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Mental Health Bill [HL]

I support the amendment. What strikes me is that, although the current Mental Health Act was never intended to sow fear into the hearts of the black community, to which I speak daily, or into the hearts of many people who have a mental health challenge or know someone who has a mental health challenge, it does sow fear into the hearts of those communities. I should declare my interest as an employee ofthe organisation Turning Point, which provides significant services to people with mental health challenges. I know from our service provision and from talking to our clients how critical this amendment is to the confidence that many outside this House will have in whatever we do next with the Bill. The principles are crucial and I hope that one of the easier things that the noble Lord, Lord Hunt, will have to do in his new job is to agree with us on that. Once we have agreed the principles, the rest becomes a little easier. To be honest, I do not understand why the Government would seek to gainsay this argument. This is one of the few occasions on which the voluntary sector, the royal colleges and many other organisations have been in total agreement. They accept that this set of principles—and one could argue about principles from here to kingdom come—are crucial. Let me explain a little why I support the amendment. We have an opportunity to set in stone how this legislation should be applied and how it should affect the lives of hundreds of thousands of our fellow citizens. As has been stated, the legislation is likely to last for several years, so we may not get an opportunity to do this again. The principles are a vital safeguard to ensure that clinicians and others responsible for administering the legislation do not drift too far from the original intentions. It would be a crying shame if in years to come we were forced to debate mental health in a similar climate to the one in which we are currently debating it. This is a crucial opportunity to ensure that mental health legislation that allows for compulsory care is applied in the right way in the first place, before being subject to challenge. The current Mental Health Act has been subject to a number of successful challenges under the Human Rights Act 1998 precisely because of its lack of principles. Let me refer to some of the specific principles that are being suggested. One is to take note of, "““the present and past wishes and feelings of the patient””." I do not mind telling noble Lords that I have had several conversations with people using Turning Point’s mental health services and in my role as co-chair of the Government’s Delivering Race Equality in Mental Health Care strategy. They have a huge fear that, if or when they become subject to the Act, their ability to make decisions about any aspect of their care—even those which do not relate to compulsion—will simply not be respected. They fear not being consulted or included, and that undermines their dignity and confidence in approaching the mental health services, including voluntary services, for help. For example, this principle is relevant to concerns about levels and types of medication: it would be especially reassuring to individuals to know that their views on medication and its side-effects—a huge issue for people in the mental health system—could be taken into account. I am aware that my noble friend Lord Patel of Bradford will put forward amendments, which I hope to support, to strengthen the race equality and diversity issues in the Bill, but I, the Government and all noble Lords know that people from black and minority-ethnic groups are discriminated against in the mental health system. The Act affects them disproportionately. We have already said in this House that reports such as Breaking the Circles of Fear and others describe people’s fear of mental health services, which, in any other situation, would be a cause for outrage and much concern. Such fears are very real. In this climate and in the light of tangible evidence of overuse of the Mental Health Act, the onus is on the Government to demonstrate in the Bill that the new mental health legislation will not discriminate against BME groups. Putting a principle in the Bill about non-discrimination and respect for diversity is essential in achieving that. Such a principle will support, rather than undermine, the fundamental aims of the delivering race equality strategy—for example, more appropriate and responsive services—and the vital progress being made outside the Act in projects such as the DRE. It is important to have principles in the Bill and not just in the code, as we know that that will help to ensure that legislation is used appropriately. This legislation is going to be around for a lot longer than many of us. Principles are a crucial safeguard and it is critical that they have statutory force. They will give more confidence and stronger guidance to tribunals and lawyers faced with interpreting the legislation, to practitioners concerned about how to implement it, and to people who may be subject to the Act and who are worried about how it might affect them. They would also set and help to raise ethical standards in mental health care and achieve greater transparency. I wish to comment further on some specific principles and turn, first, to the importance of patient participation. The value of service users’ involvement and participation in their care is widely recognised in voluntary mental health provision and other areas of healthcare. When the context is one of using compulsory powers, it is all the more important that service users subject to the Act are fully involved as much as possible at all stages of their assessment and care. That is likely to enhance their engagement with practitioners and, therefore, treatment outcomes. I give as an example the case of John, who has written a crisis plan for mental health professionals to consider if he becomes unwell again in the future. It includes asking whether, if possible, when he is admitted to hospital, he may be accompanied by his father rather than a social worker and the police, and it asks that he should not be taken to the locked ward where he has had bad experiences in the past. This makes John feel that he can participate in what can be a highly traumatic sectioning process. My second point concerns providing the necessary information and support to enable participation. In order for their involvement to be effective and meaningful, service users should be given all the necessary information about how to lodge an appeal to mental health review tribunals. We assume that people know these things but, in fact, in many cases they are simply lost in the system and do not have the information. People should know how to contact patient advocacy services and have information about their medication. Information should also be provided in a form that they can understand, taking into account the needs of those with literacy problems or the increasing number of people whose first language is not English. I want to comment on the principle that the past and present wishes and feelings of patients should be taken into account. Patient autonomy is the freedom to decide for oneself and the ability to make choices which others will respect. The Department of Health’s Review of the Mental Health Act 1983: Report of the Expert Committee pointed that out. Practitioners must recognise that many patients retain decision-making ability in relation to many decisions, despite the necessity for detention under the Act. Patients should have a right to continue to make such decisions, subject to their health and safety and the safety of others. Patient choice, which is a fundamental objective of government policy, should not be limited to those with physical health conditions alone. For example, following an assessment of Ms B, it has been decided that compulsory treatment is necessary and that that should be through a supervised community treatment order. However, Ms B does not feel safe in a community environment and would prefer to be treated in a hospital setting. Those issues need to be taken seriously and need to be set out in the Bill. Finally, I want to comment again on racial equality, non-discrimination and respect for diversity. There is considerable evidence that the current Act is applied more heavily among African and Caribbean people than among other groups. A statement of non-discrimination specifically in the context of the Mental Health Act would give those people a basis for confidence in the law. Importantly, this principle should go beyond non-discrimination and include respect for diversity, which indicates the need for practitioners and tribunals to take a proactive stance. Principles play a critical role in giving the BME community confidence in the professionals who exercise powers under the Act. The inclusion of principles in the Bill would be a visible recognition by Parliament of the need to overcome stigma and discrimination. That would assist the development of a culture of respect for the qualities, abilities and diverse backgrounds of individuals. It would also help to avoid making general assumptions on the basis of ethnic, cultural and religious stereotypes. Here I note the work of the Mental Health Act Commission in putting a spotlight on the assumptions that have led to the horrendous treatment of many people from black and minority ethnic communities in our mental health system. Crucially, it will also guide the development of future case law by establishing parameters for judicial interpretations of the Act. That will enshrine race equality in all future developments of the legislation. On this Bill, we stand at a pivotal point. We should take the Bill seriously. We should take seriously the idea that it will affect the freedoms and views of many thousands of people in their relationships with society through the mental health services and we should put the principles in the Bill to reassure people who, at the moment, are not using the mental health services, but who may need them in the future. I urge the Government to take the principles seriously, to accept the amendment and to work with us all to turn the Bill into something in which many people outside the House can have confidence.