Mental Health Bill [Lords]

My hon. Friend is absolutely right, and I shall deal with that in a minute. The BME community, and certain parts of it, seem to be affected disproportionately by the Bill’s provisions on compulsory treatment, so we need more research to understand that and see how it can be overcome. We believe that the criteria for renewing a sectioning order should be no less rigorous than the Bill’s criteria on the initial issuing of an order—it is as important for a patient as the initial detention. We therefore welcome the amendments proposing that two clinicians be involved in a patient’s treatment. We are still concerned, however, about the medical expertise of the professionals issuing renewals notices. As we said in Committee and on Report, we do not want to introduce some form of hierarchy, but we do not understand why the Government have introduced inconsistencies between the original section and the renewal, and the renewal and the provisions of the Mental Capacity Act 2005. Those inconsistencies could give rise to future problems. We have another concern about these amendments. Which of the professionals now tasked with providing the renewal order do the Government envisage will give the objective medical expertise on mental disorder that has been determined by the European Court of Human Rights? The Minister will know that we have serious qualms about how the legislation as previously framed, and even as amended by the Lords amendments, will fare under ECHR legislation. We are also concerned about the fact that the primary professional now responsible could get his or her colleague in the multidisciplinary team simply to rubber-stamp the decision on a renewal of detention. We need to ensure that the second person reaches a separate and independent decision. I would like some further clarification, and guarantees from the Minister that that is what the Government envisage. Without that, the role of the second professional, and the assurances provided by having a second professional as part of the process, are rather worthless. There must be a proper, independent and rigorous check. I turn to community treatment orders and the amendments tabled in the name of Lord Patel of Bradford in another place, which are supported by my colleague the noble Lord Howe and Cross Benchers and Liberal Democrats. We welcome the changes that were made on Report to CTOs. We have never been against the principle of CTOs, but because they are very powerful devices, we want them to be applied to a closely defined group of persons—real revolving-door patients—in closely defined circumstances as laid down by the pre-legislative scrutiny committee, of which I was a member. We were therefore particularly keen on and welcomed the change to proposed new section 17 B (3)(e), which the Minister will have at the tip of his tongue. It added a very coercive measure to the exercise of CTOs:"““a condition that the patient abstain from particular conduct.””" That gave rise to CTOs being dubbed psychiatric ASBOs. The Government dropped that, which was welcome. The new condition is that CTOs must relate to what is necessary for beneficial medical treatment, but what constitutes medical treatment is still a broad definition within the Bill. It is also a shame that an end-date was not set on CTOs. Why does the Minister still not think that appropriate? We should consider the lobster-pot scenario that Professor Genevra Richardson described many years ago in her expert committee. We can easily see how people can now be subject to CTOs and other parts of sectioning. It is difficult to see how they can get out of that system, which is why we propose a three-year cap on the operation of the initial CTOs, and a right of appeal against the conditions attached to them. If a CTO involves giving treatment that is harmful to a patient—for example, a drug that has severe side-effects on that patient, and which he would prefer not to take—in whose interests are we actually acting? I should be grateful if the Minister commented on that. In the debate in the Lords on Monday, his colleague Lord Hunt acknowledged"““concerns that supervised community treatment could be used too readily and that it could be used as a failsafe option without true justification.””—[Official Report, House of Lords, 2 July 2007; Vol. 693, c. 843.]" Lord Patel went on to say that CTOs could even become part of the normal discharge process that detains patients generally, as a kind of safety net for risk-averse mental health service staff and managers. As my hon. Friend the Member for Daventry (Mr. Boswell) said, that might apply disproportionately to members of the black and minority ethnic community. The early experience in Scotland has certainly been that a much larger number of people have been put on CTOs than was originally envisaged. Of course, that also has great resourcing implications. A lot of finances will have to go into resourcing CTOs, which will surely be to the disbenefit of other parts of the mental health service. I would like some guarantees that, under the amendments, the Minister does not think that CTOs will gobble up a disproportionate part of the resources, causing problems elsewhere. The Government originally introduced CTOs to deal with revolving-door patients, and we would like further clarification as to how the amendments apply to such patients, because there is some woolly terminology. The amendment refers to having to take account not only of the patient’s history of mental disorder, but of ““any other relevant factors.”” What does that mean? What situations will be considered? For example, if a person had been a voluntary patient, as well as being under compulsion, would that be considered? What exactly in the patient’s history of mental illness are the Government going to take into account under the amendment? We, and the Government, support the amendment, but it is not nearly as detailed and specific, or as prescriptive, as the amendments that the Lords put into the Bill, which the Government took out and we tried to restore on Report. If the purpose of CTOs, even with the amendment, is no more than to get a patient to take his medication, we are saying that medication should be forced on a patient even if it is doing him no good and even if it may lead to harm. That brings into question the whole attitude of Ministers: that CTOs have to be with the agreement of the patient. If the patients are agreeing to treatment, why do we need compulsory treatment orders in the first place? That is a clear anomaly. I would like some assurance that the code of practice, perhaps, will be clear as to the ultimate purpose of a CTO and that compulsory medication should not be used as a substitute for adequate mental health care in the community. We need some assurance that the code of practice will work as it relates to the amendments. Finally, we welcome the progress that has been made with the amendments, but we still do not think that they have gone far enough. This is a great missed opportunity in many respects to have a Bill that could serious challenge the problem of stigma. In the not too distant future, when we are in government and in a position to look at mental health legislation, we will want to review some of the provisions of this Bill. I hope that the Minister will give an undertaking to review some of these radical and innovative—but unproven and untried—measures, particularly regarding CTOs and the impact they are having, particularly on the BME community and some of our most vulnerable patients. If he does not review it, we certainly will want to and we shall monitor this legislation closely. We want to be sure that, after eight years in gestation, the Bill works for the benefit of vulnerable people.