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Mental Health Bill [Lords]

The House owes the hon. Member for Rhondda (Chris Bryant) a deep debt of gratitude for providing a solution to the core problem of the Bill. It is an ethical principle of medicine that its objective is to benefit patients, although it does not always do so. Detention by the NHS, as opposed to detention by Her Majesty’s prisons, has—save in rare cases of epidemic control—the goal of doing some real good to the patient. Indeed, the 1983 Act allows for the detention of seriously ill and at-risk patients, provided that there is a treatment likely to alleviate or prevent deterioration of their condition. That is the treatability test that, as the hon. Gentleman pointed out, applied to no one other than psychopaths and the mentally impaired. The treatability test left us with the problem of those with an untreatable personality disorder, which was dealt with without conclusion by the Joint Committee, and for which our Committee did not find a solution either. Some said that such people should be released, and I think that the hon. Member for Daventry (Mr. Boswell) said that they should be interned. In Committee, the Government made some entirely reasonable points. One was that existing legislation could be used to ignore and duck hard-to-treat personality disorder cases. I accept that that is a problem. They also pointed out that a consistent and deliberate refusal of treatment by an aggressive psychopath, for example, could engineer his dismissal by establishing, quite reasonably, that he was not treatable. The Government therefore initially favoured the definition of treatability that stated that appropriate medical treatment was available. They pointed out, quite reasonably, that not all medical treatment goes beyond palliative treatment, and that chronic conditions are often dealt with by the management of symptoms rather than by an outright cure. The Lords, fearing that the proposals involved simple imprisonment under another name, defined ““appropriate available treatment”” in the old way, as treatment that was likely to alleviate or prevent deterioration of the condition, and we were back to square one. The Rhondda amendment, if I can call it that, is an attempt to bridge the gap. It removes the word ““likely””, and defines ““medical treatment”” as having the purpose of alleviating, or preventing the worsening of, mental disorder and its manifestations. It recognises that psychiatry is a relatively young science, and that remedies are not sureties or even always probabilities. Even if it will not always prove successful, detaining desperately and seriously ill people who are at risk—which, as the hon. Member for Rhondda explained, is what we are talking about—with a therapeutic purpose seems to me to be generally justifiable, subject to the normal rules on advocacy, appeals, tribunals and so on. I believe that the amendment can and should be supported, provided that the Government and those who tabled it make it clear that by ““manifestation”” they mean symptoms rather than the public impact made by a person’s behaviour. Mental provision should not be about hiding people away and ignoring their conditions.