Mental Health Bill [Lords]

I appreciate the opportunity to speak in this debate, Mr. Deputy Speaker. I very much welcome the Government’s proposals to reform the treatment of people with severe mental illness. I recognise that this is a difficult area in which to legislate, given the necessity to meet the needs of many different groups, but I believe that the Bill will make treatments more successful. Some Members of this House and the other place have criticised aspects of the Bill, especially the reforms to enforced detention and to community treatment on the grounds that they blur the divisions between patients’ rights, patient care and public safety. However, I would argue that we will never adequately resolve those complex issues unless they are discussed and understood together. One of the overriding reasons why the area is so difficult is that any legislation that we pass will affect so many distinct groups in our constituencies: patients, patient groups, medical practitioners working in GP surgeries and hospitals, our local authority social services working in our communities, and the general public. Taken separately, my instinct is to take account of the individual rights of all involved as far as possible, but with so many groups to accommodate and because of the nature of this area of law and the need for compulsion, it is our job to take an holistic approach to scrutinising the Bill, rather than to concentrate on the concerns and rights of any single group in isolation. The rights of patients to refuse treatment must be balanced with patients’ long-term interests and the interests of the public. Given the degree of complexity, all mental health legislation is inevitably a compromise. The 1983 Act was a compromise; the medical norms that have developed from that Act are certainly compromises; and the Bill, if it becomes law, will also be a compromise. What we must ensure is the freedom of local practitioners to work in multidisciplinary care teams, the freedom of GPs and psychiatrists to form a judgment based on their relationship with their patient and, crucially, the freedom of the patient to have easier access to mental health tribunals—something that my right hon. Friend the Secretary of State said the Government would work towards as a priority. Freedom on the ground will always induce fear that the powers will be misused. We cannot escape the fact that in this area of law such fears are inevitable, but what we are discussing is a system that allows the wishes of mentally ill patients to be overridden for a period by their perceived needs. By broadening the criteria for compulsion, the Bill would allow clinicians the freedom to work across the individual health problems of a patient. Psychiatrists could impose treatments regarded as appropriate, rather than only treatments that are likely to alleviate the specific severe condition of the patient. That is an important change, because it would allow psychiatrists to provide treatment for one mental health condition with the hope of alleviating another. It would, for example, be left to clinical staff to decide whether it is appropriate to treat patients who cannot be cured of their personality disorder, but who might benefit from the treatment of their depression or anxiety. With the correct safeguards, which the Bill provides, such powers give clinicians the freedom to provide better treatment for the sake of the patient and of others. The Bill is not about turning our doctors into jailers, as has been suggested in the other place; it is about giving front-line medical staff the flexibility to provide the treatments that they think are best. Opponents of the reform ignore the fact that mental health legislation is permissive: it allows doctors to do what they think is correct and appropriate in the circumstances. After all, no reform that we make can override human rights legislation that gives clinicians the final say. Supervised community treatment orders are the second major innovation in the methods by which clinicians could care for their patients. If we want to find a balance between patients receiving their care in the place that they feel most comfortable and medical practitioners being able to ensure the continuation of treatment so that patients are not condemned to repeated periods of ill health and hospital stays, we require a model for community supervision. Some have argued that treatment should be entirely for the benefit of the patient and that threats to the wider public should be dealt with by the criminal justice system, not by doctors. I would argue that there is a role for doctors to impose treatment on those who pose a danger to their own health and that of others, and that doctors are best placed to make such decisions. My fear is that if patients are not able to receive their compulsory treatment in the community—treatment imposed for the protection of their own health—clinicians will continue to be forced either to retain patients in hospital, or to risk the decline of their patients’ health in the community. Increased care in the community will, of course, be a challenge requiring adequate investment in local authority social services and multidisciplinary care teams, but the Bill gives us the opportunity to take great strides in improving mental health care in the community and providing those receiving compulsory treatment with a great say in how and where they receive it. If we are concerned about discrimination against the severely mentally ill, it is the Government’s duty to find a way to enable those receiving compulsory treatment adequately to exercise such choices. It is also the Government’s duty to allow patients to receive their treatment with the least disruption to their lives. Supervised community treatment would allow greater confidence that when patients leave hospital, treatment regimes will be adhered to and the patients will not be made the subjects of repeated readmission to hospital and periods of in-patient care. It is vital that the choice is offered honestly and that past failure to adhere to treatment in the community is not made a precondition of a supervision order. The Bill also redefines the key professional roles involved in care, allowing a greater degree of valuable multidisciplinary care to take place in the community. The introduction of the roles of responsible clinician and approved mental health professional will allow a range of clinicians from the fields of nursing, psychology, occupational therapy and social work to perform roles that are currently restricted to consultant psychiatrists. That will greatly strengthen the multidisciplinary model of care that has emerged in mental health services in recent years and will allow clinicians to work across disciplines in the way that is most appropriate to the patient. That view is strongly supported by Amicus, Unison, the British Psychological Society, the Royal College of Nursing and the British Association/College of Occupational Therapists, which represent many of the multidisciplinary clinicians and carers who, under the proposals in the Bill, would lead such care. I fully understand the fears of some local authorities, including Tameside and Stockport councils, which serve my constituents, that the changes might prove to be expensive. It is vital that resources be made available for reforms to local social care policies, but I am confident that the proposed changes to the legislation will be in the best interests of our constituents who are in need of community care for severe mental illness. What my right hon. Friend is proposing is that clinicians should be able to offer supervised community treatment in England and Wales as a matter of course, thus not having to wait until their patients have suffered damaging and repeated health decline in the community. As I have argued, we should not forget the aim of mental health law, which is to allow mandatory treatment to be given where necessary for the sake of the health of the patient and the safety of others. There is little point in such legislation if it does not enable clinicians to provide beneficial care to their patients without disruptive breaks in treatment. It is also important not to be transfixed by an orthodox interpretation of individual human rights. The short-term right to refuse treatment and the long-term right to receive appropriate care will often conflict in cases of severe mental illness. A balancing act will always be necessary in mental health law, but the Bill promoted by my right hon. Friend the Secretary of State offers us the best balance. There can be no doubt that that the law needs to be modernised. Widening the scope for treatment and allowing compulsory treatment in the community, as well as in hospitals, will benefit patients and communities alike. That is why I shall support the Bill tonight.