Mental Health Bill [Lords]

The other place has a reputation for well-informed debates, but I have been struck by the level of expertise that hon. Members have shown today, sometimes speaking from painful personal experience. I pay tribute to all those who work in community, day-care and hospital mental health services in my constituency and elsewhere. They work very hard in a challenging area of health care where their occasional failure is often leaped on by an unforgiving media while their frequent success is much more rarely mentioned. I share many of the concerns of other hon. Members, including my hon. Friend the Member for North Norfolk (Norman Lamb), about the initial version of the Bill. I have been strongly lobbied on some of its provisions by constituents, one of whom said:"““Please do whatever you can to stop the Government’s proposals in their tracks and get a law for England and Wales that’s as fair as the law in Scotland.””" However, as the Minister knows, I also share some of the concerns that led to the Government presenting the Bill in its original form, particularly in relation to people with personality disorder, who have suffered from the fatal combination in the Mental Health Act 1983 of very specific definitions of mental disorder and illness and the treatability test. That has led to people with personality disorder being denied treatment, whether in line with the law or, as the hon. Member for Buckingham (John Bercow) noted, based on a misguided view that the condition cannot be treated. The current law is, by common consent, flawed, but the need to guard the civil liberties of some of the most vulnerable citizens in our communities means that any amendments to it must be carefully worded. That will be a difficult task, particularly in the case of personality disorder, even the definition of which is difficult to grasp. In the words of Mind,"““Slotting people into neat categories is almost impossible, because each individual is unique and personality is very complex. It’s a mistake to assume that giving people a diagnostic label means knowing more about them, and it’s too easy to use these terms in a judgemental way.””" That was certainly so in the circumstances that applied in the case—now, I am afraid, the very public case—of one of my constituents, a young man called James Green. It seemed to me that he was unable to access the treatment that he needed because, in a sense, he did not have a proper mental illness, having been diagnosed with personality disorder. I should like to take a moment to pay tribute to the care, dedication and perseverance of the Green family—Les and Jackie, James’s parents, and particularly Daniel, his brother, who has championed his case tirelessly. James had a long history of difficult, sometimes very aggressive behaviour involving self harm and of threats to harm his family. As he grew older, he increasingly said that voices were telling him to harm himself and his parents, and he wanted to be admitted to somewhere where he would feel safe. Again and again, though, the situation was that his medication was reviewed and even if he was admitted for a short time he was returned to his family, sometimes with community support but making life increasingly difficult for them. In July 2005, James set fire to his house, endangering the lives of his parents and his neighbours. He was prosecuted for arson and recklessly endangering life and sentenced to seven months in prison. That was the beginning of a prolonged relationship with the criminal justice system. Court-appointed psychiatrists examined James repeatedly and diagnosed personality disorder. An assessment in December 2005 clearly concluded that he did not have an acute, chronic or serious mental illness but that he nevertheless ran a ““high risk”” of harming himself and others. Another stated,"““no mental illness, borderline learning difficulties, personality disorder. Immature, impulsive, substantial risk of re-offending/self-harm.””" Yet the judge in the case found it almost impossible, despite repeated adjournments to seek professional advice, to locate an appropriate setting where James could receive treatment. During that time, I met the partnership trust with James’s brother, Daniel, and it said that there was a legal framework for treating mental illness but that James appeared to fall outside it. On one occasion, it stated that it believed it"““most appropriate for any consideration of his health and social care needs to be seen within the context of his current offence and resolution by the courts.””" It became clear to me that Gloucestershire probation service and Her Majesty’s prison at Gloucester were familiar with dealing with people with personality disorder. I discovered a psychiatric morbidity survey among prisoners, which revealed that 78 per cent. of male remand prisoners had some form of personality disorder. We have effectively handed over the care of many people with personality disorder to our prisons and our probation services. It is typical that James’s case reaches something of a climax tomorrow when he appears before a judge for sentencing, not before a doctor for treatment. However, the family hopes for the outcome that his assessment and treatment at a unit called Kneesworth house in Cambridgeshire will become a more permanent arrangement. James has—eventually—benefited from treatment, which has been more psychological than pharmaceutical. I compliment the staff at Kneesworth on their work with him. They have demonstrated two fundamental truths. First, no one should be excluded from treatment because of the form of words used in their diagnosis. The Bill, even as amended, appears to prevent such exclusion. It is clear that it covers personality disorders. The draft illustrative code of practice, which would not be affected by the amendments, clearly specifies that personality disorders will be covered. Secondly, Kneesworth has demonstrated that, even with difficulty and after years of trying, the current system can provide treatment, with a treatability test in place. The Bill, as amended, would provide a much better and clearer legislative environment, in which we all agree that people with personality disorder should get the treatment that they need. I said earlier that amendments to law needed to be carefully worded. Such amendments have come from the House of Lords. On the definition of mental disorder, amendment No. 3 stated:"““For the purposes of subsection (2)… a person shall not be considered to have a mental disorder… on the grounds of… substance misuse… sexual identity or orientation… his commission, or likely commission, of illegal or disorderly acts… his cultural, religious or political beliefs.””" It is difficult to see who could take exception to that. It would not have prevented James Green from obtaining treatment and it does not reintroduce the narrow definitions of mental illness that the 1983 Act contained. The amendment on the treatability test would reintroduce the words of the original Act but would not enforce a narrow test. It simply states that, for a treatment to be provided, it must be at the very least,"““likely to prevent a deterioration in””" someone’s ““condition””. The condition does not therefore have to be perceived as curable or definitely treatable. The treatment does not have to be guaranteed, simply ““likely””, to be beneficial. It is difficult to understand how that could possibly have denied someone such as James Green treatment. If that modest test is not passed, how is compulsory treatment distinguishable from detention without treatment? In Rethink’s rather blunt words:"““Hospitals are not prisons. If people are detained for non-health purposes, it must be through the criminal justice system.””" The Royal College of Psychiatrists agrees. It described the Lords amendments as ““very sensible amendments””. It even stated that they would have public support. It conducted a poll in the south-west of England, which found that 75 per cent. of people"““do not think that people with mental health problems should be forced to have treatment from which they cannot benefit.””" I have talked to not only doctors and psychiatrists but the Green family about the amendments that were tabled in the other place. Daniel Green studied them before I even spoke to him. Neither he nor I can understand why they pose any risk to people with personality disorder getting the treatment that they need. I hope that the Government will realise the potential for building cross-party consensus on such an important Bill.