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Mental Health Bill [HL]

Perhaps I ought to start with the phrase ““as I was saying””, but I shall start instead with a short apology for intervening on the wrong amendment. It is a classic example of using the first Marshalled List instead of the second, which is absolute proof, if any were needed, that sparing the Earth’s resources by using one set of papers does not spare one’s blushes when one gets it wrong. I shall not repeat what I said earlier. I had made a point about the civil liberties of patients and the individuals who are affected by them, as well as about the rights of the community. It is a balance of rights. I had made a point about the difficulty of definition and I had just started, before my noble friend drew my attention to the different amendment involved, to speak about the 1959 Act and the way in which the hospitals were changing from that time onwards. I was embarked on a grand scheme of describing a situation—I remember it all too well—where the hospitals were providing a care and safety role for large numbers of people who did not need to be there. At the same time, they were providing a place of safety for people who later on fell under the definition of not being treatable. That problem has to be addressed. Over the years, all parties have ducked it because it is so difficult. It is about personality disorder, but we have to recognise that it goes wider than that. In the 1960s and 1970s, the problems resulting from the failure of psychiatrists in particular—but not just psychiatrists—to offer treatment for personality disorders had a dramatic effect. By that time, there were many people out on the streets who would not have been there previously. Additional problems were brought on by drug abuse. In the early 1970s, I was working as a probation officer in the Kings Cross area. The problem which we faced at that stage was that one would come across people who, whether or not they had a personality disorder—there was an area of difficulty around that—clearly needed help and treatment and who were very often asking for it. They were often doing so in secure circumstances, but you could not offer it. That is a major problem. The Front Bench opposite referred to the Stone case. Michael Stone had had previous psychiatric treatment, but when he went back to another hospital and asked to be readmitted because he would do something very damaging or dangerous otherwise, he was refused. This was a common experience for probation officers and other people who were working in this area in the 1970s. It has remained so since then. Although I have left the profession, plenty of contacts tell me of instances—although there are fewer of them—of people who are refused admission or treatment because their condition is regarded as not treatable. This is a major problem. The situation now is slightly different, but almost any Member of Parliament from an inner-city area will be able to tell you what sort of people are affected. Members of the House of Lords need to be very aware of this. Your heart sinks as a Member of Parliament when people contact you and describe the behaviour of someone who is clearly unwell and whose behaviour is deeply disturbed. The people immediately around them are scared for good reason. The person will not have done anything against the law, although they will have done some things which might be profoundly dangerous. Shortly before I left the House of Commons, I came across the example a man who would throw very heavy objects over the garden wall without looking over the other side first. He was very disturbed; he had all the signs of disturbance. One could not have arrested him. The police came round to warn him, but nothing was done and the hospital trust said that he was not treatable. The police were saying, ““He has not done anything wrong. We’ve warned him, but we can’t do anything about it””. Members of the community would say to me, ““What’s the guy got to do? Has he got to kill one of us first before you take any action?”” It is a very real issue. Another case which came to me was that of a woman who had plenty of money and was not unintelligent, but her house was getting into ever-worse repair. I would have classed her without any hesitation as having a personality disorder, although she was very well presented. Her house went downhill. She set fire to parts of it and began to use the garden as a toilet. You can do things about a garden being used as a toilet if you can show that it is a danger to others in terms of environmental health, but you cannot always do that, particularly if they bury it. Eventually, after five years of the neighbours putting up with this, I got a compulsory purchase order on the house. That is the difficulty of dealing with cases such as that. It is why it is bad to say that that person did not need treatment. That certainly does not help them. When we talk about patients’ rights, we need to understand that for some people whose behaviour is disturbed and shows signs sometimes, but not all the time, of mental illness, we might need to exercise some control and restraint. If you do not, you are behaving like the bad parent. If you say, ““Well, it’s all right for her to go to the toilet in the garden and it is not harming anyone else””, you are being a bad parent. In cases such as this—as I have said, many inner-city MPs will have them—we need to be able to intervene. The Front Bench of the Conservative Party asked whether being able to do so will make any difference. It will make a difference, although, as I indicated in my