Mental Health Bill [HL]

My Lords, perhaps I could begin by posing two detailed questions about AmendmentNo. 1A and its precise effects. My concern, which perhaps the Minister, as well as the noble Baroness, would like to comment on, is whether in deciding if someone should be detained or not, the responsible clinician needs to consider whether, let us say, an expression of religious belief is a sign of an underlying mental disorder. Does the amendment mean that the patient could appeal against an order on the grounds that he was being detained because of his religious belief rather than a mental disorder? That was one of the key points that the earlier amendment was trying to get at and I would like some reassurance that this amendment, limited as it is, would get us into the same kind of territory. This amendment is certainly to be supported although it is, as we know, a pale shadow of the amendment that was passed by your Lordships at an earlier stage. The Government said that the previous amendment was absolutely unacceptable to them. However, the point of it can be expressed very simply. It was to signal in statute a clear warning to clinicians about making wrong assumptions about the presence of a mental disorder in a patient where no such disorder actually exists. Contrary to the frequently expressed views of Ministers, this was not an outlandish proposal. The Bill itself contains an exclusion relating to drug and alcohol dependency. What is the point of that exclusion? It is to ensure that, before detaining somebody under the Mental Health Act, the clinician asks himself whether the behaviour of the person before him is attributable to something other than a mental illness. These concerns matter a great deal, and not just in the context of drug and alcohol dependency; they matter in particular to black and ethnic minority patients who, as the noble Lord, Lord Hunt, said, have a deep-seated and, many would say, justified fear of what the mental health system may do to them. They fear that the system is loaded against them and that clinicians who do not understand black culture and some of the religious practices that black people engage in may misinterpret the behaviour that is often integral to those practices and cultures. Influential and highly respected doctors assert that there is no institutional racism in mental health services. I do not know whether that view is right or wrong. I hope that it is right but, even if it is, the reality that we have to deal with—the one that matters—is the perception among black people that institutional racism does exist. We need to do something that is more than just a gesture if we are to have any hope of assuaging those concerns. That is why this limited amendment, welcome as it is, needs to be accompanied by full and appropriate explanatory guidance in the code of practice. It is not just a case of saying in the guidance, ““Do not discriminate unfairly against black people””. It is necessary to set out what actually goes on in clinical practice in order to explain why this provision exists and why it is thought to be important. Some of the disparities between the treatment of black patients and that of white patients cannot be explained merely by genetic differences. Rates of detention for defined groups of black people have been recorded as being up to 18 times the national average. Rates of prescribing of old-fashioned anti-psychotics are greater for black people than for whites, and at higher doses than they should have in relation to their different metabolism. The rates of referral for psychotherapy are much lower for blacks than for whites. Why is that? Clinicians need to understand what some of their number are doing in the name of medical treatment and ask themselves the right questions before they detain someone under compulsion. These are the reasons why I and other noble Lords were so exercised about the amendment that we passed on Report, and they are why I hope that the Minister will agree to include within the code of practice a section that clearly sets out Parliament’s concern on these matters and how doctors should respond to that concern when exercising their clinical judgment.