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Mental Health Bill [HL]

I speak to Amendment No. 5 in my name. The Bill rightly clarifies that dependence on alcohol or drugs is not a mental disorder that justifies compulsory treatment. By making this clear, however, it could inadvertently mean that a person with a dual diagnosis of a mental disorder and dependence on alcohol or drugs might not get the help they need under the Act. Before I go on, I must once again declare an interest: Turning Point is probably the largest provider of services to people with alcohol and drug problems outside the NHS. I thank the noble Baroness, Lady Murphy, for her kind words on my amendment before she had heard me speak. That is quite nice. My amendment is complementary to Amendment No. 4. In the United Kingdom, it is estimated that half the people in drug or alcohol services also have a mental health challenge. Around one third of patients in mental health services also have a drug or alcohol problem. My organisation works with many people who have multiple needs. We estimate that at least one in five people we support—at last count we provided a service to 136,000 people—with mental health challenges also need help with serious substance misuse. All too often, the presence of a drug or alcohol problem alongside a mental disorder is used as grounds not to treat people. They are turned away, as has been pointed out, from mental health services when they are in the greatest possible need. From our experience, people with a so-called dual diagnosis of mental health and substance misuse problems have been turned away from mental health services in the past due to the current exclusions. Consequently, people are not receiving the help they urgently need. This has consequences across the social care system. Their mental health deteriorates even further and community services endeavour to help, despite being ill equipped to do so. I offer an example. The Bill is often given colour when we talk about its effects on human beings. Sarah is 38 and has a diagnosis of depression and borderline personality disorder. She also has long-standing drug and alcohol difficulties and self-injures on a regular basis. When admitted for in-patient treatment, sheis often put on a contract stating that she will be discharged if she self-injures or uses drugs or alcohol. These are her coping strategies; the use of alcohol or drugs is often a form of self-medication, a way of coping with mental health issues. So she invariably resorts to drinking or self-harm, and so she is discharged. On occasions she is not admitted at all when expressing suicidal thoughts because she has been drinking. Simply educating mental health staff about substance misuse will not be enough to solve this problem. While I agree with the comments about resources and training, it is not enough. The reasons why people use drugs and alcohol are complex and often misunderstood. Sometimes it can be to self-medicate and treat the symptoms of mental illness but is often interpreted as resistance to treatment or to engagement with services. It is important, if we are going to have a Mental Health Act and spend time engaged in ensuring that those in need receive treatment, that we pay attention to this group, which is a growing challenge to mental health services throughout the country. That has already eloquently been pointed out by the noble Baroness, Lady Murphy. I want to comment on the race issue, without repeating what has been said already here or in the joint scrutiny committee. There is considerable evidence that BME groups, particularly those from Afro-Caribbean backgrounds, are more likely to be diagnosed with a severe mental disorder. Simplified definitions where exclusions are removed increase the degree to which diagnosis of mental disorder depends on the subjective judgment of clinicians, which the literature now states with ample evidence is sometimes subject to quite racist interpretation. I am sure that my noble friend Lord Patel of Bradford can give chapter and verse on this, as chair of the Mental Health Act Commission. Given the evidence that racial stereotypes are significant factors underpinning notions of mental disorder, that is likely to amplify the extent to which race is a factor in defining such disorder, in effect widening the pool of people to whom legislation could be applied and who will be affected by the existing skew toward black and minority-ethnic groups, a situation made worse by amendments.