earlier, inappropriate intervention, it might not make enough difference for us not to have to return to this at a future date. It will make a difference because it toughens up the system. It will make it more difficult for a health authority to say that it will not intervene. Faced as an MP with a number of such cases, I would have felt able to go to a health authority and say, ““You cannot say that appropriate treatment is not available here””. Moreover, as some of the psychiatrists said in our meeting with them a few days ago, it will help to change the culture and practice in psychiatry, making it less likely that arguments will be put forward that treatment cannot be given and the person should be left alone. It is to a large extent a culture-and-practice matter. During my days in the probation service in the 1970s, it was very common for a psychiatrist to say, ““I am not going to deal with them; they’re dangerous””, yet probation officers, social workers and a whole variety of other people had to deal with them. You cannot just walk away from this. Psychiatrists have got better and you hear that said far less often, but you still hear it. When a psychiatrist would say that they were not going to admit the person in question, you then had to look around for a hostel. What would the hostel say? ““They’re too dangerous.”” Alternatively, they would throw them out on to the street again when they became aggressive. My final point is, again, well understood by elected Members of Parliament, who constantly face a battering from constituents about it. I deplore it when the press come up with gross headlines that actually create fear and whip up hysteria about ““mad”” or ““bad”” people. I have had plenty of occasions to have a go at the press about that and I have a record for doing so. The real warning for anybody who deals with this politically is that, however inappropriate the headline, underneath it there is very real anger and fear in the community. Legislators have to take into account not just the rights of the individual concerned, and not just the rights of the community, but fear levels in certain areas of the community on certain issues, of which this is a prime example. You ignore that at your peril. It is like sentencing policy. The reason it is so difficult to get sentencing policy right is that people always want longer and longer, and tougher and tougher, sentences. It is easy to say that that does not necessarily work, but we know what people want on it—they tell us very clearly. My basic message to the Government is: by all means keep the Bill as it is. I certainly approve of the measure. I think it will make things better, helping to change culture and practice, and enabling people to say, ““Look, this wording is tougher than the previous wording, so you cannot duck out of it””. It will enable people to get a bit more confidence in the system, which to some extent has been lost. It does not get in the way of patients’ rights, but it recognises that these rights, as I indicated before, are very much part of a package of rights, which relate to individuals in the community as well. At the end of the day, if we still get problems of the type that I have described, then the Government may well have to return to this issue with rather tougher wording. The key issue—which goes back to what I said in an intervention on Monday—is to get away from this terrible fear that we are somehow going down the road of the Soviet Union, or whatever. It is not the wording of a particular clause, about a particular mental health problem, that safeguards liberty; it is the rule of law and all the extra bits you put in, such as the mental health tribunals. That is what protects you. The idea that this could only happen in an authoritarian regime is nonsense. That is why I again ask people to think about what was happening in the 1950s when we did lock people up. Actually, they were not always locked up; they could often go out and get jobs and work from the hospital—it was like a big hostel in some ways. Some were locked up, however, and it was inappropriate. Some were kept in there for years and years and they should not have been. At the same time, we provided a structure for them, as that was the best form of treatment—a lot of this was before modern drug therapy was around. Therefore, I say to the Minister, go ahead with this and see how it works, but do not be afraid to return to it. We will never get it exactly right. There will always be a problem of definition around essentially behavioural issues—psychopathy, personality disorder or whatever you want to call it—which we know are also about grossly disturbed behaviour. In Kings Cross, I worked mainly with people who were labelled personality disordered and with alcoholics—the two were often combined, which made it even more difficult. However, it is abundantly true that you know when you are dealing with one of them for a long time. It is the old story: you cannot define an elephant, but you know if there is one in the kitchen. The issue here is not that we lock them all up, but that we have some way of containing them for periods of time, such that it is constantly open to review by non-medical and non-social work specialists—hence the importance of the health tribunals and the law, and so on. Let us not kid ourselves, however, that this is not a serious problem. The numbers are admittedly small, but the impact is great. If I took you to the neighbours of the lady who I described right now, they would express far stronger feelings than I am expressing about the inability of the health services and the law to help.