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Mental Health Bill [HL]

I support the amendment in the context of a Government who have already done a great deal to alleviate the conditions and perceptions of disability and mental illness. I am convinced that a list of guiding principles is crucial and should be inserted into the Bill. In that, I am supported by Mind, of which I am president, and by many other expert and experienced mental health charities. The principles are worth restating, even in headline form. The list shows both the ambition and the centrality of the guiding principles. They concern patient participation, the right to information, autonomy, respect for carers, the availability of a full range of options, equality with people who are not patients, racial equality, non-discrimination, respect for diversity, the maximising of benefit, child welfare and reciprocity. Moreover, there should be an overall requirement in the Bill for the least restrictive alternative, including informal treatment and care. Why not put the principles in the Bill? Why put them in the code of practice, but not in the Bill? Why not, when these principles will serve a vital purpose for practitioners, many of whom—for example, the Royal College of Psychiatrists—support this, accede to their wisdom and put the principles in the Bill where both practitioners and patients can see them equally? Why not be guided by the democratic option? The Government’s objections seem to be merely defensively technical. It would be a nailing of colours to the mast: a clear and encouraging act of faith, evidence of conviction and purpose worthy of, at its best, a fine, liberalising Government. Reiteration follows, but I contend that reiterationis evidence of widespread concern and strong,well informed feeling across the spectrum. The amendment is of crucial importance. Principles in the Bill should and will raise ethical standards in mental healthcare by guiding practitioners and lawyers in the implementation and interpretation of the law. That will also improve people’s confidence in the legislation, particularly those who may be subject to it. We particularly need principles in a law which authorises the use of coercive powers, to guard against expedience, discrimination and abuse, and to encourage proactive efforts in favour of patients’ rights and well being. Principles should not be left to the code of practice, where they could be changed without Parliament’s agreement and would carry less weight. If the Mental Health Act becomes incompatible with any of these principles, those of its aspects should be amended. Such essential principles should be at least as enduring as the legislation. For example, principles of participation, right to information and patient autonomy would all help to counter the kind of situation where people are, or feel, coerced into agreeing to treatment, or are effectively told that there is no point in refusing. In a Mind survey of people’s experiences with ECT, over half the total sample and one third of those who had had ECT most recently were not aware that they could refuse to consent to the treatment. People detained under the Act who consent to treatment do not get the second-opinion safeguard. The following quotations are from people who had had ECT in the previous six months not many years ago: "““I was told that as I was on a Section 3 … I had no rights””.""““If I had known I had the right to refuse, I would have done so. My understanding was that I had no choice in the matter and that they could do it by force””." On racial equality, non-discrimination and respect for diversity, racial inequalities in mental health have been documented in the ““Count Me In”” census of 2005, particularly for African-Caribbean peoples, including higher rates of detention. That needs tackling at every level, including the guiding principles in the Mental Health Act, because of the unequal treatment that could be carried out under the Act and because it will operate in circumstances where inequalities already exist. The existence of race relations legislation does not obviate the need for inclusion in this Bill. Those rights and duties should be reinforced by the Mental Health Bill, not treated as being taken care of elsewhere. My final example refers to something that will come up again and again: patient autonomy. The Mental Health Act clearly restricts patient autonomy by authorising the use of compulsory detention and treatment. That makes it all the more important to include a principle that people should retain as much autonomy as possible. They may have decision-making ability in many of the areas where decisions must be made. For example, it may be necessary for someone to receive treatment under compulsory powers, but they may have views and knowledge about which treatments have previously helped or harmed them. Alternatively, there may be activities or therapies available which the patients would be willing to explore and over which they could be offered real choice, rather than either not having them or having them presented as part of a compulsory package. People should be supported to make their own decisions where possible and given the same choices as people with physical health conditions. Autonomy should be curtailed only to the extent that it is absolutely necessary, and making that a principle in the Bill makes this clear. I hope that my noble friend seizes the day and accepts this amendment. I urge the Government to take full note of it. Accepting this amendment would go far to help clarify and reassure those in an area which is, at last and thankfully, ceasing to be an area of darkness.