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Mental Health Bill [HL]

One of the many aspects of my good fortune in being married to my wife is that she is also a doctor. We can talk about medical things and share rather different practices because she is a consultant pathologist. At this time, she is likely to be looking down a microscope, deciding whether a particular biopsy is cancer. Why? Because when the surgeon operates, despite the fact that he has seen the patient and done an assessment and so on, he will not be able to be completely sure what he is dealing with. It might or might not be cancer or it might be a different disorder. His treatment will be dependent on the diagnosis. When she looks at it, she may well say, ““This is a bit of a puzzler, I will talk to one of my colleagues, or send it off to an expert somewhere else””. Why? Because it is not always easy to know exactly what you are dealing with. All of us expect at some point in our lives expect to call on the services of people such as my wife, her surgical colleagues and others. We know we will suffer from disorders of various kinds and that we will need that help. When a diagnosis of that kind is made, a good surgeon will say, ““Look, there are a number of possibilities for the treatment. Some of them have a fair possibility of success, some are pretty slim, and there are a lot of side-effects. You need to consider whether you want to go through all of this for the potential benefit””. One of my friends has recently gone through this and decided against chemotherapy. As a doctor, she weighed up the prospects, the costs and the side-effects, and decided, ““No””. When I go home to Belfast, I will see a patient who has been detained in hospital on my advice for some time. This is because she has been trying to kill herself. I believe that the balance of her mind is so disturbed that she cannot really think clearly about that issue. She can think clearly about lots of other issues, but not about that one. I am quite clear in my mind that that is the appropriate thing to do, even though it means that I am setting aside —but not riding roughshod over—her right and freedom to be out enjoying Christmas with her family and so on. This is because, frankly, I suspect that she would never have come back from Christmas. That is an easier case but there are lots of diagnostic decisions that are very difficult. This is not about a small number of people who are very distant. One in five to one in seven of us will consult psychiatrists during our lives—that is at least one in every one of these Benches. That excludes all those who will not get to see the psychiatrist because of the waiting lists or whatever. The Bill talks about the fact that from time to time—this will affect people in your Lordships' House and their families—a decision will be taken not to give you, your wife, husband, daughter or son the right to decide about your own freedom and liberty and the kind of treatment meted out to you. That might involve drugs, which may have serious side effects—some permanently disabling if you are sufficiently unfortunate—but if your psychiatrist thinks you should have them, you should have them. It may involve various other psychological treatments, which sometimes people think of as reversible, but not all treatments, even of a psychological kind, are necessarily reversible. It may even simply mean being kept away from your family and your wife, which could have an impact on your personal life, social relationships, career and so on. All those things would be done against someone’s will. That is a serious thing. All of us would agree that one must think seriously before doing that. I think that in most cases my psychiatrist colleagues do. There are many situations where they decide not to take something up because they think that, on balance, they will not really be able to help a person and resolve the problem, and that the treatments available will not make much difference. However, the Bill has been introduced because there are people in the other place, in government and elsewhere who say, ““There are problems out there, and psychiatrists are opting out of their responsibility and not dealing with all these people””. Quite often, psychiatrists do not deal with them because they know that they do not have much to offer to resolve these problems. But they are being told, ““No, you have to take them on. It doesn’t matter whether your treatment will help or be effective. It is up to you to do something about it, and if you can do nothing except keep such individuals somewhere then do that, even though that means not having beds available for other people whom you can treat but who do not require to be brought in on a formal basis””. It is not as though it is easy to make a diagnosis. I mentioned the difficulties of my wife and her colleagues on the organic side, but it is no easier in psychology and psychiatry. At times, the patient has every right to disagree with a diagnosis; sometimes the psychiatrist will review it or a colleague will offer a second opinion and suggest that the diagnosis be looked at again. That is perfectly right and proper. A degree of humility in psychiatry, medicine and maybe even in politics is no bad thing. It is not just a question of a disagreement between the patient, or the patient and their family and their medical attendant. Psychiatrists do not always agree with one another. I do not agree with some of my colleagues about the kinds of treatment they undertake with particular patients at particular times, and perfectly properly so, because these are not simple, black-and-white issues. But when it comes to the law and having to impose something, the issue is black and white, whatever anybody thinks. There are circumstances where, despite all these difficulties, one must shoulder responsibility, struggle with the emotional and intellectual challenge, and say, ““I’m afraid that, however difficult it is, we have to keep you in and approach the treatment in this way, even though I know you don’t think it’s helpful””. When do those circumstances arise? Not when a person disagrees, has inadequate information or does not understand the arguments. Many decisions made in this place and the other place affect people’s lives and deaths; sometimes they are not very wise and in many cases they are not very well informed, but that does not mean that they should not be made. Where it is judged that the balance of someone’s thinking is impaired, where their capacity to think—that fundamental thing about a human being—is disturbed, that is a reason to set aside the person’s decision-making capacity. This provision recognises that of course such circumstances arise but says that outside those circumstances we should proceed with greater humility, both about the responsibilities we undertake and about our capacity to resolve all these problems. If we do not, we could end up making a bad situation very much worse, not out of malign intent but out of a belief that we can do far more than is actually possible to solve some of these problems.