April 16, 2007
Mental Health Bill (Second Reading) debate
In supporting the second reading of the Bill, John Bercow calls on the Government to rethink its opposition to amendments tabled in the House of Lords.
John Bercow (Buckingham) (Con): It is a great pleasure to follow the hon. Member for Hendon (Mr. Dismore), many of whose concerns I share. Notwithstanding those concerns, my view is that the Bill should receive a Second Reading tonight precisely because of the welcome and protective amendments that were made on a cross-party basis and with great expertise in the House of Lords.
I listened carefully and attentively to the Secretary of State as she introduced the Bill this afternoon. She invoked, in support of the Government’ determination to reform the treatability provision, the need to catch within the net people who currently are not being caught. Specific reference was made, and justification was provided, in the cases of people with severe personality disorders. I have to say that I have listened over a period of weeks and studied some of the evidence, and my distinct understanding was that there was a misapprehension about that category of person. In so far as such people have not been treated in the past, it is principally because of a combination of reasons, including an absence of resources; a mistaken and outdated belief that such people could not be treated; and, as the corollary of those two states of affairs, the lack of effective treatments to secure the desired result. If in fact one secures a proper interpretation of the existing legislation and one has the resources to deliver what is necessary, it seems that that fox is easily shot.
I respect the Minister’ intentions and her humanitarian philosophy, but I suggest that she is wrong on this issue. The use of the term “appropriate treatment” is far too broad and potentially invasive. I do not think that it can be justified. Ministers were put to the test in the other place by Lord Howe, Baroness Barker, Baroness Meacher, Baroness Murphy and Lord Carlile‚Äîto name but a few‚Äîwho tabled an amendment that said “we don’t want that. What we want is to ensure that there is provision that will guarantee that the alleviation of, or the prevention of deterioration in, the condition should be the criterion that has to be satisfied if compulsion is to be deployed.” That is entirely reasonable. If the Government think that people will benefit‚Äîthat a therapeutic gain will be derived, or an improvement or prevention of deterioration in the condition will, in most circumstances be the predictable consequence‚ÄîI do not know of what exactly it is they are afraid.
I do not doubt the intentions of the Minister and I do not seek to impugn her integrity, but if the Government get their way, the inevitable prospect is held out of an expansion of preventive detention, if not on an industrial scale, at any rate in terms of significant increases in numbers. Simply as a matter of logic that must be what is portended by Government intentions. If the Government do not intend in any way to change the numbers, why do they need to go to such lengths to defy the professional wisdom and change the law?
My view is that the Government are wrong. They should accept the Lords amendment and there is a powerful consensus on that point. It is the view of the Joint Committee and of the Richardson review, which was requested by the Government. It is the considered judgment of the House of Lords and the opinion of the Mental Health Alliance, as well as the determination of the Scottish Executive. In terms of humility, the Minister might like to consider the possibility that she is in splendid isolation for the simple reason that she is mistaken.
Lynne Jones: I agree with the hon. Gentleman that “appropriate treatment” is inadequate, but is not the problem in the very words that he uttered? One cannot guarantee that treatment will bring about therapeutic benefit or prevent deterioration. I hope that we can find some compromise that will improve on “appropriate treatment” but not go so far as to say that we can guarantee the outcome.
John Bercow: That is a perfectly reasonable point, but I think‚ÄîI shall stand corrected tomorrow if I am mistaken‚Äîthat study of the record will show that I went on to say “guarantee” what the “likely outcome” would be. The hon. Lady is absolutely right. I concede the point: there are no certainties in this field and it does not do to be either arrogant or presumptuous, but we have to work on the balance of probability of the effect of one policy as distinct from that which is likely to flow from another. That is one area of concern and I beseech the Government at least to reconsider their position.
My second concern is that we should preserve the judicious amendment made in the House of Lords to bring the rights of people who suffer from mental illness into line with those of people suffering from physical illness. In other words, if someone possesses full decision-making capacity about his or her mental health, I cannot see why he or she should be subjected to compulsory detention and compulsory treatment‚Äîcompulsorily undertaken, manifestly, against his or her will‚Äîwhen that person has said, “I don’t want it”. If somebody suffers from a physical condition and is told, “You’re ill, you could be treated and it would benefit you”, but the person does not want to be treated because of the pain incurred, the side-effects experienced, the financial loss sustained or the family disruption entailed, that individual is entitled to say no. I simply point out to the Minister that if that principle applies in the context of physical illness, it ought in all propriety and equity to apply in the context of mental illness, too.
