All Party Parliamentary Group on Mental Health

2 May 2006

MEETING TO DISCUSS THE REFORM OF THE MENTAL HEALTH ACT

Chair: Lynne Jones

Speakers: Rosie Winterton; Cliff Prior (Chief Executive - Rethink)

Lynne Jones opened the meeting saying it was a follow-up to the meeting in January when Lord Carlile had addressed the Group on the same topic.

The Minister spoke first. She began by setting the scene by discussing points such as extra investment into mental health services but noted that there is still a long way to go in improving services and that part of this will be to work much more closely with organisations like Rethink. The Minister also stated that mental health was one of her Department’s top three priorities and she was proud that they were making a real difference to the lives of service users and their carers particularly through reaching out to people in the community.

The Minister then ran through the key policy changes announced on 23^rd March and noted this had occurred after seven years of work and consultation. She noted that stakeholders had complained that the 2004 draft had been too long and felt that the workforce wasn’t in place to implement the new tribunal system so consequently the Government now planned to introduce a short Bill to amend the 1983 Act. The new Bill aims to bring the 1983 Act into line with human rights law and modern service delivery. The proposed amendments are:

Introduction of Supervised Community Treatment (SCT) so patients discharged from hospital will continue to comply with their treatment.
Single definition of mental disorder.
The treatability clause will be replaced and instead appropriate treatment must be available.
Changes to professional roles.
A European Court of Human Rights matter in relation to the nearest relative will be cleared up.
Make tribunals more accessible.
Address the Bournewood Gap.

Lynne Jones MP then asked a couple of quick questions about the definition and the tribunals and the Minister replied that there will be a single definition with exclusions for alcohol and drugs dependency and learning disability. The Government will not introduce a whole new tribunal system but are looking at bringing forward the timing of the automatic tribunal.

Cliff Prior then addressed the Group. He highlighted that the Act is used around 45,000 times a year and that it will be used 1million times over the course of its life, it is a major part of the mental health system and has a huge impact on people’s lives. Mr Prior stated that seven years of consultation was appropriate considering the importance of the Act but that the Mental Health Alliance had grave concerns about the 2004 Draft and that the new proposals seemed to contain many of the worst aspects whilst the safeguards have been dropped.

Mr Prior said that the proposed SCT was an improvement on the Draft Bill but it was hard to see how a person could get off an SCT. The Cochrane review of compulsory treatment in the community was very negative and showed little evidence of success. It was also disappointing that the tribunal system would not be much improved through the automatic tribunal and advocacy and advanced statements had also been lost. Mr Prior stated that a proper process was needed for those who are detained and that there are parallels with the recent debate in Parliament over people held without trial on terrorism charges.

Mr Prior also noted that race is a major issue for the legislation as evidence shows that people from Afro-Caribbean background are over-represented in the system in terms of use of compulsion and use of medication and seclusion. The Mental Health Alliance feels that the new Race Equality Impact Assessment (REIA) should be applied to the whole of the 1983 Act with the new amendments.

Mr Prior said that when patients access the system voluntarily they get better outcomes than those who enter by being detained, people need to be given help when they ask for it rather than later on when their condition has deteriorated. He also said that the Government needs to take time to consider the new proposals in depth with proper consultation as the language of the Bill is so important. In response to a question from Lynne Jones MP about tribunals Mr Prior said that he was disappointed that the proposal for a tribunal at 28 days had now been changed to one at six months especially considering that advocacy would not be introduced in the legislation.

The Minister commented that the Draft Bill did propose a new tribunal system but the Mental Health Alliance had criticised it as unwieldy so they had reverted to the current system. Advocacy was also lost as the Bill had been criticised for being too long. She noted that the development of SCTs had followed calls from carers who wanted more help outside of hospital, but it will only be used in small number of circumstances. On race issues the Minister said that the legislation was not the only way of tackling the over-representation of black people in the system.

Mr Prior agreed that carers should be listened to but noted that their most common request was for a right to assessment and care.

