health setting every day for the past three and a half years. It is also worth noting that the amendments are entirely in sympathy with the thrust of the approach recommended by the national service framework.
The issues that we are debating are of fundamental importance. It is essential that we get the Bill right. It needs to stand the test of time, and it needs to have the confidence of those who work in mental health services. It is remarkable how cavalier the Government seem to be in the face of overwhelming opposition from those with real expertise.
The Bill is not perfect. We want core principles to be set out in it, and I see no reason why that should not happen. I agree with the hon. Member for Stafford (Mr. Kidney) that those facing compulsion should have the right to an independent mental health advocate, and should be made aware of that right. But if the Government insist on driving through the removal of clauses added in the other place that provide safeguards for vulnerable individuals, they will make a very serious and dangerous mistake.
Mental Health Bill [Lords]
Proceeding contribution from
Norman Lamb
(Liberal Democrat)
in the House of Commons on Monday, 16 April 2007.
It occurred during Debate on bills on Mental Health Bill [HL].
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2006-07Chamber / Committee
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