Mental Health Bill [HL]

My Lords, I would like to identify myself with the comments that were made by the noble Earl, Lord Howe, when he welcomed the changes to the Bill. There have been a substantial number of positive changes. I also identify myself with the appreciation that he expressed of the work of Professor Zigmond, Dr Daw and many other colleagues who have devoted a great deal of time and effort to trying to assist us in improving the Bill. I also have to identify myself with the rather downbeat remarks of my noble friend Lady Barker and my colleague, the noble Baroness, Lady Murphy, because despite all the work that has been done I do not find this a good Bill. It does not address things in the way that it ought to. The whole process has suggested to me, rather than a move forward and an appreciation of the complexity of the problems that we are dealing with, a damping down, indeed a dumbing down, of those problems. I speak at this point because of the concept of ““responsible clinician””, which expresses some of the dilemma that we are in, as pointed to by the Minister in her reference to the changes as doing away with a paternalistic, ““doctor knows best”” attitude. Frankly that is part of the problem of not understanding the complexity. Mental illness cannot be dealt with simply at a sociological, psychological or biological level; it is a highly complex group of phenomena with which we are struggling to become familiar. I understand that parliamentarians, lawyers and others who do not immerse themselves in the business of understanding and dealing with these problems want a simple answer. It is always the same when as a professional one finds oneself in court: the lawyers want a yes or no answer and get frustrated when the truth is not a simple yes or no. Parliamentary colleagues, particularly those with constituency responsibilities, want a simple yes or no answer to whether a troublesome person can be locked away in one way or in another way. It is simply not like that, yet we find increasing pressures from the community and from colleagues in other professions to give those simple yes and no answers to get rid of troublesome and difficult problems and indeed people. Despite the improvements in the Bill, all the work and energy that have gone into it, and the extensive process that we have gone through, it is with a rather heavy heart that I see it go forward, because it represents a lessening of our understanding of the complexity and difficulty of the issues with which we are dealing, and a slipping back into a rigid, simplistic way of viewing things. That is certainly easier to communicate in terms of a slogan, a remark or what may be passed in a court of law, but the complexities of mental disorder in particular are not susceptible to that kind of understanding. Many will suffer more because of this approach. It is not just a question of the victims being adversely affected, physically or otherwise. The first victims of mental illness are those who suffer from it, but the second group of victims comprises their partners, family and friends, and those with whom they live. The third largest group, in terms of the number of people involved, comprises the healthcare workers who have to work with the victim and frequently find themselves grossly affected by what is happening. The last and much smaller group are those in the rest of society who, on unusual occasions, come across the problem. But frankly, that happens less often with those who are mentally ill than with those who are not. I see a lessening of the understanding of the distinction between frank mental illness, as a falling away from normal function, as against personality disorder, a disturbance of a different kind. I am worried that more will be admitted to and kept in hospitals on a formal basis, and that, because of that, many others who are not admitted on a formal basis will find that there is no bed for them. There will be no possibility of them being attended to because, unless substantially greater resources are invested, what resources there are will be devoted to those who are creating difficulties and causing trouble rather than those able to be treated successfully. I welcome all the positive things about the management of young people in more age-appropriate circumstances, advocacy and some of the other changes that have taken place. But, as I have said, it is with a heavy heart that I see this Bill pass, as it may be a considerable time before we can return to repair the attitudes that we see represented in the Bill’s provisions.