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Mental Health Bill [HL]

This issue was put to me very simply by a psychiatrist when we were discussing some of the ongoing problems with patients. When somebody first presents and the acute crisis occurs, and several healthcare professionals have to be involved, it is pretty obvious that that person is very seriously disturbed. People with psychological and psychiatric illness, though, over time also get other illnesses. It may be that their psychiatric condition has ameliorated but other physical illnesses emerge that may aggravate their symptoms and be mistaken for ongoing disturbance. This population are particularly at risk of some diseases. They tend to be heavy smokers, who are at risk of developing lung cancers, which develop silently. Lung cancers can metastasise to the frontal lobes of the brain and present with disturbed behaviour. If somebody is retained under compulsion because of a disturbance of his mind, it is absolutely crucial that after six months the diagnostic processes are gone through again. Medical training and the training of the psychiatrist incorporate complex diagnostic training. The other disciplines that will be able to be involved have not received that complex physical diagnostic training. Indeed, nurses may have trained purely in mental health—that is not to denigrate their skills, it is simply that they have come up through another path. It is terribly important that we remember that the subtlety of diagnosis on review may be much more difficult than the initial barn-door presentation.