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Mental Health Bill [HL]

From these Benches, I welcome the Minister home to the health portfolio. I am sure that I speak in part for the healthcare community, which will be delighted at his appointment. We all want to have confidence that this Bill will protect the public in so far as legislation can; that it will be respected, if not always liked, by service users; that it feels fair and just to relatives and provides an ethical set of principles within which professionals work. In trying to provide that ethical set of principles, we should go back to the inherent principles in this Bill and all mental health legislation since the Vagrancy Act 1714. That Act specifically included the ““furiously mad”” among those who should be detained in bridewells but specifically excluded them from the punishment meted out to rogues and vagabonds and set some rules as to how they were to be treated. The primary purpose is to permit interventions to stop individuals from harming others or themselves should mental disorder impair their judgment to the extent that the usual psychological, moral and legal constraints no longer apply. Secondly, the purpose is to constrain those professionals charged with intervening. So in Committee today we are talking about the counterbalancing principles within which we take away freedom—and I remind noble Lords that this is almost the only time, outside the criminal justice system, when we do that. We must balance compulsion against what society offers to those compelled. There are other public health provisions to detain physically ill or aged people in the public interest, but they are now very rarely used, generally out of favour and many people think that they should no longer be on the statute book. At present, it happens about 46,000 times every year. As the noble Earl, Lord Howe, remarked, every mental health patient knows about these powers and fears their use. Even people with quite mild depressive symptoms—I would guess that there are noble Lords in the House who have experienced those—sometimes feel as if they are going mad. They might lose control and be taken away under a section. When I mentioned pink forms in the House, everybody knew what they were for. The Government have an extraordinary opportunity to set a new cultural context within which mental health services are delivered. They know that they have been, albeit unwittingly, the instrument that has managed at long last to unite service users, families, health and social care professionals and campaigning organisations to agree on some fundamental principles within which care should be delivered to those under compulsion. Although I know that there are healthcare professionals who support other parts of the legislation that I have my doubts about, we are all agreed—even those psychiatrists who have expressed support for some parts of the Bill—on the general principles outlined today. We know that the Government are not against principles, because there are some in the draft code of practice. Indeed, the National Service Framework for Mental Health has a splendid set of 10 guiding principles. Nowhere in the framework document is there any statement that it does not apply to those under compulsion. They are reflected in many of the principles tabled in this amendment. I understand that there has been much talk of this being an amending Act and that therefore there are clauses in the 1983 Act that might not be consistent with the new principles. My own trawl through the 1983 Act suggests that there is only one area, in Part IV, dealing with patients under criminal proceedings, which might not be entirely consistent, but it does not seem to be beyond the wit of man or the Government to introduce a small amendment to deal with them. This is such an important issue. I do not see any reason why in future principles for mental health should be abandoned because of one or two clauses that might need slight amendment. Principles should apply to those restricted as a result of criminal proceedings, if they have a mental disorder. If the Bill is to contain the reciprocity of principles, which principles will we adopt? We have proposed here those that the Scots have found in their recent Bill to cover the fundamentals. They are very similar, with minor differences of emphasis, to those recommended in the Richardson expert report in 1999 and were supported by the joint scrutiny committee. Summed up, they are designed: to promote patient autonomy and involvement and, when possible, to provide choice within the necessary constraints; to respect and involve carers; to promote equality, non-discrimination and respect for diversity; to provide for the least restrictive or invasive alternative; to maximise the benefit to the patient and act always in their best interest; to clarify that the welfare of any child under the Act should be consistent with the principles of the Children Act; and to recognise that the state has a reciprocal duty of care to exchange necessary compulsion with the promise of beneficial care and support. I first heard most of these principles outlined by the noble and learned Baroness, Lady Hale of Richmond—now our first woman Law Lord, but then plain Brenda Hoggett—at a joint meeting of psychiatrists and lawyers in 1989. I wrote them down, right then. Those who go back to see what Brenda Hoggett wrote then will see that these principles have been around, talked about and supported by those who need to use mental health legislation for along time. They are entirely consistent with the Government’s wish to improve public safety. I hope that, with so much to gain and every patient, every caring family and professional urging them to accept these principles on the face of the Bill, the Government will accept the amendment.