---

Mental Health Bill [HL]

I support all that the noble Lord, Lord Carlile, has said, and I hope that the Minister will acknowledge that there is a real issue here that deserves a positive reaction from the Government. We have to listen to what the professionals are telling us. They are saying that renewing a detention order should not be an easy process, and that the 1983 Act facilitates the continuation of compulsory detention in too easy and straightforward a way. As the noble Lord said, the circumstances in which a decision to detain a patient is made initially are often much more clear-cut than those that obtain later, when the patient has received treatment and has been stabilised. At that later stage all sorts of question marks can arise over how ill a patient still is and what the nature of his illness is. Diagnoses frequently change over time, and they do not necessarily remain set in stone. All this argues for as much clinical rigour to be applied to the renewal decision after six months or a year as to the decision to detain the patient in the first place. If one accepts that idea, the proposals in the amendment are surely compelling. We are at a time when increasingly the evidence base for medical decisions has assumed paramount importance, and rightly so. Any diagnosis of a mental disorder needs to be based on objective clinical evidence. The weight and validity of such evidence can only be evaluated by those who have the necessary medical qualifications to do so. I was 100 per cent with the noble Lord when he said that it should not be enough for someone who is not medically qualified and who may have played no part in the original decision to detain a patient to assume responsibility for renewing the detention order; yet that is what we shall get if the Bill goes through in its current form. The noble Lord was right to remind us that in the 2004 draft Bill renewals would have been overseen by a tribunal with access to a panel of experts, and in this Bill we no longer have that safeguard. I am worried by the fact that we live in a risk-averse culture. If we leave decisions about renewal of detention to one individual—and not necessarily a medically qualified individual at that—we may well see defensive practice rearing its head even more than we do now. That prospect is not appealing. I hope the Minister will listen carefully to these arguments and above all will listen to the united voice of the profession, which is saying that the Government have quite simply got this one wrong.