Tim Loughton: My hon. Friend is making an excellent case and expanding on the point that I tried to make earlier, but which the Secretary of State clearly failed to understand. On the Government’ logic, does not my hon. Friend agree that the 92 per cent. of heart disease patients who fail to take their statins according to prescription, or the cancer patient who declines chemotherapy because of the possible after-effects, should be subject to a degree of compulsion, because they do not agree with the diagnosis and the medication for their physical condition? Why should the two be treated differently?
John Bercow: My hon. Friend is absolutely right. He has reiterated on the Floor of the House a powerful point made by my noble Friend Earl Howe in the other place. I was surprised and disappointed at the paucity of the comeback of Lord Hunt of Kings Heath‚Äîan extremely experienced Minister with considerable expertise.
Ms Rosie Winterton rose‚Äî
John Bercow: I shall give way just once more because it is the Minister and it is courteous to do so.
Ms Winterton: I thank the hon. Gentleman for giving way as there is a point I need to put to him. There are people, particularly young women with personality disorders, who do not lose their judgment‚Äîthey do not have impaired judgment and do not lose capacity‚Äîbut if left untreated and uncared for they would commit self-harm and, in some instances, suicide. Is the hon. Gentleman prepared to say that we should turn our backs on those people and not give them treatment?
John Bercow: I did not say that we should turn our backs on them, but that we should have respect for them and be willing to accept the verdict they give. That is where, in a sense, never the twain shall meet between us.
Finally, in terms of the Bill’ architecture, I turn to the subject of community treatment orders. Let me say at the outset that there is scope for some consensus on this point, although I do not particularly approve of the way in which the Government handled the matter‚Äîthe evidence was suppressed and published late, which seems rather a pity‚Äîbut the suggestion has been made that CTOs could be the way forward for the structure of modern provision in the community. I see some merit in that suggestion although I think that the case is unproven.
My argument is not against the community treatment orders per se, but rather, as articulated by the hon. Member for North Norfolk (Norman Lamb), against what seems to be envisaged in terms of conditions and restrictions on the lifestyle of the people who would be subject to the orders. What is proposed by the Government in a rather all-encompassing power seems to me quite frightening. It is a disproportionate, far-reaching and adverse provision that could have an impact on a great many people. There is reference to the entitlement to impose a condition that a patient shall refrain from “particular conduct”‚Äîconduct gloriously unspecified. Might Ministers have it in mind to say that patients should not be allowed to go to a public house, or that they should have to observe a curfew from six in the evening until six in the morning? I do not know quite what Ministers have in mind, but we have to be careful that we are not guilty of an intolerable infringement of human rights and, throughout the Bill, an approach that would have another damaging effect in practical terms‚Äîto drive mental illness underground. We do not want to do that. United across the House would be the conviction that we must avoid that eventuality; the disagreement is about the means to do so. I listened to expert voices, including that of the former chief executive of Broadmoor, who is known to me and who says that is his particular fear. Many others have said the same.
Having expressed my concerns about the Government’ intentions on treatability, severe impairment and the conditions to be imposed in CTOs, I conclude on this point. In the media‚Äîespecially the less responsible and more hysterical elements thereof‚Äîthere is all too often a single view of the mentally ill as a homogeneous and undifferentiated group who should, almost without exception, be regarded with suspicion, anxiety and probably foreboding, too. That is to do a great disservice to hundreds of thousands, indeed millions, of people who at some time in their lives suffer from mental illness. My appeal to the House is to accept that, whatever our views, Parliament has a duty in this matter not to play to the lowest common denominator‚ÄîI do not suggest that the right hon. Lady is doing so and I hope others will not suggest that either. We should not in any sense fan the flames of popular and misguided prejudice; rather we should seek to raise our game, to recognise that pertinent and compelling points have been made to us by the mentally ill, by people with extensive professional experience and by Members of the other place who spent a great deal of time in detailed scrutiny and deliberation of these matters. I am sure that some of what the Government intend, and which is in the Bill, will be of benefit, but I worry about Ministers’ fixity of purpose at this stage, when they say, “We don’t like those amendments, they’re bad news and we shall use our majority to get rid of them”. I appeal to the Government, in the interests of the mentally ill, the community as a whole and the reputation of the House, to think again. It is not too late.