Mental Health Bill [HL]

There is one occasion in the 1983 Act, in Section 141, where you can have the renewal of detention at the say-so only of two specially chosen doctors, appointed by the president of the Royal College of Psychiatrists. That is the renewal of detention of Members of Parliament. I find it very interesting that when they were considering this issue in 1982, Members of Parliament singled themselves out to have their renewal of detention by specially appointed doctors chosen by the president of the Royal College of Psychiatrists. Would that we were all so lucky. In supporting this amendment, I want you to feel for a moment what a patient feels like after six months of detention. Remember that when you were admitted, it would have been a very frightening and difficult to remember experience. You would probably remember the GP, the police and the journey, but everything else would be a bit hazy. Now you have had six months of treatment, probably still have symptoms—not as terrifying as they were six months ago—but are feeling a bit better clinically. However, you may still feel very resentful about being detained. The symptoms are abating, but you are now more concerned about getting out, having somewhere to go and resuming life, getting back to where you started. You are frustrated that, just as you begin to feel a bit more normal, you are under threat of continuing detention. The clinical team has a much greater dilemma than when first faced with the overtly ill person. It is not an easy decision whether to continue with the compulsory treatment in detention. It is a matter of weighing up all those clinical symptoms and assessing compliance and likely co-operation with rehabilitation care plans. Many of us feel that that is when a second opinion is valuable. Determining whether a patient can be discharged requires careful handling of risks and benefits to others. The 2004 Bill was an improvement on the 1983 Act, as has already been noted, because the renewal was overseen by the tribunal, with access to a panel of experts. That safeguard has, sadly, been lost. The amendment provides an alternative, with a similar requirement for more than one medical opinion. The noble Baroness, Lady Meacher, pointed out that it is possible for a patient to be detained for up to a year or so on the say-so of a responsible clinician who is not a doctor—one nurse, one psychologist or one occupational therapist. I ask the Minister and noble Lords whether they would be happy at the prospect of themselves personally, or their family members, being detained for up to a year on the decision of someone who is not a consultant psychiatrist without the need for that person to consult anyone at all who is qualified. I am not happy with such a prospect. I know that clinical practice has changed enormously and that to make use of clinical teamwork and clinical time it is good that members of the team should be consulted—and approved mental health clinicians should certainly make a big contribution in the decision—but I am trying to imagine a clinical situation outside of this in, for example, treatment of patients with physical disorders, where we would leave such major decisions to someone who was not a consultant in his or her field. Although I would like team members to be consulted, I would like the responsible clinician to be a psychiatrist, and a second doctor to be involved, to give equivalent rights to someone who is being detained.