30th
January 2007
Joint meeting of the Mental
Health, Ageing and Older People, Autism, Disability, Drugs and the Primary Care and Public
Health All Party Parliamentary Groups and the Associate Parliamentary Health Group
The
Mental Health Bill
Lynne Jones MP opened the meeting and
introduced the speakers.
Rt
Hon Rosie Winterton MP, Minister of State, Department of Healt
The Minister began by outlining the background to the reform of the
Act noting that the process had been going on for 8 years. The previous draft bill was
criticised for being too long and for having too many workforce implications so the
Government had decided to introduce a shorted bill to amend the old Act instead. The
Government’s motivation is to get treatment to as many people as need it.
The Bill will introduce supervised community treatment (SCT) to England
and Wales as has happened in many other countries. This will apply to people who have been
detained in hospital previously and will ensure that they take medication at home.
The Bill also amends the treatability test to bring in a concept of
appropriate treatment instead to combat confusion over what treatability means and closes
the gap which prevents some people receiving treatment.
The Bill aims to reflect modern services by involving a broader range
of professionals and to come inline with human rights legislation. The Code of Practice
has been published to show how the legislation will work on the ground.
In response to a question the Minister said that principles could not
be put on the face of the Act because the Bill was an amending piece of legislation, but
principles would be added to the Code.
Paul
Farmer, Chief Executive, Mind
Mr Farmer began by saying that he felt everyone was relieved to see
the Mental Health Bill in Parliament and he had been impressed by the high quality of
debate in the House of Lords. He stated that images of the Barratt and Stone inquiries are
ever present when discussing the Bill as well as the recent Confidential Inquiry into
suicides and homicides. Service users have told him that they are scared that the focus on
risk associated with the Bill will increase the stigma people already hold against people
with mental health problems. Mr Farmer said that no legislation could eliminate homicides
or suicides, instead services need to be properly funded to ensure that people receive
care whine they ask for it. Services are improving but are not excellent and it is
important that they are supported and that the media’s obsession with dangerousness
does not overshadow the debate.
Mr Farmer said that when a crisis occurs and compulsory treatment is
required, all parties feel there has been a failure, the service users, families and
mental health professionals. During your stay in hospital you may well lose your job, your
house and your friends so it is important to recognise how disastrous compulsory treatment
can be for a person’s life.
Mind is many positive amendments which could be made to the Act to
improve the service users’ rights and safeguards such as principles on the face of
the Act and advocacy. Mr Farmer stated that the Government should not miss this
opportunity to improve the compulsory system through accepting some of these positive
proposals.
Marcel
Vige, Co-chair BME Mental Health Network
Mr Vige presented findings from the Mental Health Act Commission’s
2005 census which showed a huge disparity between black and white inpatients especially in
terms of levels of detention and referral from the police. He noted that the Department of
Health has a project called Delivering Racial Equality which is designed to tackle the way
practitioners work and reduce inequalities. However he stated that is was important that
the legislation backed up what the Government was doing through services and highlighted
the smoking ban as a way the Government has used legislation to change practice.
Mr Vige said that principles of equality and non-discrimination
should be on the face of the Act to guide professionals. He expressed concern about the
Government’s proposal on appropriate treatment which could lead to a rise in the
level of compulsion and in turn disproportionately affect people from BME backgrounds.
Professor
Louis Appleby, National Clinical Director for Mental Health
Professor Appleby stated that the Government was trying to get the
system right to help marginalised people. Services are also very important and need to
ensure that people receive treatment when they need it. It is hard to talk about mental
health and violence but it is an issue and it occurs when people don’t receive
treatment. Professor Appleby said it was wrong to blame the media for linking mental
illness to violence as the public are aware that service failure can lead to violent
incidents. He stated that every restriction was a person not treated and noted that the
treatability clause put clinicians in a legal grey area. People with personality disorder
are excluded because they have the wrong type of mental illness and this needed to be
addressed. People with treatment resistant depression were now receiving help which should
be extended to others. In response to Marcel Vige, Professor Appleby said that the way to
address racial discrimination was through services not legislation.
Baroness Murphy, Member of the
Joint Committee on the Draft Mental Health Bill
Baroness Murphy reported that the Bill had received 4.5 days in
Committee in the Lords and there had been a lot of good discussion. Amendments had been
tabled from all parts of the House largely inline with the Joint Committee’s
recommendations. Major amendments had been tabled on principles, exclusions, therapeutic
benefit, Bournewood, children’s issues and supervised community treatment. Lord Hunt
was the new Minister but had got on top of his brief very quickly. Only the amendment on
impaired decision making was voted on and at vote was accepted. Baroness Murphy stated
that she hoped that service users felt that their concerns had been adequately raised in
the debates.
