Mental Health Bill [Lords]

Time is short so I will not go into some of the details of mental health issues in Hackney. I managed to mention some of them in an intervention. People in Hackney are three times more likely to be admitted to hospital with schizophrenia than people across England as a whole. I highlighted in my intervention particular issues about people from black and minority ethnic communities. Although that was the reason why I began to look in detail at the Bill, this is not the Bill that tackles those many concerns. However, the Bill does deal with the important area of compulsory treatment and how and when it is applied. I have had the opportunity to canvass opinion from a wide range of sources and I pay tribute to the people I spoke to for their time and expertise. In particular, I pay tribute to Hackney Mind and the service user group there, and members of the staff of the East London and The City University Mental Health NHS Trust, including nurses, approved social workers, consultants and other mental health professionals. I also pay tribute to some people who have not been mentioned so far in the debate: tenants, residents and housing managers, who have to deal a lot with the reality of mental health issues on a daily basis. Because time is short, I am going to focus on only two issues in the Bill. I hope that, if I am lucky enough to serve on the Committee, I will get the chance to probe these and other issues in more detail. The first issue is the compulsory community treatment order, which is one part of the Bill that I welcome. Treatment on the basis of need is a principle that pervades the national health service. Even when consent is not possible, because somebody has not got the capacity to identify their need, that treatment should still be forthcoming. That basic principle protects patients with mental health problems. The patients and service users that I spoke to had mixed views about the matter, as one might expect. The main concern of mental health users that I spoke to was to ensure that the care package, whether it be voluntary or compulsory, was properly delivered. There is further debate to be had—but again the area is not properly part of the Bill—about the way in which care packages are delivered. I hope to go on to that in more detail in the second half of my comments. I will give some comments from users themselves, because their voices have not been heard enough in the debate. One of them said to me: ““At least in hospital there is monitoring, but in the community you can feel lost.”” Possibly with compulsory community treatment orders that feeling of being lost may be addressed. Someone else said: ““It would be better if people were not going to hospital so often.”” That individual’s view was that, if compulsory treatment in the community was forced upon them, that would be better than being forced to go into hospital. That comment came from somebody who had a mental health problem and who, when she was not in her worst condition, was aware of the problems and had the capacity to judge her situation. Others had concerns about being forced to take medication—because of the bad side effects. That is obviously a huge issue for people who have to suffer the many uncomfortable side effects of medication. One person said that, in her case, medication may quiet the voices, but it caused a range of problems for her. There is a place for compulsory community treatment orders, but it depends on the individual. That was the message that came loud and clear from service users in Hackney. Interestingly, the overriding view of the service users that I spoke to was that, when someone needed police involvement in their case, there was therefore a strong case for compulsory treatment. When I spoke to people—not just in Hackney—in the course of my research it was interesting to note that, in effect, compulsory treatment currently exists and is allowed under case law. Under section 2 of the 1983 Act, people can be detained for 28 days, and under section 3 for six months, in hospital. But then they can be released on long leave. Long leave presents people with the possibility that they may be once again admitted to hospital. In effect, clinicians are addressing the difficulty of not having compulsory community treatment orders by finding ways through that, through case law. If we get things right in the Bill, it will make it easier for clinicians to provide that option and that choice. Talking to professionals, they said that, depending on the relationship the team had with different individuals, the option was sometimes sold as a method of support and sometimes it represented the strong arm of compulsion that was necessary to ensure that people got the treatment that they needed. I have already quoted the consultant who talked about a section being an act of kindness. He and others I spoke to who deal with the issue of sectioning and compulsory treatment on a daily basis believe that, in place of hospital, compulsory treatment orders are a useful and important option, as long as there are safeguards. I am sure that, in Committee, we will look in greater detail at those safeguards. The consultant that I quoted went on to say that the paperwork involved in sectioning was a great discipline for clinicians to justify their decision. I hope that, in any future compulsory treatment that is introduced, that will equally apply. Among approved social workers and community psychiatric nurses, there was concern—it is a concern that has not really been addressed so far in the debate—about the risk to staff of applying compulsory treatment in the home. I hope that the Minister will look into that. It may not be something that comes up in the precise, narrow aspect of the law that is contained in the Bill, but it is nevertheless an important issue. If we are to introduce a Bill that is workable, we need to consider how compulsory treatment will apply. It may be that, in a lucid moment, the patient is aware and wants to have the compulsory treatment, and that the family and other carers may support that. However, if there is an issue about how the treatment is applied in a patient’s home, for example, we need to look carefully both at the rights of the patient and the safety of the staff involved. It is clear from talking to both patients and professionals that it is chaotic people who prefer self-medication, but then do not take it. They are often at great risk themselves, but they also put staff at risk. I want to highlight one example from the point of view of residents in my constituency. A tenant leader rang me in some distress because a neighbour of hers in a small estate was behaving rather erratically. It was clear that the individual had mental health problems. The neighbour was not judgmental. She herself had suffered from mental health problems in the past. At one point, though, the individual was running round the estate with no trousers on. In a worst case scenario, without proper treatment in the community or in hospital, that could have led to the individual being put on the sex offenders register. As far as any of us were aware, that was not the issue for that individual. It seems that sometimes compulsory treatment can protect a patient from worse scenarios and perhaps inappropriate criminal treatment. That is important. It is in the best interests of the individual, his neighbourhood and the other people he has contact with that he gets the treatment he needs. That is not to say that the crisis teams and the current approach to sectioning are not important as well. I pay tribute to those who work in the crisis teams in Hackney, who deal with the sharp end of the issue. The other key issue that I want to touch on is advocacy. I feel strongly about this matter, partly because of my experience in a different area as an advocate for someone with a learning disability and my awareness of the difficulties of getting through the system. I have not really got time to go into the issues of advocacy in general, but, particularly in relation to the compulsory treatment element of the Bill, it is vital that advocacy is included. I give the Minister notice that, if I am lucky enough to serve on the Committee, I intend to table amendments to try to make sure that advocacy is better enforced and part of the Bill. Professionals agreed with me that there was a need for more advocacy, although interestingly they had different views about what advocacy should be. Under the Mental Capacity Act 2005, Hackney was granted only £40,000 for the whole borough for advocacy. Clearly, there is a resource issue involved as well. If we make sure that advocacy is written into the Bill— to protect patients who are having compulsory treatment—we should also make sure that the resources follow. That is important. In Hackney, as well as the need for mental health advocacy, many mental health patients have complex needs in relation to language and literacy. Mental health advocacy in a constituency such as mine is particularly important. The East London and The City University Mental Health NHS Trust is currently working to give service users a greater say in their own treatment. That is clearly the best form of advocacy. But the Revolving Doors Agency—I should declare an interest, because my husband is a patron of the agency—says that half of the people that it is involved with are dealing with six to 10 agencies. Its view is that a lot of people in the criminal justice system are there not primarily because of their mental health, but because of the level of chaos in their lives created by their health needs. For example, they have no GP so therefore no incapacity benefit. Without incapacity benefit, they have no housing benefit. With no housing benefit, they have no hostel or they lose their homes. A lot of things are missing in the system if we do not get that advocacy in place. I hope to expand on some of these issues in Committee.