---

Mental Health Bill [Lords]

The threshold is lower because I do not think that the supporters of new clause 12 would want people sectioned under the Mental Health Act 1983 to qualify automatically for ECT. Although the hon. Lady might not agree with me, I hope that she has received an explanation of her point from this side of the House. Let me deal with the interesting challenge that the Minister gave the hon. Member for Rochford and Southend, East (James Duddridge). He deflected the challenge somewhat, but I am happy to meet it head on. I think that the hon. Member for Birmingham, Selly Oak (Lynne Jones), who spoke superbly, as she always does on such matters, also would have done so. The matter was dealt with eruditely and logically by my hon. Friend the Member for Southport (Dr. Pugh), who has a PhD in logic. The point to make is that it is possible to want to end one’s life or to have one’s life ended without necessarily having impaired judgment. It is also possible to have a mental illness as well. I shall describe two scenarios. If someone is terminally ill, they may reject immediately life-saving heroic treatment because they know that they are going to die and they want to exercise their autonomy and be allowed to die, not to have their life saved if they know they are going to die or suffer. Indeed, they may seek something that is unlawful in this country at present—assisted dying, which has never been opposed on the grounds of being irrational. It has been opposed for other reasons, which we cannot discuss now. That is one scenario. It is possible in that scenario for the person to be depressed as a result of their terminal illness, and/or it is possible for the person to have a serious mental illness anyway, whether or not it is depression. Just because someone rejects non-mental treatment because they wish to die or end their life, which may be considered suicidal, does not mean that they should be sectioned. That is why a test such as the one proposed in the new clause in that small minority of cases would add extra confidence and insurance against what otherwise might be deemed to follow automatically—that is, sectioning—because the person is suffering from a mental illness, which makes it appropriate for them to receive mental treatment in a hospital for that illness, and to protect them from taking actions that might end their life. There is a case that the Minister must address, which the new clause seeks to do. There is also the case—for reasons of brevity the hon. Member for Birmingham, Selly Oak did not go into it in as much depth as she might have done—about non-discrimination. People who refuse treatment that is life-saving and who are not terminally ill are entitled to do so if they retain capacity to do that. So a patient might, without not having capacity, refuse to have a big operation that a doctor would recommend and that would be life-saving. That does not mean that they are being irrational, that they do not have capacity or that their judgment is impaired. We do not force such physical treatment on them for their physical ailment. As for people with a mental illness, although we must take care that we act in their best interests and I recognise the difficult judgments to be made, we should not presume—it goes to the stigma—that they have impaired judgment if they are not looking after themselves or have an intention that their life should end sooner rather than later. It is vital that we ensure that people who have a severe mental illness and as a result of that are suicidal, are able to access treatment. I am satisfied, as I think my hon. Friend the Member for Southport was, that the new clause would not prevent that. It may help cope with stigma and raise doubts in the minds of people who might otherwise automatically seek to impose compulsory treatment on people with mental illness. It represents an extra test that might prevent unnecessary restrictions of liberty where that is not appropriate. I know plenty of people who have rightly been sectioned, who are not suicidal but who are self-neglecting to the point of infestation and to the point of malnutrition, who have a severe mental illness. I have sought in my medical practice to have them sectioned. A test of suicidal intent is not required. That was the point that I made to my hon. Friend the Member for Southport during his important contribution. For reasons of addressing stigma and of identifying a group of people who, if the new clause were not in the Bill, might be compulsorily detained for treatment, who need not be detained and for whom it would be inappropriate, and in order to ensure that we as a House recognise the need not to discriminate—discrimination law is changing all the time and the Government have just proposed consultation on discrimination law, and if the Bill goes through unamended in this place that will put the Government on the wrong side of that case—I will support new clause 12 in the Lobby tonight.