Mental Health Bill [HL]

My Lords, I am grateful for the support of the noble Baroness, Lady Howarth, and the words expressed by the noble Baroness, Lady Murphy. As she said, changing attitudes takes a huge amount of time, but I am sure that in the end we shall arrive at a situation with which we are all content and where we have achieved all we want to for patients with mental health problems. I note the continuing concerns and heavy hearts of noble Lords. The Government understand that this is a highly complex area with a lot of grey; it is not a question of black or white, yes or no. I agree with the noble Lord, Lord Alderdice, that there are different victims as he broadly defines them. Our policy is to allow the patient’s case to be led by the most appropriate professional to address their main treatment needs. In the majority of cases, a psychiatrist will be the most appropriate professional, but it will not always be so. For example, if the patient requires, exclusively or primarily, psychological interventions, inflexible and outdated legislation, as the noble Baroness, Lady Howarth, said, must not stand in the way of the most appropriate person doing the job. One professional cannot address all of a patient’s needs; that is why there must be a multi-disciplinary team. If the patient is receiving medication but their main treatment needs demand a responsible clinician who is not qualified to prescribe, the medication will be the responsibility of a professional who can prescribe. I stress that the Bill does not require any professional to act beyond their competence. A responsible clinician who is not qualified to prescribe cannot decide to perpetuate medication decisions. Medication should be kept under review by an appropriately qualified professional, separate from the decision to renew compulsory powers. A patient whose case is being considered for renewal will have their medication authorised by a second opinion appointed doctor. No responsible clinician will be expected to act beyond their expertise, and statutory competency requirements will ensure that all responsible clinicians, of whatever professional background, will have the expertise to carry out their functions under the Act. This includes providing objective medical expertise about the patient’s need for detention. We have worked closely with stakeholders, including the Royal College of Psychiatrists and the BMA, on drafting the competency requirements for responsible clinicians. Advice from the Queen’s Counsel, sought by the coalition, has confirmed the Government’s opinion that the Bill as originally introduced, in conjunction with the statutory competency requirements, complies with the Human Rights Act. The noble Baroness, Lady Murphy, asked which professions will be able to take on the responsible clinician role. The professions that can become approved clinicians and therefore take on this role will be set out in directions from the Secretary of State and Welsh Ministers. Only suitably regulated professions will be selected. In both England and Wales they will include chartered psychologists, mental health and learning disability nurses, occupational therapists and social workers, in addition to doctors. Individuals wishing to become approved clinicians will need to demonstrate that they have the right experience, skills and competencies to take on that role. Draft directions for England, which include the professions that can be approved, are in the Library and on the Department of Health website. The noble Baroness quite rightly asked what will be in the regulations to require the second professional to examine a patient. The primary legislation will require the second professional to be professionally concerned with the patient; they will know the patient’s case. The draft regulations will, of course, be made available, and we would welcome the input of all noble Lords. I am glad that we can support Amendment No. 4A and I ask noble Lords to do so. I also urge noble Lords to support the government amendments. On Question, Amendment No. 4A agreed to. On Question, Motion, as amended, agreed to.