Mental Health Bill [Lords]

It is not surprising that the Bill has proved controversial. After all, we are dealing with contentious issues of liberty and personal responsibility, and we have been asked to determine in what circumstances anyone with a mental disorder should be detained against their will. Those and other issues have been the subject of debate since the Government announced their intention to introduce new legislation in 1998. During the Bill’s controversial passage through the other place, their lordships sought to address those problems where they still believed that an individual’s human rights were at issue. As elected Members of Parliament, we need to take into account, too, legitimate public concerns about safety. However, given the importance of this area of legislation, it is essential that we find a way forward that addresses the concerns of all parties. We need legislation on the statute book that is, and will be, suitable for our communities in the 21st century. A stand-off between the two Houses on the issue would not be helpful, and we can achieve our aims by considering the way in which the Lords amendments would work in practice, rather than in principle. I am not a lawyer, but I trained as a psychiatric social worker, and worked as such for many years before moving on to different things. I should like to consider the Bill from the perspective of the approved social worker—or the approved mental health professional under the Bill—who sets up and undertakes with doctors the assessments that determine whether or not someone needs to be admitted compulsorily under the Mental Health Act 1983. Approved social workers are highly trained and skilled professionals who act independently and are personally and legally accountable both for their decisions and for the safety and well-being of the service user who has been sectioned until they are accepted on a ward by nursing or other staff. How will the amendments to the definitions of mental disorder and treatment for it help or hinder that process of assessment? I have looked at the original Bill and the Lords amendments in relation to the criteria for compulsory admission from the community, particularly the issues of ““medical treatment”” and ““impaired”” decision making. The original Bill talked about the availability of ““appropriate medical treatment””, whereas the Lords amendment used the words,"““medical treatment…likely to alleviate or prevent deterioration””" in the patient’s condition. In both cases, the term ““medical treatment”” has the same broad meaning. It includes medication, nursing care, habitation and rehabilitation, as well as psychological treatment or support. One focuses on the notion of availability of ““appropriate”” treatment, and the other on its likely benefits, but are those two notions very far apart? If the treatment available would not help the patient by alleviating or preventing deterioration in their condition, can it be said to be appropriate? It appears to me that the issue involves interpretation rather than the words themselves. The Lords have also inserted a new condition into the provision on criteria for formal admission for consideration in the assessment:"““because of his mental disorder, his ability to make decisions about the provision of medical treatment is significantly impaired””," which, of course, refers to the patient. In my experience, the amendment reflects exactly what already goes on with Mental Health Act 1983 assessments, where doctors and approved social workers use their skills and knowledge to ascertain through the assessment process whether the person before them is, in effect, unwell and in need of treatment or care, or whether the person should be given choice and take responsibility for their actions and decisions. I want to provide the House with an example. I spent last Wednesday in the company of approved social workers and observed a mental health assessment in a police station. The gentleman concerned had been picked up by the police at 8.30 after a complaint from a neighbour, and the forensic medical examiner expressed concerns about him and asked for an assessment under the 1983 Act to determine whether he needed assessment or treatment and whether he was fit for interview. During the mental health assessment, he was asked questions to establish the nature of his relationship with the complainant and his understanding of why he was in a police cell. The professionals probed his belief system and his emotional state and sought to determine whether there was an underlying psychosis, depression or anxiety state and the level of risk that he posed to himself, to the person who had made the complaint against him and to the wider public. Although the professionals were clear that the man had a level of mental disorder, when they discussed the issue between them, they concluded that it was not so bad that they needed compulsorily to detain him and that he should receive treatment on a community basis. The outcome of such an assessment is likely to be the same, whether or not the Lords amendment is accepted. As I have said, we can set the boundaries within which professionals make their decisions about assessment, treatment and responsibility of people who experience mental disorders. We can also—the Government, to their credit, have done this—regulate to ensure that the professionals who are involved in those essential decisions have the knowledge and skills to make informed, professional decisions. Having ensured that, we must then trust the professionals to make such decisions to the best of their abilities. However, we must also ensure that the professionals whom we ask to undertake assessments on our behalf and on behalf of society as a whole have the resources to do so safely and in a timely manner. Department of Health figures show that 27,353 patients were compulsorily admitted from the community to NHS facilities and independent hospitals under part III of the Mental Health Act 1983 and other legislation in England in 2005-06. As I have said, the approved social worker is responsible for organising the assessment, but the responsibility is greater than that—they have to apply to courts for a warrant if the person will not let them into their home to undertake an assessment, make judgments about whether to involve the police in the assessment process, consider how quickly the assessment should take place, consult other professionals and family members about their views and, ultimately, make an independent and balanced decision whether admission to hospital is, given all the circumstances of the case, the most appropriate way forward. They decide whether or not to apply for a formal admission, and if they decide not to apply, there will be no admission. The process of admission can be fraught, but representations from approved social workers via the British Association of Social Workers and the ASW national leads network suggest that the situation is being made worse by problems with the way in which resources are managed. I have mentioned my day with the approved social workers in central London, but I did not mention that when we left the office last Wednesday there were two other mental health assessments that had been waiting since the previous Thursday, which was before the bank holiday weekend, for police support to be available to enable them to take place. That was because the person requiring assessment was known to have been aggressive or had used threatening behaviour, and the ASW and the doctors could have been at risk without police support. There is also the issue of perhaps having to convey an unwilling patient to hospital. That delay of almost a week for police support could have had very serious consequences for the people who needed assessing and those around them. Other issues are involved in the assessment process, such as the identification of the bed and the availability of ambulances. The British Association of Social Workers points out that although the individual approved social worker has responsibility for managing the assessment process, for making informed and professional decisions about whether to admit someone, and for the safety and well-being of the patient from the time that they sign the section papers to the moment the person is admitted to hospital, the resources they need to complete their tasks are not within their control locally. The Government have said that those issues, including police time, are best dealt with through local arrangements. I hope that in recognising some of the present difficulties there will be consideration in Committee on how to give guidance about what local arrangements Ministers believe should be in place to protect the individual and the public by ensuring that where admissions to hospitals are necessary they happen in a safe and timely fashion. The Government have made great progress in the provision of mental health services—not an easy area in which to legislate or to work. I hope that the Bill has a constructive passage through the remainder of its legislative process.