Mental Health Bill [HL]

moved Amendment No. 18: 18: After Clause 7 , insert the following new Clause— ““Administration of medicine In section 58(1)(b) of the 1983 Act (treatment requiring consent or a second opinion) for ““three months”” substitute ““28 days””.”” The noble Earl said: Amendment No. 18 takes us once again into serious and important territory. It relates to what is known as the three-month rule. The 1983 Act entitles the medical practitioner to treat a patient with medication for his or her mental disorder without the person’s consent—indeed, in the face of his outright opposition—for a period of three months. Before the end of this period, Section 58 of the Act requires that a second medical opinion must be sought from a doctor appointed under Part IV before treatment can continue. A second opinion is required under two sets of circumstances: either when the patient does not consent, assuming he has capacity; or where the patient lacks capacity and the responsible clinician considers that the treatment should be given. What this amounts to in the Act is an exceptional power to override the choice of those patients who retain the capacity to make their own choices. In no other medical context would such a power be countenanced. Theoretically, the responsible clinician should seek the consent of the patient and listen to his or her views, but all too often this does not happen. The Mental Health Act Commission has reported as follows: "““Too many patients feel that they are excluded from decision making and the exercise of choice in their hospital treatment, and unable to discuss their subjective experiences of therapeutic effect or adverse side effects. This is likely to exacerbate the likelihood of non-compliance after discharge and may contribute to the problems of ‘revolving door’ readmissions””." That is from the commission’s biennial report for 2003-05. In fact, the commission finds when it visits hospitals that the issue of medical treatment is a key one for patients. It is an area in which complaints are frequently made. Patients are reported as being dissatisfied with the side effects of their medication and with the medication that has been prescribed without their own preferences being taken into account. Let me remind the Committee of some of the side effects that these powerful and potentially toxic chemicals have on those who take them: serious weight gain, leading to obesity; diabetes; impotence; disabling and embarrassing movement disorders; lethargy; and feeling drugged up all the time. Those are just a few examples out of a very long and pretty unpleasant list. Quite apart from the bad side effects, a patient’s diagnosis is hardly ever straightforward. It can change several times over the period of detention. Medication not uncommonly needs to be changed. Dosages need to be changed. The whole business of prescribing the right drug in the right amount is very difficult. I would argue that these are factors that militate strongly in favour of careful and prompt oversight of any medication given in these circumstances. Three months of being treated without consent or with a lack of capacity to consent to treatments, which may be causing harm, is simply too long. There is a power in the 1983 Act for the Secretary of State to reduce the period by order. However, this has not happened. Under the 2004 draft Bill, there would have been tribunal authorisation of compulsory treatment by 28 days. In keeping with that, I am proposing through this amendment that the period should be reduced to 28 days. Once again, I feel that I should quote the views of the Mental Health Act Commission, from its 11th biennial report: "““We believe that the current Act provides insufficient protection to patients in the first three months of their treatment under detention, when they may be forcibly given medication in doses or combinations without the oversight of a Second Opinion Appointed Doctor. Some RMOs appear to share our unease: we receive (but have to decline) occasional requests for statutory Second Opinions in relation to such patients””." Let us seize the initiative and take the opportunity now to give patients an extra safeguard. It is one that I believe will have enormous impact on their health and well being, without, as far as I can see, necessitating any cost implications. I hope that the Minister will share my view that it is time for the change to be made. I beg to move.