Mental Health Bill [Lords]

As many people have remarked during the debate, this is a complex Bill with a history of controversy, compromise and confusion. That is mainly because the plan to introduce a mental health Bill was replaced by the decision to amend the Mental Health Act 1983, and this has clouded the discussion of what the Bill is saying, as opposed to what many people want it to do, to say and to promote. I recognise the anxiety felt by families, carers and those with a mental health problem. With at least one in six of the population suffering from depression, anxiety or obsessive compulsive disorder at some time in their lives, one in 22 having a personality disorder, and one in 200 suffering from psychosis, with the resulting loss of contact with reality, mental health issues touch most families at some point and bring them into contact with our mental health services. It has been good to hear recognition across the House today of the Government’s improvements to mental health services. The range, availability and effectiveness of the services has certainly changed. Years of neglect are slowly being counteracted. I also recognise that an increase in budgets is not the only thing that will improve services. Training, new facilities and new partnerships need time to be put in place and to become effective. The Bill has achieved a high profile specifically because of the voluntary sector, which now receives a huge amount of funding to improve mental health advocacy, raise awareness of mental health issues and provide a new range of services. Organisations such as Hafal, the Mental Health Alliance, Mind, and my own Bridgend organisation, Mental Health Matters, are rightly eager to ensure that the Bill will provide the highest level of protection and rights to those who face compulsion at some time in their lives. Like others, I pay tribute to their unending commitment and creativity in providing a range of services to people who are mentally ill. Statistics cannot give a realistic picture of the pain, suffering and torment experienced by those with a mental health problem, and by their families and carers. I want to stress that. When considering the Bill, I have borne in mind the fact that, of the 300 people in every 1,000 who experience mental health problems every year in Britain, only six will become in-patients in psychiatric hospitals. In 2005-06, 27,779 patients were sectioned and would therefore have been considered for a community treatment order. The Bill relates to how we deal with the limited number of people who face formal admission every year. It is about strengthening patients’ safeguards and tackling human rights incompatibilities. It is not about improving access to services, expanding the range of community-based mental health provision, or handling housing problems caused by tenants with mental health problems. It is not about tackling mental health awareness. It must, however, signal the Government’s commitment to dealing with all those issues if it is to be effective and to reassure those who use mental health services. While only six of the 300 in every 1,000 people who experience a mental health problem are likely to face compulsion, failure to address these issues will lead to the vast majority of sufferers, and their families and carers, fearing that the services will not be there to meet their needs, to help their recovery, to keep them safe, to enable them to live in the community and to avoid compulsion. It has been alleged that the Bill is driven by media stories of murder and other violent crimes committed by people with mental health problems. There are fears that it is heavily biased towards extending the powers of compulsion and control. I believe that many of those fears have been addressed by changes in the Bill, including a list of exclusions, clarification of impaired decision-making and the use of places of safety and time limits in the context of renewal of detention. Others have already highlighted the fear and anxieties of families such as one in my constituency. A family member was murdered by her husband, who had a mental health problem. The family were frustrated by a system which they felt left their sister vulnerable. Within a very few years of her murder, her husband was seen in the local community in the company of a nurse. The family felt betrayed and insecure, not knowing whether this man would be in their street, shop or pub. They were angry that they had not been consulted about community rehabilitation plans, or made aware of an appeal to the mental health review tribunal. They, and I, feel strongly that victims’ families should have such rights. Like others who have spoken, I welcome the duty placed on health authorities to admit children to age-appropriate settings, and to provide specialist assessment and supervision for detained children. My constituency has the highest suicide rate among young males in Wales. I have spoken to parents of young people who are afraid of being returned to adult wards that are frightening and threatening and increase their vulnerability at the time of greatest need. Many years ago I lodged an advance directive with my GP. I set out the limits to treatment that I wanted to establish in the event of my losing capacity. I believe that those who are mentally well should be able to write an advance directive nominating the person whom they wish to act as their nearest relative, primary carer or advocate, specifying people with whom information can be shared by medical practitioners, and giving directions about future treatments. Such documents should be taken into account by those making decisions on the provision of treatment and on compulsion. An advance directive gives individuals a voice at a time when they may well be unable to speak for themselves in their own best interests, and can reduce anxiety for patients’ families and friends. For a time I managed a specialist health and social services project for people with dementia. Joint assessments were made by the community psychiatric nurse and me when people were referred to our service. Our assessments and conclusions were different, reflecting our different training and perspectives, but they were better assessments for being joint. I fear that there will be a risk of ““medicalisation”” of assessments if the social workers and two doctors are replaced by a range of health professionals and a responsible clinician, especially if they work in the same mental health team. I hope that care will be taken in the training provided for that new role, and that advocacy of the service user’s perspective will not be lost. It is in the best interests of the Bill for the fundamental principles to be written into it, and the status accorded to the code of practice clearly identified. I believe that that will reassure users, carers and mental health professionals about the ethos on which mental health services are predicated. It will provide evidence of the Government’s commitment to improving services consistently in line with those principles, and demonstrate their commitment to the mentally ill while also protecting the public. As I have said, the Bill deals only with the very small percentage of people who require compulsion. We should not forget that it is aimed at that small percentage of people with severe mental health problems. It is sad that much of the debate, and the anxiety that has been created, relates to issues outside the areas covered by the Bill. We have sometimes been sidelined into discussing things that are missing from our mental health services, rather than the good aspects of the Bill and the safety and security that it provides for people at their most vulnerable. I trust that the anxieties expressed by Members today will be discussed again in the Committee on which I hope to serve.