Baroness Murphy spoke and noted that she was a co-author of the Code of Practice on the 1983 Act and a member of the Joint Committee on the Draft Mental Health Act 2004 and was very disappointed by the decision to revert to the old Act as it has no principles attached to it and does not reflect modern practice. The Joint Committee had many criticisms of the Draft Bill, not just the length and it seems the new proposals contain the worst bits of that Bill without any of the good bits. She felt the new Bill should also go to scrutiny as it will have a profound effect and the changes to treatability in particular needed to be looked at. She said the Government should go back to first principles and consider what they are trying to achieve and also felt that the Government’s proposals really failed to address the Joint Committee’s concerns at all. She also felt that the nearest relative did not need a change in the law.

The Minister responded saying that the ECHR meant that a change to the nearest relative was essential. She noted that the Joint Committee and Mental Health Alliance had made a lot of noise about the tribunals and the Government had to make a decision but they will aim to move the automatic tribunal to earlier in the process. On treatability she had heard from a clinician that some of his patients were being advised by their solicitors to refuse treatment and claim they were untreatable to escape detention and that this needed to be addressed. Some vulnerable patients are not getting treatment and then becoming a danger to others, the public needs to have faith in the system and this in turn will reduce stigma. In fact some people say the legislation is too soft. Baroness Murphy pointed out that the Minister was from the Health Department and health should be her main concern. The Minister replied that it was important to see the bigger picture and strike an appropriate balance.

Emily Frith asked whether the REIA would cover the whole Act and whether there would be scrutiny. Jo Squires said that the Mental Health Alliance was made up of 77 organisations and their concerns with the old Draft were far deeper than saying the Bill was too long. The Minister said that the REIA would cover the amendments and that following seven years of consultation and scrutiny the Bill would not go straight to Parliament. It would be published as soon as possible and the intention had been for this to occur during this session of Parliament.

Miranda Moreland noted that the tribunals proposed in the Draft Bill would have been excellent if the funding had been in place. The Minister responded that she felt the system could have been achieved but that it was scrapped due to criticism. Mr Prior asked whether the automatic tribunal could be reduced over a set period, month by month. The Minister noted that people can get an earlier tribunal if they appeal.

Dr Ian Hall said that many psychiatrists were unhappy with the removal of treatability as clinicians have a duty to help people and would not want to detain people without giving them a health benefit.

Philip Dixon-Phillips said that after the seven year consultation people wanted a revolution in services not just reform. The implications of the proposals are huge and the stigma that increased compulsion will cause will effect many people with a trickle down effect to even those with mild mental health problems.

Caroline Hawkings asked how advocacy would now be pursued.

Martin Aaron asked why there will be cuts to services including spiritual support when there was a manifesto commitment to providing services. The Minister noted that Strategic Health Authorities may provide spiritual services but that there were problems in some areas with trusts providing all the services they should such as bereavement counselling.

Lynne Jones thanked the Minister who had to leave at this stage.

Mr Prior summed up saying that the 2004 Bill had been badly drafted and that it was unacceptable for the Government to pursue a new Bill through Parliament with allowing sufficient time for consultation to get it right. He noted that the biggest issue in mental health was providing care to people when they first ask for it. Homicide inquiries always say that people were turned away by health services and after that they deteriorated. He expressed doubt that the money earmarked for the tribunals in the 2004 Bill was now going into services. He reiterated that a full REIA should be carried out.

Adrian Sieff responded on behalf of the Minister. He said that they were working on a Regulatory Impact Assessment on the new Bill to look at costs. They will also look at reducing the time of the automatic tribunal and will talk to the Mental Health Alliance about it. Changing the treatability clause is very important to the new legislation and part of looking at treatment in a holistic way. The changes to professional roles will also help the system work better. Race equality is being addressed but is also an operational problem with the legislation and needs to be improved through changes in practice. Di Barnes’ project is looking at how to implement advocacy and the government is also looking to link this with the Mental Capacity Act advocates.

Lynne Jones MP thanked speakers and concluded the meeting.

Members:

Baroness Barker

Sandra Gidley MP

Baroness Howells

Lynne Jones MP

Tim Loughton MP

Madeleine Moon MP

Baroness Murphy

Baroness Wilkins

Observers:

Adrian Sieff – Bill Team