Mental Health Bill [HL]

My Lords, I should like to say a few words on this amendment in the context of the Bill as a whole. It would be wrong to let this occasion pass without, from these Benches, a short word of appreciation to the Minister, whose last appearance at the Dispatch Box as a Health Minister this may be. I thank the noble Lord for his personal contribution to the way this Bill has been successfully amended during its passage through both Houses. The amendments passed in another place, which I hope will be approved by your Lordships today, represent individually and collectively a vast improvement on the Bill that we were first presented with. The changes made in such areas as general principles, age-appropriate services for children and young people, advocacy, renewal of detention, ECT, and of course the definition of appropriate medical treatment—to name only the most salient issues—are most welcome. I firmly believe that we have a much better Bill as a result of these changes. It is right to acknowledge that the Government have listened and responded constructively to the concerns raised from many quarters. I thank them for that. I also thank the members of the Mental Health Alliance, in particular Professor Zigmond and Dr Daw, whose professional advice I have drawn upon throughout the Bill. At the same time, however, there is a sense of regret. The sadness is that Ministers and we on this side of the House should have approached the task of amending the Mental Health Act from two different perspectives, which in the final analysis have not been reconciled. I say very readily that this is a better Bill, but it is also a lost opportunity. The Millan Committee said: "““It should not be the function of mental health law to impose treatment on those who are clearly able to make decisions for themselves””." That principle has been the subject of much high-level support over the years. It is the reason why we sought, unsuccessfully, to persuade the Government that a test of impaired decision-making would do more to bring mental health services into the modern world than just about any other change. As it is we are, in a real sense, back in the world of Enoch Powell and 1959. Patient empowerment and respect for the wishes of the patient are acknowledged features of good clinical practice in all other areas of healthcare—but not, it seems, in mental health. It is true that some amendments passed in another place, such as those on advocacy and ECT, tip their cap to the principle of patient empowerment. Finding a way through this issue would have been the way to show that we wanted to banish the stigma and discrimination associated with mental illness. The Government were not willing to engage in that discussion—I, for one, am very saddened by that. In this, as in other ways, the whole approach of the Bill views mentally ill people as patients who need compulsory treatment for their own good, whether they like it or not. Compulsion is, of course, necessary for many patients. But we need to remember—I do not think that some doctors always do—that it should always be a last resort. The Government say that every limitation on the ability of doctors to detain patients against their will has the effect of preventing those patients receiving the treatment that they need. To put the matter in those terms, however, presupposes that compulsion is the only means by which effective treatment can be delivered. Of course, it is not: good treatment is available without compulsion, and the fear of some of us is that the wider the gateway to compulsion and the easier the law makes it to get people through it, the less likely it is that those who need help will come forward to ask for it. To have acknowledged in law that there is a place for the wishes and feelings of patients who are capable of making their own choices would have been a profoundly far-sighted and beneficial change. Never let us forget the anguish, trauma and humiliation involved in subjecting a patient to compulsion—and never let us forget, as the RCN has emphasised, that compulsion should never be seen as a substitute for good healthcare. So we bid farewell to this Bill with mixed emotions—a mixture of apprehension, disappointment, gratitude and relief. It is to be hoped that the revision of the draft code of practice and the professionalism of the generality of mental health practitioners, which we are firmly told can be relied on, will make the practical implementation of the Bill something that we can all be proud of.