Mental Health Bill [Lords]

I am sorry that the hon. Member for East Worthing and Shoreham (Tim Loughton) ended a thoughtful and sometimes lively debate with a rather mean-minded speech. The debate has emphasised the importance of the Bill and its great sensitivity in dealing with the difficult matter of the law governing people who have a mental illness that has become so serious that they have to be detained, either for their own safety or for that of others. The figures are stark. Each year, 1,300 suicides and 50 homicides are committed by individuals who have had contact with mental health services. Today’s debate has illustrated how controversial the subject is, and I am the first to admit that it is one on which it is difficult to find consensus, but after almost eight years of debate on reforming the current legislation, the Government have listened and compromised. I pay particular tribute to the work of the pre-legislative scrutiny Committee, which expressed concern about the length and complexity of the previous draft Bill, which is why we produced the much shorter amending Bill which is before the House today. It is important to see the Bill in the context of the much wider investment and inclusion policies that my right hon. Friend the Secretary of State mentioned in her opening speech. They include £1.5 billion more spent on mental health each year than was spent in 2001, 14,000 extra staff, 700 new community teams and a range of measures to improve inclusion in society of those with a mental illness. However, as well as improving services, it is important to make sure that our mental health legislation is updated and modernised. That is one of the points on which consensus has been reached. Those who have contributed to the debate have made several important points. The hon. Member for South Cambridgeshire (Mr. Lansley) acknowledged the increased investment and paid tribute to the staff, as did the hon. Member for East Worthing and Shoreham. I hope that they will support the amendments that we want to make to the Bill as it has emerged from the other place to restore the multidisciplinary approach. As the Bill stands, every decision will have to be referred back to doctors. The changes that we want to make have the support of Unison, the Royal College of Nursing and the British Psychological Society, so I hope that the hon. Gentlemen will join us in reversing the changes that were made in the other place. My right hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) spoke of the importance of advocacy and getting services right for young people. He paid particular tribute to the work of Jayne Zito and the need to ensure that victims have proper protection. I am sure that we will return to that in Committee to make sure that we do everything necessary to help victims. The hon. Member for North Norfolk (Norman Lamb) talked about issues relating to the black and minority ethnic communities. Through the ““Delivering Race Equality”” project, which we are undertaking now, it is important to ensure that there is no stigma or discrimination against people from BME communities. The hon. Member for Tiverton and Honiton (Angela Browning) spoke about autistic spectrum disorders and the Bournewood clauses. I know that she has a special interest in those subjects, and I am sure that we will return to them in Committee. I hope that she will be a member of the Committee. My hon. Friend the Member for Hendon (Mr. Dismore) referred to the points made by the Joint Committee on Human Rights, which he chairs. I have responded to him in a letter and we shall give those points further consideration. The hon. Member for Buckingham (John Bercow) normally makes extremely well considered speeches. He made several important points today and I shall refer to his comments about treatability, but I am concerned about his use of the phrase ““catching people.”” The Bill is about getting treatment to people—not catching them, but ensuring that the people who need it get treatment. My hon. Friend the Member for Stafford (Mr. Kidney) talked about putting principles in the Bill. We returned to that issue, but it has been difficult to put principles in it, because it is an amending Bill. However, what we have done—we have reached agreement with the Opposition in the House of Lords on this—is make sure that the Bill refers to the factors that would be taken into account, in terms of the code of practice principles. I hope that when he looks at clause 10 he will realise that it addresses some of the issues that he raised. My hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) gave a moving account of experiences in her constituency and made important points about advocacy. I know that she feels extremely strongly about the subject, and I am sure that we will return to it in Committee. The hon. Member for Caernarfon (Hywel Williams) talked about his professional experience and the situation in Wales, and my hon. Friend the Member for Rhondda (Chris Bryant) made a moving speech about his personal experiences. I understand that he is running the marathon for Mind, and I congratulate him on that. He talked particularly about exclusions, as did the hon. Member for Wyre Forest (Dr. Taylor). Many of the exclusions inserted in the other place have to do with culture and religion, but culture and religion are not mental disorders. That is why it is inappropriate for them to be exclusions. However, the issue of sexual deviancy was included in previous legislation. There were times when unmarried mothers who had babies were detained because that was felt to be a mental disorder, and homosexuality was considered a mental disorder, too. However, there have been issues around paedophilia, and that is why we need to remove the exclusion for sexual deviancy. The hon. Member for Windsor (Adam Afriyie) made a considered speech about stigma. My hon. Friend the Member for