All Party Parliamentary Group on Mental Health

9^th November 2004

Annual General Meeting of the All Party Parliamentary Group on Mental Health

Results of the AGM:

Joint Chairs re-elected: Dr Lynne Jones MP, Rt Hon Virginia Bottomley MP, Sandra Gidley MP

Secretary re-elected: Lord Alderdice

The Revised Draft Mental Health Bill:

Lynne Jones opened the main part of the meeting

Rosie Winterton MP, Minister of State with responsibility for mental health, Department of Health

The Minister began by thanking the Group for its work in raising the profile of mental health issues in Parliament and noted that this in turn helped to maintain a high profile for mental health within the Department of Health.

The Minister reported that there was a consensus in the mental health field that a new Bill was needed so that legislation was in line with the way that modern mental health services are delivered and to reflect modern best practice. There has been much discussion surrounding the reform of the 1983 Act and the Government has listened to comments and suggestions from a broad range of organisations and individuals.

The Minister noted that several changes had been made in the Revised Draft Mental Health Bill, including:

• A raised threshold in the conditions, “for the protection of the patient from harm”;
• Treatment in the community (non-residential orders) tightened in the accompanying regulations to tackle the “revolving door” patients who need extra support;
• Compulsion in prison has been dropped from the legislation and
• A patient who is over 16 and has capacity can refuse ECT.
• The Minister then outlined the benefits of the 2004 Draft:
• There will be no compulsory treatment unless appropriate treatment is available;
• Increased safeguards including the new Mental Health Tribunal, the choice of nominated person and access to advocacy and
• Legislation which meets the needs of patients, society and human rights.

The implementation of the new Bill will include increasing the workforce to meets the demands of the new legislation. An Implementation Advisory Group is being set up to aid the process.

The Minister concluded by saying that she has held many meetings with stakeholders and the issue of public protection has been raised many times. The Bill provides new safeguards but does recognise that compulsory powers are needed. Stigma and fear towards mental illness cannot be tackled until the public has confidence in the system.

Lynne Jones thanked the Minister and asked Paul Farmer to respond.

Paul Farmer, Chair of the Mental Health Alliance and Head of Public Affairs at Rethink

Paul Farmer – Mr Farmer began by thanking the Minister for her useful presentation. He noted that the Mental Health Alliance had been formed to campaign for good legislation and now had a membership of 67 organisations including voluntary organisations, professional bodies and service user groups. The Alliance has engaged with the Government’s process and has tried to be constructive and is happy to continue with the process. He noted that Alliance policy could be viewed online at:

 www.mentalhealthalliance.org.uk

Mr Farmer said that mental health legislation is extremely important in the way that mental health care is delivered. Compulsory treatment can be painful and traumatic, especially if the police are involved.

Mr Farmer outlined the areas on which there is agreement between all parties:

• ·         Compulsory treatment should be kept to a minimum and used as a last resort;

• ·         Good services will provide the greatest impact on improving conditions for those with mental health problems and the emphasis should be on good quality voluntary care;

• ·         The 2004 version of the Draft Mental Health Bill is an improvement on the 2002 version;

• ·         The pre-legislative scrutiny process is very important, the members have a good breadth of knowledge and the Chair is impressive.

Mr Farmer noted that personality disorder treatment trials were under way and that time was needed to assess their effectiveness. He also noted that Criminal Justice legislation was sufficient to cope with many of the issues to do with dangerousness.

Mr Farmer highlighted the progress of the Mental Capacity Bill which he said would provide a broad framework for the treatment of people who lacked capacity. He noted that the key group of ‘Bournewood’ patients needed to be dealt with through the legislation and that safeguards would be vital.

The Mental Health Alliance has submitted evidence to the scrutiny committee, the main recommendations were that:

• Principles should be on the face of the Bill;
• Conditions should include ‘impaired judgement’;
• Reciprocity should be written in to the Bill, compulsory treatment should only be allowed if there is therapeutic benefit;
• Same conditions for compulsion and the same safeguards for Part III patients as for Part II;
• Stronger safeguards;
• Stronger commitment to resourcing for advocacy etc;
• The Bill needs to last a lifetime and may be used over one million times so it needs to be right.

Prof. Louis Appleby, National Director for Mental Health

Prof. Appleby said that he would speak from the perspective of the clinician. The Mental Health Act is necessary so that people who are too ill to recognise their own needs can receive care. He reported that very few clinicians actually use the Act on a regular basis and when it is used it is always for therapeutic reasons. He noted that the 1983 Act needs to be updated in line with modern practice and to recognise greater patient autonomy. The 1983 Act is ambiguous in places and can leave clinicians in a grey area of law. The 2002 Draft was revised to reassure people that the Act would not be used unnecessarily and in response to clinicians who felt that their role was being made more containing.

Prof. Appleby also reiterated the main changes between the new Draft and the 1983 Act including, compulsion in the community, stronger safeguards and the conditions.

Q&A

The session was then opened up to the floor:

Dr Ian Gibson MP asked how the new Act will impact on the employment chances of people with mental health problems. Mr Farmer said that the Bill would not help the discrimination faced by people with mental health problems in the workplace and may increase stigma through its focus on risk.

Brian Iddon MP asked whether the panel were happy with the difference between the advocacy proposed in the Mental Health bill and that proposed in the Mental Capacity Bill. Mr Farmer voiced concerns about Independent Consultees (IC) which he felt would not be the same as advocates. The Minister felt that ICs would be ‘advocacy plus’ and the role could be expanded. Consultation was ongoing about this issue.

Lord Chan asked how the new Draft would affect people from BME communities. Mr Farmer noted that there was a long debate ongoing about why a greater proportion of people from BME communities are treated under compulsory powers and that we welcomed the group set up by the Department of Health which was looking at this. The Minister noted that the Department would publish ‘Delivering Race Equality’ in the near future.

Dr Evan Harris MP asked about the meaning of clinical appropriateness and how this was different from therapeutic benefit and whether it is right to use compulsory treatment with someone who retains capacity but refuses treatment. Prof. Appleby said that mental and physical disorders are different and that clinicians should intervene to save a person who is suicidal regardless of whether they have capacity. He did not feel that “therapeutic benefit” was a useful or specific enough phrase. Mr Farmer replied to say that many service users want equal treatment rights to people with physical disorders however he recognised that medical professionals cannot just stand by when dealing with a person who is suicidal. He also noted that people with physical illnesses frequently ignore the advice of their doctors and fail to take medication which has been prescribed to them and that it was wrong to assume that people with mental health problems should not have the same right to choose to ignore advice.

Baroness Murphy asked about the overlap with the Mental Capacity Bill and whether people with mental health problems would be treated under it. Prof. Appleby said that the Bills allow psychiatrists to choose to use the most appropriate way of dealing with the person in front of them.

Dave Tombs (UK Federation of Smaller Mental Health Agencies) said that it was important to separate the issue of mental health care from dangerousness and that he hoped that if the Bill remained unchanged that there would be strong opposition in Parliament. Mr Farmer said that the Mental Health Alliance will keep pushing for a better Bill. Prof. Appleby said that the new Act shouldn’t be seen as a substitute for good services and that he was committed to improving services.

Lynne Jones thanked all the speakers. She noted that Lord Carlile would be invited to present his report on the Draft Bill following its publication at the end of March.

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