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Mental Health Bill [HL]

moved Amendment No. 7: 7: After Clause 3 , insert the following new Clause— ““Rights to support and treatment After section 1 of the 1983 Act insert— ““1A Rights to support and treatment (1) This section applies to persons who have or have had a mental disorder and who are not in hospital. (2) Such persons have the right to a comprehensive assessment of their needs for support and treatment arising from their mental health, emotional and social support needs and accordingly it shall be the duty of each local authority and each NHS body (““the responsible authorities””) to carry out such an assessment on receipt of a request by such a person or his authorised representative. (3) In carrying out an assessment under subsection (2), the responsible authorities shall ensure that the person concerned is empowered to define his own needs. (4) Persons falling within this section have the right to assistance by— (a) a nominated supporter or an independent advocate, or (b) a communication support worker (or both), in order to express and define their needs and accordingly it shall be the duty of the responsible authorities to make arrangements for such assistance. (5) The responsible authorities, having due regard to the results of an assessment carried out under this section, shall then decide whether the requirements of the person concerned call for them to— (a) provide him with services which provide support and treatment, or (b) secure the provision of such services for him. (6) Where the responsible authorities are satisfied in the case of any such person that it is necessary, in order to meet the needs of that person, for them to provide, or secure the provision of, services to him then it shall be their specific duty to make the necessary arrangements. (7) All arrangements made under this section shall be agreed with the persons concerned and written down in a support plan. (8) Any treatment or support provided by virtue of this section shall be provided in accordance with the choices, lifestyle preferences and aspirations of such persons. (9) Services provided by virtue of this section shall be designed to— (a) minimise the effect of the mental disorder on such persons; (b) promote the dignity, well-being and social development of such persons; (c) accord them respect for their individual qualities, abilities and diverse cultural and religious backgrounds; and (d) increase the extent to which such persons are able to enjoy the same choice, freedom, dignity, control and substantive opportunities to participate fully in work, family life, education, public, community and cultural life as persons who do not have or have not had a mental disorder. (10) For the purposes of this section, ““treatment and support”” includes, without prejudice to the generality of that expression— (a) talking therapies; (b) assistance with personal care routines and daily living; (c) practical and emotional support in a crisis; (d) residential accommodation with appropriate levels of support; (e) social, cultural and recreational activities; (f) support, including advocacy, which enables participation in mainstream services and activities; (g) training and assistance in obtaining and in undertaking employment; (h) assistance in welfare rights and managing finances; (i) such facilities for, or assistance in, travelling as the relevant authorities may consider necessary to enable those persons to attend or participate in any services provided or arranged under this section. (11) For the purposes of this section, in relation to England ““local authority”” means— (a) the council of a county; (b) the council of a district for which there is no county council; (c) the council of a London borough; (d) the Common Council of the City of London; (e) the Council of the Isles of Scilly. (12) For the purposes of this section in relation to Wales ““local authority”” means the council of a county or county borough. (13) ““NHS body”” means— (a) in relation to England, a Strategic Health Authority, a Special Health Authority, an NHS trust, an NHS foundation trust, a Primary Care Trust (including a Care Trust established under section 16A of the National Health Service Act 1977); (b) in relation to Wales, a local Health Board or an NHS trust. (14) The appropriate national authority may by regulations make provision for and in connection with requiring or authorising the relevant authorities mentioned in the case of a person of a prescribed description who falls within this section to make, with that person’s consent, such payments to him as they may determine in accordance with the regulations in respect of his securing the provision of the services mentioned in this section. (15) In this section the ““appropriate national authority”” means— (a) in relation to England, the Secretary of State; (b) in relation to Wales, the Welsh Ministers.”””” The noble Baroness said: The amendment addresses the need for reciprocity, which was argued for so cogently in our previous debates on principles. It is supported by the Disability Rights Commission and the Mental Health Alliance. It will implement the recommendations of the Joint Committee on the draft Mental Health Bill that public services should assess and seek to meet the needs of people with mental health problems. Its aim is to ensure that people get help before they reach crisis point, and to eliminate the inequality that people with mental health problems in England and Wales face by comparison to mental health service users in Scotland, as has been so powerfully exposed today. The Scottish reform of mental health law recognised that rights to assessment and support were a vital component of a modern mental health service. Surely today our mental health service should be designed to support mental well-being and be geared towards prevention rather than focusing on arrangements for the use of compulsory powers, which should be a matter of last resort. Currently, people with mental health problems have no right to assessment or support for their mental health needs. This amendment would give them the right to a comprehensive assessment. Carrying out such an assessment would be a joint responsibility of the NHS and social services, mirroring existing good practice under the care programme approach. Advocacy and communication support should be provided as appropriate and clients are to be supported to define their own needs as far as possible. People with a mental disorder would then have the right to receive services to meet those assessed needs. A joint duty is again placed on the NHS and social services to determine whether the person’s needs called for the provision of services by them or other agencies, such as the voluntary sector. It would then be their duty to make the necessary arrangements. In this way, the core standards and guidance set out in the National Service Framework for Mental Health would be supported for the first time by clear statutory entitlements. Services are to be provided not merely with a view to improving the person’s mental health but also to promote their social development, dignity and well-being and to increase the extent to which they are able to enjoy the same dignity, choice and control as people without mental health problems. Support provided would also be geared towards increasing real opportunities for people to participate fully in work, family life, education and community and cultural life. In arranging support, the authorities must give full respect to the person’s choices, aspirations and their cultural and/or religious beliefs. This would force gaps in the services