Question
and Answer session
A question was asked about why the treatability clause needed to be
amended if conditions such as treatment resistant depression could already be treated
under the Act. Professor Appleby stated that personality disorder was currently excluded
from the Act.
Another questioner asked whether the Code was compulsory reading for
mental health professionals and whether it held any weight. Baroness Murphy responded
saying that the Code is read and taken note of and Professor Appleby confirmed that it is
referred to when there is a problem.
Baroness Howarth spoke about the importance of age-appropriate
settings for the treatment of children and the problems that can stem from children being
kept on adult wards. Professor Appleby stated that this was an issue for services and that
in an emergency sometimes only adult wards are available which could prove a problem if
age-appropriate setting was included in the law.
Another questioner asked why the Government was increasing the use of
compulsion through treatment in the community when there was little evidence of success
elsewhere in the world and that increased compulsion could scare service users away from
services. Professor Appleby responded saying it was hard to do gold-standard research on
compulsory community treatment but that good results had come from North Carolina and New
Zealand. In response to a question from Lynne Jones MP, he said that the Government’s
report on community treatment orders would be published shortly. Rowena Daw said that she
hoped there would be more of a debate on compulsory treatment in the community, the Mental
Health Alliance was concerned about the criteria and felt that the new powers would only
be suitable for a very small group of people. She reported that John Dawson who had
reported on the example of CTOs in New Zealand had pointed out that the Act there was very
different with different criteria to the Bill in England and Wales.
Several questioners including Angela Browning MP asked about why
there isn’t an explicit exclusion for learning disability, Asperger’s and autism
from the new Bill and also raised the issue of whether the Bournewood safeguards would be
rigorous enough. Baroness Murphy reported that the Government had been very responsive to
the issues raised on Bournewood and Baroness Ashton was looking for solutions. In relation
to the exclusions Professor Appleby said that people would not be detained on the basis of
their diagnosis alone but only if there was a risk. The abuse in Cornwall was unacceptable
but was not an issue for this legislation.
Baroness Darcy de Knayth reported that the amendment on advocacy
would be pursued at Report Stage.
Another question related to older people and how over 65 year olds
are discriminated against in the health service. Other questioners asked about
misdiagnoses and also side effects from treatments and asked how this could be addressed.
Lynne Jones MP brought the meeting to a
close and thanked the speakers.
Attendees
Members:
Lynne Jones MP
Sandra Gidley MP
Tim Loughton MP
Baroness Murphy
Baroness Eccles
Lord Turnberg
Baroness Greengross
Baroness Darcy de Knayth
Madeleine Moon MP
Baroness Carnegy
Dr Richard Taylor MP
Paul Burstow MP
Angela Browning MP
Baroness Barker
Baroness Howarth
Brian Iddon MP
Observers:
Neil Balmer (office of the Liberal Democrat whips in the Lords)
Richard Etley – Autism Consultancy Services
Andy Harris – Kent County Consultative Group
Lucy Cork
Libby Whittaker
Rhya Homewood – Kent Able Disabled PWP
Anna Kennedy – Autism Consultants
Mirand Moreland – Bruised UK
Anthony Motyka – Autism Consultants
Mike Shannon – Hospital Liaison Officer
Angela Cheyne – Ageing and Older People APPG
Tom Hamilton – Mencap
Robert Yuille – NAS
Beth Capper – RADAR
Martin Barnes – DrugScope
Ruth Goldsmith – DrugScope
David Evans – DeafBlind UK
Agnes Wheatcroft – Royal College of Psychiatrists
Dr Kim Fraser
Professor John Gunn
Roy Webb – NCIL
Kiran Dattani Pitt – Values into Action
John Trolan – Nelson Trust
M Mikkelson – APHG
Tom Moore – Surrey County Council Autism Project
Roger Painter – Autism West Midlands
Amanda Thomson – Action on Addiction
Dr Caryl Morgan
Eugene Bolduc – ASAP
Cris Bolduc – ASAP
Adrian Hill – IBM
David Shamash – NAS
Dr Rebecca Syed
Fiona McKinstrie – YoungMinds
Kathryn Pugh – YoungMinds
Andy Bell – Sainsbury Centre for Mental Health
Dr Tony Zigmond
Andrew Delemore – Justice in Health
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