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Mental Health Bill [HL]

I shall be relatively brief, as I was on Monday, but I approach this important amendment from the standpoint of a neurologist, rather than that of a psychiatrist, although it is clear, as every neurologist and psychiatrist will agree, that there is a great deal of common ground between the two specialties. I certainly do not subscribe to the view once expressed by the late Sir Francis Walshe, a distinguished neurologist, that neuro-psychiatry is that hybrid which, like the mule, has neither pride of ancestry nor hope of progeny. Everyone who has handled patients with dementia, which can be defined as a disorder due to a physical degeneration of the brain that causes a progressive disintegration of the intellect and personality, knows that they slowly but progressively lose capacity. They may lose testamentary capacity and may ultimately totally lose the capacity either to give or to withhold permission for or consent to medical treatment. Of course there are patients with serious mental disease who lose such capacity, but many patients with serious mental disorders may be characterised by, for example, systematised delusions, where they may believe that they are being persecuted by those who are responsible for their medical care or by members of their family, or that they are being poisoned by the drugs that they are being given. Yet they may remain lucid, persuasive and, in many respects, perfectly in charge of many of their cognitive abilities. Nevertheless, no one could argue that their decisions about their medical care are not significantly impaired. That is why the amendment is such a crucial part of the Bill, and why I wholly support it.