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Mental Health Bill [HL]

It seems to me that this particular group brings us to the heart of some real difficulties in applying legislation, and the law in general, to mental illness. It is not like physical illness; it is about the very essence of people and what they are, which is a very difficult issue. The issues of diagnosis, management and practical reality all come to ground in this particular group, as the Government have recognised by introducing a specific exclusion. Nothing in the provision says that the exclusion is on a point of principle or a particular kind of difference in terms of psychology or psychiatry. It is quite clear that dependence on alcohol and drugs involves a disorder of the mind. There is no doubt about that. There is not much doubt either that it is also similar to lots of other kinds of addictive behaviour. When treating one of these folk, often you get rid of the alcohol problem and they turn to drugs; then you get rid of the drug problem and they turn to gambling, an eating disorder or whatever. It is not an issue of principle, and the Government know perfectly well that if they were to include all those people as likely to be detained, the services would collapse completely because of the enormous number of people involved. It is not to do with there not being a possibility of violence; in fact, there is a much greater likelihood of violence from this group of people than from people suffering with schizophrenia. However, the Government recognise that they cannot cope. The truth is that they cannot cope with lots of the other folk they are going to bring in anyway. It is hard enough to find a bed for a psychotic young suicidal patient at the moment, and it will be even worse with a lot of these other things. Let us take the reason for some of the exclusions being set down here. Some are about real difficulty of diagnosis. If, for example, someone comes along and speaks about being low-spirited—they are not sleeping at night, they have lost interest in a lot of their affairs and are not behaving in their usual way—they might well have a depressive disorder but, of course, if their wife died three weeks ago, it would be a perfectly normal reaction to one of the vagaries of life. As my professional colleague the noble Baroness, Lady Murphy, pointed out, the difficulty is that if you do not look for all of the things that are around, the diagnosis can be faulty. Taking personality disorder as an example, there is often a circular argument: this person is breaking the law; they do it repeatedly and do not stop; there must be something very disturbed about somebody who behaves in that way; therefore, they have a personality disorder and need to be treated. More insidiously, if the psychiatrist does not have much understanding of or sympathy for the cultural or religious background of the person involved, there is another kind of circular argument: this person has some very strange ideas; they might be religious ideas. I come from a part of the world where a lot of the religious ideas that are very current among people would be regarded as quite mad on this side of the water. I refer not just to religious ideas. One colleague came across to work in Northern Ireland, and after interviewing one patient said, ““I think we have a really paranoid person here””. When I asked why, they said, ““They think that if they go up this particular road they will be attacked because all sorts of people will be against them because of their religion””. I said, ““They are not paranoid; they are realistic””. I guarantee that the reason for the undoubted fact that many more people from Afro-Caribbean backgrounds find themselves in a mental hospital is that there is less understanding of the cultural and religious beliefs and actions of many of those people by my colleagues in psychiatry. You find a difficulty in coping with and managing someone who has a very different set of understandings of what life is about. You think, ““It’s a bit strange. How am I going to deal with it?”” At present, the fastest growing special interest group in the Royal College of Psychiatrists is the spirituality group. It is not so long since there was no such group. Why? Because 10 or 15 years ago, it would not have been politically correct to regard spirituality as a proper professional interest within psychiatry. Now, people have begun to change their view of it. This amendment tries to point out that, without a serious look at understanding issues such as culture, politics, religion, breaking the law, sexual behaviour and so on, we could end up dragging into the net all sorts of people who are not suffering from mental illness in a proper sense and it becomes a question of how we deal with people who are difficult, different or deviant in our society. That is a real problem for colleagues in psychiatry, not least because of a move to diagnosis on the basis of people’s behaviourand a set of symptoms, rather then necessarily understanding something more about the depth of the disorder and its likely prognosis. Unfortunately, over the past few years I have heard from Ministers a set of views that suggests that there is a simplicity about all of this—that it is very easyto be clear about certain matters; that clearly psychiatrists are not taking their responsibilities seriously and are avoiding all sorts of issues because they are distasteful or difficult. The reality is that these are difficult questions, not susceptible to clean bits of legislation. Psychiatrists sometimes have real difficulty assessing these things, and find themselves lapsing back into making mistakes because of their own cultural, religious, or political views. I ask that we take these things seriously, not because Amendment No. 4 necessarily solves all the problems, but it points up some of them, and I hope that Her Majesty’s Government take that problem very seriously.