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Mental Health Bill [Lords]

I shall not give way for a while, as several conversations seem to be going on at the same time. Those hon. Members who want to make a contribution to the debate should do so before the Minister accepts the new clause. The breadth of the law as its stands contrasts with the provisions in most countries, where the seriousness of a condition, or the harm that might be caused, are essential criteria for detention. We consider that the criterion of impaired decision making provides a preferable alternative to the seriousness criterion in the 2004 Bill, because it is more specific and directs the clinician to the correct issue of patient choice and autonomy. The vast majority of people with a mental illness, like those with a physical illness, retain in full their ability to make their own decisions throughout. They are treated by GPs or psychiatrists without being detained. Of those who are detained under the Mental Health Act 1983 some, as I have said, will also retain their capacity. A recent study found that 15 per cent. of detained patients, especially those who had been detained on a previous occasion, retained their capacity. The authors of that report also found that a capacity test worked with a high level of reliability, which answers part of the point raised by the hon. Member for Stockport (Ann Coffey). The IDM test imposes a lower threshold, and does not apply to section 2 patients. If it were passed into law, I believe it would lower the percentage of detained patients who retain their capacity. What are the consequences of failing to take account of decisions taken by a person who has insight into his condition and is fully capable of making a choice? I think that there are four. First, patients with full capacity come to resent their psychiatrists. As I said earlier, they tend to avoid their services for fear of being forced to have treatment that they do not want and which they believe may be harmful to them physically. That in turn can lead to them becoming more ill, with some slipping below the clinical radar or being deterred from presenting in the first place. Secondly, patient outcomes may be damaged if personal decisions are not taken into account. Thirdly, patients may be harmed by treatment that may be unnecessary, and fourthly—and most importantly—stigma is increased. Failing to take account of vulnerable people’s decisions can, and does, destroy their trust in the medical profession, on whose members they rely for mental and physical health. Inevitably, detention in hospital is a major disruption to a person’s life. In the context of the blame culture, in which every tragedy caused by a patient can potentially be attributed to misjudgments by a psychiatrist, psychiatrists often feel required to section patients against their better judgement or the best interests of those patients. The predictable consequence of the present law is that people with full capacity can stay away from the psychiatrist because they can justify an irrational fear of being detained. In that sense, the law is totally counter-productive: as I have said before, we need patients to engage early. Tony Zigmond, vice-president of the Royal College of Psychiatrists, has followed our proceedings very closely and I am sure that he is doing so at the moment. He has said:"““Enabling people to feel able to seek help early, to talk about their fears and difficulties, without fearing scorn, humiliation or loss of status, freedom, job and friends is the best way to bring about improvement in their health””." As in other areas of medicine, the best outcomes are achieved when patients engage early, take a full and active role in their treatment and have trust in their psychiatrist or other professional. In that connection, the NICE guidelines on anxiety state:"““involving individuals in an effective partnership with healthcare professionals, with all decision making being shared, improves outcomes””." Another aspect of the problem is the stigma felt by members of the black and minority ethnic community. They strongly support the new clause, and feel deeply stigmatised by the present law. The figures for the disproportionate detention and sectioning of people from the BME community bear out those fears.