Asked by
To ask His Majesty’s Government what plans they have to reform
the Mental Health Act 1983.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
We are committed to improving the care and treatment of people
detained under the Mental Health Act, including taking forward
non-legislative commitments such as culturally appropriate
advocacy, as well as continuing to expand and transform NHS
mental health services. I am grateful to the noble Lord and his
colleagues on the Joint Committee for their work on the Bill to
date, and I assure him that it remains our intention to bring
forward a Bill when parliamentary time allows.
(Lab)
My Lords, for over six years, the Government have promised to
reform the 1983 Act, from manifesto commitments to the Wessely
report, draft Bills and consultations, and now the Joint
Committee which reported to this House in January of this year—
11 months ago. Then, to the astonishment and no little anger of
thousands of people with mental ill health, autism and learning
disabilities, who have been supported by their tremendous
advocates, there has been deafening silence from the Government.
Now the proposed Bill has been completely dropped from the
legislative programme. There is a real feeling of frustration
across the country about this situation. Will the Minister now
give a real explanation so that we can try and restore the
breakdown of trust that has come about from this situation?
(Con)
I understand the frustration and disappointment about the fact
that the Bill has not been brought forward. I am keen to focus on
what we can do in the meantime. Of course the Bill is trying to
decrease the rate of detention and, within that, decrease the
racial disparities, such as the fact that a black person is four
times more likely to be detained than a white person. There are a
number of things that I hope we will be able to discuss more,
particularly in the debates on Thursday as well, such as the
things we have introduced in pilots, like the culturally
appropriate advocacy. That really can make a difference here and
now.
(Con)
As the chairman of the inquiry, I reassure noble Lords that my
noble friend the Minister is very aware of our frustration.
However, I am pleased to hear—I am sure others are too—that,
along with others in the department, he is looking to see what we
can achieve without primary legislation. Could he and his
officials focus on the further development and implementation of,
for example, advanced choice documents, which would really make a
difference to the dignity and choice that people with mental
health issues thoroughly deserve? Could he also, as he touched
on, really research and respond to why a highly disproportionate
number of black men are unfairly detained?
(Con)
I thank my noble friend for her question and for her work on
this. The advanced choice documents are a perfect example, like a
birth plan, of where people can put in place what their hopes are
for the future. There are good examples at King’s College and at
South London and Maudsley of what they are doing in this
direction, and I am really keen to learn from those and expand
them further. I am also keen to invite all the participants to a
round table that Mental Health Minister Caulfield has agreed as
well, where we can really talk about the action that we can take
on the ground to implement as many things as we can to rectify
the problems in this space.
(CB)
My Lords, 40 years ago, as a young consultant psychiatrist, I
argued against the inclusion of learning disabilities and autism
in the 1983 Act—it is out of date; these are not mental
disorders. Does the Minister agree that it is time to take this
Bill forward seriously?
(Con)
We are all agreed on the intent behind what we were trying to do
with the Bill. On learning difficulties and autism, the most
important thing we are trying to do is to make sure that the CQC,
within 48 hours of a person being put into segregation, is
investigating and doing an independent review on whether that is
the best place for them. Like the noble Baroness, I share the
feeling—we all think it—that it is much better that they are
treated in the community, where they can be.
(LD)
My Lords, mental health legislation relies on good data; we do
not have good enough data about the detention of people from
different groups. Does the Minister agree with the committee that
a step forward that could be taken now is the appointment of a
responsible person in each organisation with a duty to record not
only the detention of people under the Mental Health Act but the
demographic data surrounding it?
(Con)
Yes. The data, and fundamentally understanding what is beneath
it, is key to all this. We have put an executive lead on each
trust board to look at exactly these sorts of issues, including
the data, so I am happy to take that forward.
(Lab)
My Lords, the provisions of the Mental Health Act have no clear
definition of a safe place in which a sectioned patient may be
taken while awaiting medical assessment. That often results in
vulnerable people being taken to police stations and forcibly
detained by the police. What assessment have the Government made
of the frequency of this continuing due to the Government’s
failure to reform the Mental Health Act—something that Labour, if
we win the next election, will put right? How will the Government
ensure that patients are no longer detained in such inappropriate
and punitive environments?
(Con)
I appreciate the feeling that our response on minimal
standards—in our reply, I think, to the report by the noble
Baroness, Lady Hollins —did not go far enough to make sure that
those patients are in the right quality setting for them, so the
noble Baroness, Lady Merron, has made an important point. I was
going through with the team what we can do to make sure that that
is right. As I mentioned before, the fact that the CQC now has
responsibility for those independent reviews will mean that it
will look not only at whether it is right that the patients are
in those in-patient environments but at whether it is the right
environment as an actual place.
(Con)
My Lords, the committee heard about disproportionality,
particularly with community treatment orders, which are about 11
times more likely to be imposed on someone from an
ethnic-minority background. Can my noble friend the Minister look
at that, and maybe meet with colleagues in other departments to
see whether there is a legislative opportunity to sort that out
by putting that provision into a different piece of
legislation?
(Con)
Yes. I have tried to get into this further, and my understanding
is that lot of the trouble is that there is often a fear from
black and ethnic-minority people of the existing institutions
that can help people early on. As we all know, with mental health
difficulties, we have to act quickly. A lot of this is about
getting everyone in society open to the idea that the earlier
they can go to these sorts of places, instead of trying to brave
their way through, the better. That is one of the key things to
do to make sure that we do not then see problems down the
pipeline, including the disparity whereby a black person is 11
times more likely to have community reviews and the disparity in
detentions.
(CB)
My Lords, I think that other noble Lords will welcome the idea of
sitting down at a round table to look at the future. In
particular, what do the Government intend to do to invest in
children’s and adolescents’ mental health services to make them
accessible in schools? Early intervention will prevent a high
proportion of people needing to be sectioned later on.
(Con)
The noble Baroness is absolutely correct. With the mental health
units to detect problems early, we are now at around 35%; last
year it was only 25% but in the next 18 months or so we should be
at 50%, which is higher than ever before. I freely accept that
50% is not 100% but it is clearly a step in the right direction.
The £2.3 billion investment we are putting in means 350,000 extra
places for young people as well.
(LD)
The Government keep telling us that they plan to take other
measures to improve mental health outcomes in the absence of the
legislation. I hope the Minister will understand why, having been
let down on the promised Bill, we want to see the colour of the
Government’s money. Can he go back to his department and ask it
to produce a list, with details and dates, of all the measures it
intends to take to improve mental health practices via statutory
instrument and new guidance in this parliamentary Session?
(Con)
Yes. I am happy for the noble Lord to come to the round table and
put those points himself as well.
(Con)
My noble friend will be aware that autism is not a mental health
condition but a communication disorder. However, of course like
everybody else, people on the autistic spectrum can develop
mental health problems as well. What assessment has the
department made or could it make, quite urgently, of just how
able and experienced psychiatrists around the country are at
disaggregating between an autistic person having a meltdown and a
mental health condition? If they get it wrong, as often happens,
the consequences of the treatment that follows are
devastating.
(Con)
My noble friend is absolutely correct, and from personal
experience I know the importance of getting that early diagnosis
right. I am quite happy to write in detail exactly what we are
doing in this space.
