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Mental Health Bill [HL]

I rise to speak to Amendment No. 18. I have great sympathy with the purpose of this amendment and great interest as chairman of the Mental Health Act Commission, which was mentioned by the noble Earl, Lord Howe. It will be useful to go back a bit. The justification for the current three-month period, during which treatment with psychiatric medication can be imposed upon a detained patient regardless of consent, derives from the words of the Minister during the 1982 Standing Committee debates on the Mental Health Bill, as it was then. Practitioners in the field today who seek advice on or interpretation of the statute will find the words of that justification preserved in the Mental Health Act Manual: "““The three months gives time for the psychiatrist to consider a treatment programme which suits the patient. Three months seems to fit best with both clinical experience and clinical practice. It is long enough to allow a proper valuation and assessment of what, if any, long-term treatment may be needed. It is also short enough to ensure that a patient’s consent, or a second opinion, is obtained before a long-term course of drug treatment gets too far ahead””." Noble Lords may think that that is fair enough. But I have to ask, a quarter of a century later, are we still content that three months must pass before a patient who is being treated with medication has a right either to give their consent or to withhold it? Should it be three months before a patient is afforded the safeguard of a second opinion, when he or she is being forced to take such medication? I think not. I, for one, am certainly not content. Everything that I believe tells me that three months is too long to withhold a patient’s rights. I suspect that that is also the feeling of this Chamber. In the 25 years since the argument was made, the general recognition of and sensitivity towards human rights in the health care context has come a long way. I add my support to the amendment. However, I am not ignorant of its possible consequences and I hope that the Minister will forgive me for anticipating his response to the amendment, as I suspect that his greatest concern will be with its resource impact. It is certainly the case that reducing the period before which patients are entitled to a second opinion will cause a rise in the numbers of second opinions. As the chairman of the body responsible for administering those second opinions, this gives me slight pause—but it is only slight. In any case, the number of second opinions has significantly increased over the lifetime of the Act by some 250 per cent. The Mental Health Act Commission’s last biennial report speculated on the possible reasons for that rise, one of which was that was a growing appreciation and care by clinicians to consider whether apparent consent from a patient was genuine, rather than being based on inadequate understanding, capacity or freedom of choice. So far, the administrative burden of the safeguards provided by the 1983 Act has already increased dramatically over the lifetime of that Act. The Mental Health Act Commission has managed that burden and the Department of Health has, in the main, funded it. I urge the Minister to be cautious in rejecting this amendment on the grounds that its costs are uncertain. We should welcome the extension of an existing safeguard over a wider population of those who are treated without consent and be prepared to meet the costs that safeguards may entail.