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Mental Health Bill [Lords]

I congratulate my hon. Friend the Member for Rhondda (Chris Bryant) on assembling such a powerful coalition against me. There is not a grudge in sight. My hon. Friend set out very clearly all the ways in which he had tried to address this difficult issue. Let me remind the House what the Government hoped to achieve by removing the treatability test in the 1983 Act and replacing it with an ““appropriate medical treatment”” test. I am sure that Members, especially those who served on the Committee, will know that—as I think everyone has now acknowledged—the treatability test did more harm than good. As my hon. Friend said, it required clinicians to predict that treatment would be likely to work before certain patients could be detained. As he also said, on occasion it has been misinterpreted as meaning that patients could be detained only if they could be cured, rather than treated. That led to a culture in which, too often, patients with personality disorders were turned away from services on the grounds that they were supposedly untreatable. My hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) gave the example of a particularly disturbing incident in her constituency. That culture was bad not only for public safety reasons but because of the trauma that it caused to patients, their families and their carers. It also held back the development of services for people with personality disorders, despite the clinical advances being made. I believe that as a result of our removal of the treatability test, such development will be enabled rather than frustrated by legislation. The wording of the test has given some patients a perverse incentive to refuse to engage with treatment, in the hope of arguing that they cannot be detained because the treatment is not likely to work. I have been told of disturbing cases in high-security hospitals where patients have been advised by lawyers not to engage with treatment because it would lead to release. I know that all members of the Committee were concerned about that. The new ““appropriate medical treatment”” test requires a patient’s medical treatment to be"““appropriate in his case, taking into account the nature and degree of the mental disorder from which he is suffering and all other circumstances of his case.””" That is much more than the treatability test currently requires. Nothing in that test requires medical treatment to be appropriate to the patient as an individual, and, unlike the treatability test, this test applies regardless of diagnosis. Accusations were made that the new test would require detention without proper treatment. That is not the case, and is not what was intended. As my hon. Friend said, an amendment made in the other place would effectively have reinstated the treatability test, and in some cases would have made it worse by extending it to all areas of mental disorder. We removed that amendment in Committee because of the problems that it would have created. I accept that there have been doubts and concerns about the effect of the new test. Genuine worries have been expressed by a number of organisations. That was raised by my hon. Friend when he tabled his amendment in Committee. I agreed to consider it then, but in the meantime my hon. Friend discussed it with a number of organisations, clinicians and others. The amendment that we are discussing today has considerable support from Members in all parts of the House. I have given it serious consideration, and have met representatives of several organisations. I recently met members of the British Medical Association, who urged me to support the amendment provided that it was clear that ““manifestations”” were linked to an underlying mental disorder. My hon. Friend rightly explained that manifestations of a mental disorder were the way in which the disorder was manifested. Clearly a disorder can manifest itself only in the thoughts and actions of the person who has the disorder, not in the reactions of others. The crucial difference is that this amendment describes the purpose of the medical treatment; it does not turn on the likelihood of treatments achieving that purpose. The hon. Member for East Worthing and Shoreham (Tim Loughton) asked about the difference between signs and manifestations, as did the hon. Members for Southport (Dr. Pugh) and for Wyre Forest (Dr. Taylor). We believe that ““manifestations”” is better than ““signs”” because the latter can be interpreted more restrictively as only the things that clinicians observe in a clinical setting. The hon. Member for Wyre Forest was getting at that with his stethoscope point. Some clinicians use ““signs”” to mean only what a clinician can observe through examination at a specific time, which would exclude, for example, reports by third parties of self-harm or suicide attempts. The examination would, therefore, be confined to what was happening there and then. That is why we believe that ““manifestations”” is a better word to use than ““signs””. My hon. Friend the Member for Rhondda, with the support of Committee members, and latterly of the Opposition parties, has certainly—[Interruption.] I carefully looked at the signatories to the amendment, and I am glad that the Opposition parties support it; I do not wish to give the impression that I begrudge that. My hon. Friend and the Opposition parties have proposed this measure and it is a good compromise. I assume that the Opposition parties had discussions with my hon. Friend, and I am glad that they wish to support his amendment. In light of everything that he has said—and of our meeting this morning when we discussed the ““manifestations”” issue and the fact that many organisations have backed his amendment—I am glad to say that the Government will agree to the amendment. Amendment agreed to. Amendments made: No. 2, page 4, line 18, after ‘care’ insert—"‘(but see also subsection (4) below)’." No. 3, page 4, line 18, at end insert—