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Mental Health Bill [HL]

I shall certainly write to the noble Lord. I am not aware that it is suggested that the commission, or likely commission, of illegal or disorderly acts is, by itself, a clinically recognised mental disorder. Hence, the proposed exclusion is again unnecessary. It has been suggested by noble Lords, and in the evidence cited by the noble Baroness, Lady Barker, that the purpose of the amendment is to prevent the Act being used for social control. If that is the case, we are fully supportive of the objective. However, the Act already achieves this objective. This is a mental health Bill; it is not about social control. We are all aware of what happened in Russia, and noble Lords have quite rightly brought this to our attention, but this is not what this Bill is about. The most that the proposed new words in the amendment could achieve is wrongly to suggest that, in other contexts, such behaviours would be mental disorders or, worse still, that they might place uncertainty in the minds of professionals, and even the courts, about whether behaviours of this kind can be taken into account when deciding whether someone has a mental disorder. Redundant material should not be included in Acts both as a matter of good drafting practice and for fear that an unintended meaning will be read into any such words. The courts will assume that Parliament would not have put material in the Act if it were unnecessary. However carefully drafted is an exclusion—I know that noble Lords have been most careful in their drafting—there is always the risk of it being interpreted in an unexpected way or being misunderstood and misapplied in practice. If, as in this case, an exclusion is unnecessary to start with, we think it better not to take that risk, remembering that what is at risk is whether people get the treatment they need to relieve their own suffering and, where relevant, protecting other people from harm. Many noble Lords understandably raised the issue of people from black and ethnic minorities being disproportionately affected by the Act. We fully acknowledge that rates of admission and detention are significantly higher for some BME groups and that they are more likely to arrive in care through the criminal justice system. Once in hospital, some groups of BME patients are more likely than white British people to be subject to measures such as seclusion or restraint. This fuels a circle of fear which deters many BME patients from seeking early treatment for their illness. We have heard many examples of that cited today. The reasons for this are complicated and still not fully understood, but the problem has effectively been left unchallenged by government for decades. Last year, we published a comprehensive, five-year action plan for delivering race equality in access to services, experience of services and outcomes from services. A high level of resources has been committed to the plan and it has made a sound start. Bridging the system of equalities once and for all might not be easy, but we cannot be satisfied with anything less. However, excluding cultural and religious beliefs from the definition of mental disorder is unlikely to help. It is possible of course to have disordered cultural and religious beliefs in any culture or religion, and indeed in any person, regardless of whether they see themselves as belonging to a particular culture or religion. Such beliefs may well be symptoms of clinically recognised mental disorders, but in the absence of such a disorder, political or cultural beliefs, values or opinions are simply not mental disorders. It is therefore unnecessary and potentially a source of uncertainty and misunderstanding to exclude them from the definition. Disordered thinking and beliefs are central elements of many mental disorders. That these are expressed in cultural, political or religious terms makes them no less disordered than if they were expressed in any other terms. But it is axiomatic that in diagnosing whether thoughts are disordered, professionals must understand them from the patient’s own perspective. However strange a thought or belief may appear to be to someone else, it is not a sign of mental disorder unless it is disordered within the framework of the person’s own cultural, political and religious heritage, convictions and attitudes. We therefore do not think that this needs to be said inthe Bill. The noble Baroness, Lady Murphy, asked why the Government said that cultural beliefs could be signs of mental disorders. This is not what we said and indeed it would have been extraordinary had we done so. What we meant was that sometimes disordered thinking expresses itself in religious, political or cultural terms. In summary, Amendment No. 4 seeks to exclude various behaviours and beliefs from the definition of mental disorder. On substance misuse and sexual behaviour we disagree about the objective if those terms are meant to cover the consequences of misuse and what is currently termed ““sexual deviance””. On the rest, we differ only as to means, not ends. Noble Lords say that it should be explicit in the Bill that it cannot be used for what some have described as social control. We say that there is simply nothing in the Bill which would allow it to be used that way. Adding unnecessary words does nothing to alter that butdoes increase the potential for confusion and misunderstanding in practice and the risk of an unintended meaning being read into the words by the courts. It is for the same reason that, while agreeing entirely with what he seeks to achieve, I cannot support the amendment of the noble Lord, Lord Adebowale, to make explicit that dependence on alcohol and drugs does not preclude a person from treatment under the Bill if they also suffer from another mental disorder. I understand that this group of people is getting bigger. For the reasons the noble Lord has eloquently and colourfully explained, I agree that it is essential that people using the Act in practice are clear about what the exclusion for dependence means, and perhaps more importantly what it does not mean. We have tried to spell this out in the draft code of practice for England that we have issued alongside the Bill. But if the noble Lord does not think the current draft of the code is sufficiently clear, then of course we would welcome his suggestions for improving it. To the noble Baroness, Lady Masham, I must stress that the Bill does not exclude people who are dependent on alcohol or drugs from the Act entirely. If such a person has another mental disorder, then of course the Act applies in the normal way. That is true even if the other mental disorder is a result of the dependence or reinforces it, or if the dependence exacerbates the other disorder or makes it harder to treat. The amendment would put into words only what is anyway the case because of the absence of words to the contrary. It is therefore not necessary and while I agree with the objective, it is best not included in the Bill. I noted the fine words of the noble Earl, who urged me not to reject the amendment out of hand but to listen carefully to the debate which has ensued as these are extremely important issues. I regret, however, that I am going to have to ask the noble Earl to withdraw Amendment No. 4 at this juncture and I hope that I have reassured the noble Lord, Lord Adebowale, that he may safely not move Amendment No. 5.