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Mental Health Bill [HL]

In expressing my strong support for this amendment I salute the tone and temper, as well as the quantity, of the opening speech by the noble Earl, Lord Howe. From the moment we started discussing this very important Bill it was extremely important that we should all agree on the tone and temper of what the importance of this subject represented. I was particularly glad that, on the principle in proposed new paragraph (f), he talked about the need to ensure that, unless justified by the circumstances, the patient is not treated less favourably than a person who is not a patient might be treated in a comparable situation. We have already drawn attention to two groups who might benefit from this: minority and ethnic communities, and children. There is a third group, which represents an enormous well of psychiatric morbidity in this country, and that is those who are in custody or in the hands of the Prison Service. It is unfortunate that the National Health Service assumed responsibility for mental health, as well as primary healthcare, in prisons only in 2003. Until then no provision for people suffering from mental health problems in prison had been made in the planning of the National Health Service. It is estimated that up to 500 prisoners each year might have needed to be transferred to special mental hospitals, but had to compete with the requirements of people from the community. Very often the prisoner lost out and became worse as a result. That, of course, is a public health issue. Had this principle been enshrined in the original 1983 Act, and had Prison Service healthcare been subject to the National Health Service, the Act would have required that those in prison received—or be capable of receiving—treatment exactly equal to that received by those outside. It is important that this should be included in the principles at the start of this Bill because, if included, it tempers our judgment on many of the other issues in the Bill, which we will be discussing during the course of the amendments. I should like to add one practical point, though not the one mentioned by the noble Lord, Lord Warner. It is surely axiomatic that the parliamentary draftsmen should work night and day to get a Bill of such importance absolutely correct—perhaps we should add extra parliamentary draftsmen to the task—rather than that we regard that as something to prevent it happening. My practical point concerns the provision of services to the people who require them as a result of this Act. I shall quote two statistics in support of that. In 1999 when this Government introduced a paper about what they called people suffering from dangerous and severe personality disorder—neither term being recognised by psychiatrists—it was said that there were some 2,500 in the country. Four hundred were in special hospitals receiving the treatment they required; 700 were somewhere in the community, possibly receiving some form of treatment; 1,400 were in our prisons, where nobody knew who they were and they were certainly not receiving treatment. That is one end of the spectrum. At the other end, it was said by the Office for National Statistics in a report published in October 1998 that 70 per cent of all those in prison are suffering from some form of identifiable personality disorder. That is an enormous well. We must remember that all except some 35 of that huge number will come out and join the community. Therefore, we have a responsibility to use their time in prison to do something to help them lead useful and law-abiding lives when they come out. That is why it is so important that, in any Bill discussing mental health, the needs of those in custody are included so that provision is made for them as a result of that Bill, be that in principle or in practice.