Mental Health Bill [Lords]

I have a long-standing interest in mental health having recently been a member of the Joint Committee that found the Government’s 2004 draft Bill to be ““fundamentally flawed.”” I was involved in the education and training of social workers for 15 years and, before that, I was a mental health social worker—one of the first to be approved under the Mental Health Act 1983. Methuselah-like, I also worked under the Mental Health Act 1959 for seven years and sectioned under the very old system. I have applied for compulsory admission many times, including while working in extremely difficult circumstances as a member of an out-of-hours night duty team. In my opinion, compulsory admission is essential in some circumstances, but it is a frightening and demeaning experience for the individual concerned and often has profound effects on professionals, sometimes with regard to their physical safety. Almost any attention to mental health is welcome. I really do not want to hear the resigned admission from professionals that mental health is yet again the Cinderella of the NHS. After all, Cinderella got to go to the ball and the prince to boot, but that is not what has usually happened in mental health. New spending, some of which the Secretary of State outlined, is welcome, but in Wales, as I pointed out in an intervention, we are still far behind the situation in England, with some people reckoning that we are four years behind. We still have some Victorian facilities. For decades, mental health has been denied proper resources that would turn the promise of new drug and behavioural treatments into a reality of a sustainable life in the community for people with severe mental problems. The reform of mental health legislation is thus long overdue. After all, Professor Richardson, who convened and ran the specialist group, began her work in the last century—more than eight years ago. I share the general disappointment of the Mental Health Alliance and others about the Government’s successive efforts to formulate a worthwhile and workable Bill. After all, the draft Bills—miraculously, almost—managed to unite nearly all interested parties in opposition, including the royal colleges, Hafal, which is the mental health alliance in Wales, the British Psychological Society and the local Mind groups that I consulted in the Rhymni valley and in my constituency in Gwynedd. They were all against the 2004 draft Bill, which one gentleman described as a ““mad axe man Bill””. Others complained less colourfully that the Bill, at least as it was then framed, might just about calm some of the headline writers. As we know, stranger murder, which is so beloved of the tabloids, is thankfully very rare. The number of homicides has gone up over the past 20 years, but, as was pointed out earlier, the proportion of homicides committed by people with mental illnesses has remained constant. However, when there is any assault involving a mental illness component, a great deal more needs to be done to attend to the victim’s needs, or, sometimes tragically, the needs of those who are bereaved. I say that as someone who represents a family that has suffered in one of the most high-profile cases, which is often cited, but cited thoughtlessly. I would, however, apply the same principle of care for the victim to cases that do not have such allure for journalists of a certain type. The focus of the 2004 draft Bill was compulsory detention and treatment, as is the case with this Bill, along with community supervised treatment. The vast majority of people with mental problems are in no need of detention or compulsory treatment. They pose no danger to anyone except sometimes, tragically, themselves. Rather, they face the problem of accessing assessment and treatment in the first place. Hafal correctly points out that there is a right to assessment in Scotland—I leave that thought with hon. Members. However, this long-expected Bill, which it is assumed will last for 25 years, does nothing for the vast majority of people with mental or emotional problems. In that respect, the Bill is a colossal lost opportunity and, worse, it risks stigmatising such people. The Government seem to presume that it is possible more perfectly than is the case to identify those who constitute a danger to others so that they can be detained. As the Royal College of Psychiatrists points out,"““the prediction of risk whether done by actuarial or clinical methods is at best an inexact science””." The Department of Health states that in the past eight years, there have been about 400 homicides in which mental illness has been a component. However, about a third were carried out by people who had been judged not to be a risk just days earlier—this is not an exact science. I need say only that the vast majority of professional people in the field do not share the Government’s presumption. Indeed, if the Government’s intentions are enacted, we will run a real risk of detaining a number of people who do not constitute a risk to others, while having no guarantee that some of those who constitute a danger will not be out in the community. That would be the worse of two worlds. Much has been said about treatability, and the treatability test is there for a good reason. Treatment has developed, and cognitive behavioural therapies and assertive outreach are employed by talented individuals. However, it is clearly the view of professionals involved that the treatment of personality disorders is usually not possible. Incidentally, I fear that more coercive measures will have the effect of putting off some people from accessing mental health services in any way at all. Such measures might thus have a perverse effect. I have seen at first hand the dehumanising and institutionalising effect of detention in a mental hospital with no therapeutic effect. We have already been there and done that. The advances in drug therapy in the 1950s allowed large hospitals to be closed. However, their closure was also driven by a humanitarian appreciation of the pointlessness of the experience suffered by many long-term patients. Many lives dribbled away to no point, such as those of seven ladies whom I met one day in the back ward of a hospital. They had clocked up between them more than 350 years of hospital life for being moral defectives—for having babies out of wedlock in the 1930s. If we are to admit people to hospital against their will when they are not capable of being treated, or at least deriving a therapeutic effect, the condition of some who are untreatable on their admission might not change throughout their detention. On what possible basis could they be discharged if there was no change or the treatment did not work? Would we not be in danger of locking people up indefinitely? As Professor Richardson said, we are in danger of compulsion being a lobster pot—easy to get into, but very difficult to get out of. I fear that the Government’s proposals will lead to people being detained who are then unable to be treated and discharged. In this case, the Government need protection from their own folly. Compulsory supervised treatment in the community should be possible only when appropriate treatment is available. That is an especially important point for rural Wales—and, no doubt, elsewhere—because of the remoteness of treatment centres. Complying with a community treatment order for a person in a city, where the treatment centre might be a journey by bus of only a few miles, would be quite a different proposition than doing so for a person in Pwllheli, in my constituency, where the local hospital is 30 miles away, or even in Aberdaron, which is 17 miles further on. The same could be said for much of rural north-east and south-west Wales, as well as rural Monmouthshire. Other aspects of the Bill have a particularly Welsh dimension. For example, there is a disparity between the thrust of the Bill and standard 2 of the Wales national service framework, which is titled ““Service user and carer empowerment””. I hope that the Welsh Assembly will ensure that communication through the medium of Welsh will be available. It is a long-established principle that someone before the courts in Wales should be able to use Welsh ““without hindrance””, to use the formulation of His Honour Edmund Davies. People covered by the Bill should be able to use Welsh freely because freedom itself might be at risk. Equally, in the case of compulsory detention, a full apprehension of the meaning of words and the way in which they are used will be essential because someone’s freedom might be at risk.