Mental Health Bill [Lords]

I very much welcome the contributions that have been made, particularly by Labour Members, because they show that there is some support for some of the House of Lords additions to the Bill, most of which I support very strongly. On a light note, I am delighted that the exclusions under the definition of mental disorder include political beliefs. When I stood for election to this place, I was not actually accused of being mad, but I was certainly accused of being a militant activist, a medical dinosaur, Swampy and even King Canute. I am absolutely delighted, therefore, that there is no chance that abnormal political beliefs could be included. I want to say a little about treatability, because so many Members have concentrated on it. What do we, as doctors, mean by treatment? First, the ideal is a cure. Obviously, infections can be cured, and depression can be cured in many cases. Secondly, if we cannot cure, we want to control. Diabetes and hypertension can be controlled. Schizophrenia can be controlled with the right treatment and the right follow-up, and nobody would argue against detaining people with treatable schizophrenia. The third bit of treatment is palliation. If it is incurable, cancer can be palliated. The neuroses can also be palliated, as can some of the psychoses if they cannot be helped otherwise. With the addition of psychological treatment, some people with personality disorders can perhaps be helped, but it is a very big ““perhaps””. I personally like the phrase"““likely to alleviate or prevent a deterioration””" in the House of Lords amendment; it takes me back to my time working as a physician taking in emergencies. We took in well-known psychopaths from the accident and emergency department, but it was impossible to get one’s psychiatric colleagues to help at all once a psychopathic personality had been diagnosed. I always remember one chap who came in having swallowed a parcel of nails. He was assessed by psychologists and did not have a psychological illness, so we had to let him go. The only way we could have settled our consciences when we let him go would have been by taking his supply of nails from him, but he would not let us take them, because that was robbery. I ended up having to buy them from him, and he no doubt moved on and tried the same trick somewhere else. The point of mentioning him is that no amount of psychological advice or anything else would have dealt with him. Unless we include the House of Lords amendment, such people might be at risk of being locked up for ever and a day, because there is no way anybody would change them. On clause 4, which deals with impaired decision making, because of the restrictions of time, I will only point out the Law Society’s absolutely excellent paragraph on that subject. It is very short, but it is an excellent, explicit explanation of the Lords amendment, and it should be read by everyone. Moving on to the renewal of detention, the fact that the Lords want a doctor to be involved has already been mentioned. I was pleased to learn this morning that the Medical Health Alliance has slightly changed its stance and agrees that there is a very strong place for professionals other than doctors to be involved, but at least one of those involved must be medically qualified. I have a fear that, in the national health service as a whole, the moving of certain tasks to professionals other than doctors possibly happens because it is a cheaper option and, perhaps in some cases, as a response to the deficits. On clause 32, which deals with a doctor being involved in the decision to place the treatment on a community treatment order, I have learned of the tremendous usefulness of assertive outreach teams at home. They are excellent when they are adequately supported, and I am very keen for the Government to consider the support that assertive outreach teams get. As other hon. Members have said, mental health services are always soft targets when one is trying to balance the books, and it should be a target for the Government to help those teams. It has always puzzled me why there is no target for the time taken to see a consultant psychologist. That seems to be a complete gap. Turning very briefly to young people, a lot has been said. When I was still working, which was a few years ago, to walk into an adult psychiatric ward would put almost anyone off, and to put children into those circumstances would be awful. I wish to conclude with two very important things. First, as has been mentioned several times, the Mental Health Alliance—the broadest coalition in the mental health world, with 79 members, and a unique alliance of all the groups—supports the Lords amendments with slight provisos, one of which is about doctors’ opinions, but it cannot be swept aside. The Mental Health Alliance says that reform"““must be fair and workable””." The Royal College of Psychiatrists says that reforms must"““command the support of the professional groups and patients””." To conclude, I can say as an independent what party members possibly cannot say, and this is an appeal to the Government that this is not a political issue; it is an issue that we must get right for the good of all the patients who suffer from such illnesses. I shall leave the House with some words from a far more eminent independent MP than myself: A. P. Herbert, who was the independent MP for Oxford University before world war two. He wrote in his book:"““I have even thought that, on great occasions where the parties were furiously raging together, the votes of Independents, cast with, of course, more conscience, might be as straws in the wind and show the party leaders which way the pure air of free opinion blows.””" I think that the pure air of free opinion blows in favour of a lot of the House of Lords amendments, and I should very much like the Government to support some of them.