Stockport (Ann Coffey) made a number of points about local arrangements, and there are matters that we need to discuss in Committee about guidance that we can issue. The hon. Member for Cheltenham (Martin Horwood) spoke of his constituency case, and I have met the brother that he spoke about. The case illustrates some of the difficult issues that families face in such circumstances. My hon. Friend the Member for Bridgend (Mrs. Moon) acknowledged that the Bill is not about services, but about how important it is to take a multi-agency approach, and the importance of taking the views of carers into account. The hon. Member for Broxbourne (Mr. Walker) started off by making a thoughtful speech about stigma and Members of Parliament, but I was taken aback by the fact that he was derisory about an article in The Daily Telegraph that said that if the Bill saved lives, people should vote for it. My hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) talked about the nearest relatives, and that is an important subject that I am sure we will return to in Committee. The hon. Member for Rochford and Southend, East (James Duddridge) talked about his local trust, and the importance of people accessing services. My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) talked about the importance of letting clinicians make decisions, and that is a significant point that I wish to address with regard to the general issues that have been raised, especially by Opposition Members. First, on the treatability test, it is without doubt true that the fact that the treatability test is in the Mental Health Act 1983 has prevented the development of certain services, particularly those for people with personality disorders, and has led to people being turned away from services. A woman came to see me as part of the Mental Health Alliance lobby, and the first thing that she said to me was ““Rosie, I have a multiple personality disorder, and I keep being told that I can’t be treated.”” We have to get rid of the treatability test to prevent people from being turned away. Baroness Corston, in her report on the Mental Health Bill, said that she welcomed getting rid of the treatability test because of the number of women who ended up in prison as a result of not being treated for personality disorders. The appropriate medical treatment test that we have inserted is stronger, because for the first time it gives legal status to the provision of appropriate and available medical treatment. Turning to supervised community treatment, many hon. Members asked for evidence of independent inquiries that had discussed the need for such treatment. The inquiry into John Barrett’s treatment said:"““In our view, the only means of securing John Barrett’s compliance with treatment as an out-patient would have been a community treatment order, which is not available under the Mental Health Act.””" That is why we need to make sure that community treatment orders are available, not only to people who are a danger to others but to people who are a danger to themselves. We know from the evidence that we published last week that 56 people who committed suicide last year could well have been saved if they had received supervised community treatment. It is not right that the Lords amendments should say that someone should have two relapses before such treatment, as someone could have a history of voluntary in-patient non-compliance with treatment, so they should not be required to fulfil the same conditions as an out-patient. Finally, on impaired judgment, the examples that I am given most often are of young women with personality disorders who have suffered terrible emotional, physical and sexual abuse, but who do not have impaired judgment. If we deny those people treatment because we want to institute an impaired judgment test we would leave them to self-harm and sometimes suicide. It is important to remember, too, that some people have fluctuating capacity—they do not always have impaired judgment, but sometimes they do. If we want to tell people that they can refuse treatment for mental illness in the same way that people can refuse treatment for physical illness, we are making the decision as society, and saying, ““It is fine for you to go away and commit suicide. We will take no action.”” We do not do so at the moment, but the impaired judgment test would allow that to happen. I do not believe that we as legislators should say that that is what we want to do. As I have said, this important debate has addressed a number of issues raised by right hon. and hon. Members. It has looked at the wider issues of inclusion and the way in which we make sure that a sensitive piece of legislation receives proper scrutiny in the House. I am not saying that it has not been difficult to achieve consensus on the Bill. It has not been easy all the time, but as a political commentator said in The Daily Telegraph this morning, the issue before the House ““could hardly be graver””. As my right hon. Friend the Member for Sheffield, Brightside said, if we fail to act, we will let people down. Supervised community treatment is a vital part of the changes that we need to make, as is the removal of the current treatability test, which has meant that too many people, particularly those with personality disorders, have been turned away from treatment. To achieve those changes, we will ask the House to overturn some of the amendments made in the other place, but if the Opposition parties try to water down our proposals that will lead to some extremely vulnerable patients being denied treatment, and to an increased risk to public safety. I am sure that there will be a full and lively discussion in Committee, but I hope that the House will eventually agree that our proposals strike the right balance between patient safeguards and patient and public safety. Question put and agreed to. Bill accordingly read a Second time.