Mental Health Act 2007 (Consequential Amendments) Order 2008

My Lords, I should first of all like to thank the Minister for introducing the order in her customary clear and helpful way. Much of its substance is non-contentious and consequential on the 2007 Act, and I do not propose to detain the House by referring to each and every provision. There are, however, some associated issues, which I hope the Minister will not mind if I raise. The first relates to advocacy. When the 2007 Act went through this House there was strong cross-party support for including a right to an independent advocate for anyone who found himself subject to compulsory detention and treatment. Many of the voluntary sector organisations specialising in mental health reconciled themselves to some of the more difficult provisions in the Act in the knowledge that commitments on advocacy had been made by Ministers. There is, however, an emerging worry that the measures necessary to enable commissioners to prepare for the introduction of independent mental health advocates are not in place, resulting in people with a legal right to an IMHA from April being unable to access one. What measures are needed? There are perhaps four. The first is commissioning guidance. I should be glad if the Minister could say what progress the department has made in preparing guidance for commissioners, following the example set by Wales. While some good commissioners have taken the initiative on this, I understand that many others will not be building IMHA provision into their 2009-10 plans. There have been signs that the department will not be in a position to publish guidance by the end of this year, which is worrying. The second measure is effective training. Training with mandatory qualifications was another important element to IMHA development, but again there are signs that it has been allowed to slip. That cannot be satisfactory. A trained and qualified workforce should be seen as a priority, and momentum is absolutely key to the full rollout of such training. The third issue relates to the relationship between advocacy and community treatment orders. There are strong concerns about community treatment orders being introduced several months before the introduction of the legal right to an IMHA. It would be extremely helpful if the Minister could clarify how the transition period is managed to ensure that service users are fully protected. The final issue is to do with money. No budget announcement about advocacy has yet been made, and I am afraid that this has further contributed to the confusion that exists in the field and to the fact that planning at a local level has been limited. When will an announcement be made on this? Apart from advocacy, the other issue of critical importance to patients and families is access to information. Information needs to be both adequate and appropriate. While the care services improvement partnership has put some fairly minimalist leaflets on its website covering several of the key legal issues, there is no obligation on trusts to make these available to service users, or indeed families and carers. Also the leaflets are not themselves adequate to provide the kind of information that a person, including a member of the public, might need. Secondly, the statutory information leaflets that are required to be given to patients are not at all helpful. Their language is almost incomprehensible. Patients in this situation are likely to be frightened and on medication. They will also be ill and may have a learning disability. I feel very strongly that these forms should be made available as a simple guide at an appropriate level of literacy so that they can be readily understood. In practice, a nurse or other staff member will sit down with the patient to explain the contents but this may not happen properly and, in any event, it is not in itself enough. People should have ready access to information at all stages so that they become less fearful and more able to talk to staff. Good information aids effective communication with staff and helps them to reach together a better way forward. The 2007 Act introduces a major new regime in CTOs as well as new professional roles, and everything needs to be done to help vulnerable patients to feel secure in this new regime. Finally, I raise a practical issue—readiness for the 3 November deadline. The Royal College of Psychiatrists tells me that it is concerned that the new detention forms are not yet available and that an insufficient number are being sent to hospitals. Will the Minister look into that urgently? It would be better if the forms were available on the website and could be downloaded as PDF files, instead of having to be ordered and paid for as paper copies when, in all probability, there will not be enough of them anyway. In advance of the Act commencing, the forms need to be sent out or otherwise made available to practitioners who may be involved in sectioning patients. We must all hope that, as the provisions of the Act come into force, practitioners administer it in a way that ensures the maximum dignity and autonomy for patients. Some of us fear that defensive practice may kick in and that the Act may be applied in ways that may not be in the best interests of patients and others. We hope that CTOs will be used only as intended, and that they will not lead to a rise in the overall use of coercion in the care and treatment of those with mental illness. If that were to happen, the consequences in increased stigma and discrimination against mental health patients would undoubtedly be damaging.