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Mental Health Bill [HL]

This has been a long but very interesting debate. It has gone to the core of what the Bill is about; there is no question about that. That is why it has been such an emotional debate. Though it is emotional, I hope that we can none the less try and dispassionately go through the issues and why the Government believe the arguments they have put forward are right. I want to place something on record because of the fears that have been expressed by some noble Lords. The idea that this provision is going to be used to bung people into a bin is quite the obverse. I am not a mental health expert but I joined the National Health Service a long time ago, in 1972. One of my first jobs was as a works study officer. At that time works study schemes were being introduced into many mental health hospitals, so I had an opportunity to see how mental hospitals worked. The last thing that I would ever want to do is to go back to some of the bad old days and practices. Whatever one’s view about this Bill, we are all committed to high-quality and improved mental health services. I also want to say that this is not about fingering psychiatrists. Part of the reason we are bringing forward this part of the Bill is to respond to a concern about how the issue of treatability has been addressed. It is not about putting psychiatrists into the dock—far from it. We want to support psychiatrists. We admire psychiatrists, and we understand the pressures they work under. A number of noble Lords mentioned the development in the quality of the services and suggested that if only everything were perfect we would not need this legislation. Of course we need to improve clinical services, but the Bill is a genuine approach to improving the framework in which high-quality services can be given. That is our intent. To go through the arguments and reasons for our proposals, Clause 4 formally removes the so-called treatability test from the criteria for detention for treatment under Section 3 of the Act; for those under hospital orders and hospital and limitation directions made by the courts under Sections 37 and 45A respectively; and from those under directions by the Home Secretary transferring sentenced prisoners to hospital under Section 47. It also removes the treatability test from the criteria for renewal and discharge of such detention as well as discharge of unsentenced prisoners transferred to hospital by the Home Secretary under Section 48. It then inserts into all those provisions a wholly new test of whether appropriate medical treatment is available. Clause 5 inserts the same appropriate treatment test into the criteria for remanding patients to hospital for treatment under Section 36 while in custody awaiting trial or sentence; for the transfer of unsentenced prisoners to hospital under Section 48; and for giving a hospital order under Section 51 of the Act in a patient’s absence—sometimes without convicting the patient in rare cases where a court thinks that that is the proper thing to do. In those circumstances, the treatability test has never been part of the criteria. The result is that no one may be detained under the sections in question unless, in addition to the other relevant criteria being met—I stress that, because the test is not just the appropriate treatment test—the other stringent tests and safeguards in the legislation must be met. They remain; we have perhaps passed over that in our discussion. By contrast, Amendment No. 13 would retain the treatability test. The noble Earl, Lord Howe, fairly asked me what is wrong with the test. My noble friends Lord Soley and Lord Warner have very effectively answered that. We believe that there are several things wrong with the treatability test. The fact that it has become known as the treatability test has encouraged the idea that there are whole classes of patients who are inherently untreatable. The fact that the test is especially associated with what the Act terms ““psychopathic disorder”” has meant that the tendency to a blanket assumption of untreatability has especially affected people with personality disorders. That has meant not only that the Act is not always used when it should be but it has held back the development of personality disorder services generally. The noble Lord, Lord Alderdice, and I may disagree about why those services have been held back, but I think that we agree that there is a problem about how they have developed. That has left too many clinicians feeling reluctant, ill-prepared or ill-resourced to intervene to offer help to people with personality disorders. As noble Lords have said, such people often experience significant distress and suffering.