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Mental Health Bill [Lords]

I shall be brief, as I fully expect the amendments to be supported in all parts of the House. They deal with safeguards for patients who are to be treated for their mental disorder with electroconvulsive therapy, or ECT. The issue was debated at length in the other place and in Committee. ECT is an invasive procedure and some patients are fearful of it. Although it is an established psychiatric treatment, it is a controversial one. We have already introduced amendments in the other place under which the refusal of a detained patient, with capacity to consent, to consent to ECT should be respected, except in an emergency. Following further debate in which other concerns were raised, the amendments before us provide even stronger safeguards in the very rare circumstances where young persons are treated with ECT. In Committee, my hon. Friend the Member for Norwich, North (Dr. Gibson) was particularly concerned about the provisions for giving ECT in emergencies. I hope he welcomes the changes that we have made. The amendments also clarify the position for community patients. Government amendment No. 12 ensures that, for patients under 18 who agree to treatment with ECT, a second opinion appointed doctor must first certify that it is appropriate for the ECT to be given. Even where a young patient consents to treatment, we want a second opinion. We have also considered the needs of patients under 18 who are not detained under the legislation or subject to a community treatment order. Government amendments Nos. 16, 21, 25 and 27 require that, where such patients can lawfully be treated with ECT or any other treatment made subject to section 58A, a second opinion appointed doctor must certify that it is appropriate. This is an important new safeguard for voluntary patients under 18. The Mental Health Act 1983 provides for a limited number of circumstances where the patient can be urgently treated without the need for a statutory second opinion. We have reconsidered those circumstances in the light of requests to do so in the other place and in Committee. As a result, we have concluded that ECT may be given as an urgent treatment in only two circumstances: where it is immediately necessary to save the patient’s life, or to prevent a serious deterioration in the patient’s condition. Amendment No. 19 achieves that, and we have made similar amendments—amendments Nos. 36, 37, 41 and 42—to the urgent procedures for community patients. Obviously, ECT is rarely administered to patients who are not hospital in-patients. The Bill does not afford community patients the same safeguards, and to rectify that we have tabled amendments Nos. 29 to 34, 39, 43 and 46. We have tabled other technical amendments. Amendment No. 14 removes the requirement that the second opinion appointed doctor certify that the giving of treatment does not conflict with the court order. Amendment No. 28 makes it clear that the certificates for adult community patients and child community patients apply when a patient is recalled to hospital, or when their community treatment order is revoked. Amendment No. 45 provides that the authority that issues a SOAD certificate under part 4A may require the approved clinician in charge of that treatment to report on it. As I said, I think that the amendments will be supported by all hon. Members, and I recommend them to the House.