to be addressed and ensure that people receive the help that they want when they ask for it. Moreover, it would prevent needless expenditure and high personal, social and economic costs further down the line. The case for such provisions is compelling. It is a case not just founded on the principles of social justice, equality and human rights but also rooted in practical knowledge of what kinds of approaches work best, deliver better outcomes and deliver greater economic efficiency over the long term. First, there is the argument for justice, equality and human rights. If you have a law under which a person can be deprived of their liberty, separated from family and friends, detained against their will and otherwise subject to compulsion on grounds of their mental disorder, that must be counterbalanced by rights for such a person to receive support and treatment that would prevent the need for such action arising. That principle—the principle of reciprocity—was strongly articulated and endorsed by both the expert committee and the Joint Committee. It speaks to the very basic values of fairness and decency which we as a country claim to uphold. Further, current law and provision has been demonstrated to produce gross racial inequalities, as we heard so eloquently argued by the noble Lord, Lord Adebowale. People from black African and Caribbean communities are more likely to be diagnosed with psychotic conditions and treated using medication of a higher dosage and are 44 per cent more likely to be detained under the Mental Health Act compared to other patients. My amendment would help address that by decisively breaking the circle of fear that prevents people from black and minority ethnic communities seeking the help and support they need, when they most need it. Equally, if we are concerned to uphold the human rights of everyone in the community, not just the person with the mental health problem, then we need a statutory framework that maximises the likelihood of people with mental health problems making a positive contribution to society through work and learning, successful parenting and cultural and community activities, and at the same time minimises the impact of mental disorders on families and the wider community. As we know only too well, mental ill health can have an appalling impact on carers, family and society. Not only are carers at greater risk of developing mental health problems themselves and experiencing major social and economic inequalities, but families may also have to face the loss of a loved one when someone with a mental disorder, who has failed to get the treatment and support they need, becomes violent. Lesley Savage, mother of Daniel Gonzales, who was convicted of killing four people in September 2004, said in her statement following her son’s conviction that the family had made 100 attempts to get help at various times. She said that they could not list every phone call that went unanswered and every contact with a professional who told them they could not help. Daniel had been in contact with support services from his school days up to his conviction at the age of 24. But in all that time he received the help he needed—help that saw him begin to get well—for just one period of six months, between 1998 and 1999. The rest of the time his family was left to defend for itself. His family and the many concerned professionals were failed by a system that his mother describes as under-funded and incapable of providing joined-up care over any period of time. Secondly, I want to focus on the practical and economic need for this amendment. Current evidence tells us that most people with mental health problems receive too little help, too late. According to Rethink, 50 per cent of people who end up being treated without their consent have previously asked for help and been turned away. Yet treatment that people ask for is known to be much more effective than treatment given without someone’s consent. We know too that most mental health problems go untreated. In 2000, less than a quarter assessed as having a neurotic disorder were receiving treatment of any kind. The Healthcare Commission recently reported that 51 per cent of mental health service users do not have access to crisis care out of hours. According to figures from the Department of Health, around 10 per cent of five to 15 year-olds have a diagnosable mental health disorder. Of those, 40 per cent are not in touch with specialist services. That is but some of the evidence of a system in crisis, and the resulting human, social and economic consequences are dire. They can be seen not only in reduced life expectancy and the staggering 80 per cent unemployment figure among people with mental health problems but also in the situation of carers who experience poorer health, lower earnings and pensions as a result of struggling without adequate support. The Sainsbury Centre for Mental Health has estimated that the current system generates a bill of £70 billion a year in costs of compulsory treatment, economic losses and premature deaths. That is how much we currently spend—or, rather, waste—because we have failed to provide support to people with mental health problems when they need it. The solution lies precisely in providing that timely and effective support. In order to ensure that that happens uniformly and that the investment is provided, we must quite simply legislate for it. There is plentiful evidence that the right to get treatment and support in the critical early phase of illness would have a profound effect on outcomes. As the organisation Rethink points out, early treatment has been shown to improve the long-term course of psychosis. It says: "““If left untreated, there is greater disruption to the person’s family, friendships, study and work. Other problems may also occur or intensify, such as unemployment, depression, substance abuse, breaking the law and causing injury to him or herself. In addition, delays in treatment may lead to a slower and less complete recovery. Psychosis can disrupt a very critical stage of a young person’s life. Adolescents and young adults are just starting to develop their own identity, form lasting relationships and make serious plans for their careers and future. Being able to treat psychosis early greatly increases the person’s odds of being able to enjoy a healthy and productive future””." Much research is available, highlighting that investment in early intervention—investment which would be required by this amendment—can deliver substantial economic benefits. For example, my noble friend Lord Layard and distinguished colleagues at the Centre for Economic Performance at the LSE have shown that making effective psychological therapies such as CBT—cognitive behavioural therapy—available to all those who need them would pay for itself in reducing expenditure on incapacity benefits and people being able to get back to work. We urgently need these provisions if the Government’s ambitious targets in welfare reform, child poverty, health and social care reform programmes are ever to be achieved. I hope the Government will recognise that this amendment is the best way to build on their achievements in mental health services and that it would deliver a powerful legacy in independent living and equality for some of our most excluded and unequal citizens. If we are seeking in the Bill to extend the powers for compulsory treatment, it is essential to balance that with a reciprocal right that people with mental health problems can access treatment and support at a much earlier stage, when they first need it. In that way, the Bill might begin to win their support. I beg to move.