Coroners and Justice Bill

I wish to speak to Amendments 151 and 158 in the name of my noble friend Lord Thomas of Gresford, Amendment 154 in the name of the noble Earl, Lord Listowel, and Amendment 155 in the name of the noble Baroness, Lady Murphy, who has just spoken. One of the difficulties for psychiatrists who have any contact with the courts and the law is that we are working on totally different sets of understandings. It is not that one side or the other is not looking for the truth of what has gone on, but in a sense the second part of the Title of this Bill points to the problem. The concepts of justice are really quite different. For psychiatrists, it is trying to understand what is appropriate for this particular person at this particular time with this particular kind of mental functioning. That is what I should like to talk about for a few minutes. It is important first to recognise that human beings and their mental functioning are nothing like computers. For a computer, you draw up a plan, build the machine, plug it in and, with the addition of a little software, it is operational. But that is not how the minds of human beings are constructed. They develop over a period of time, and they do not develop all of a piece. Noble Lords will know from their children—or, looking around the Chamber, perhaps from their grandchildren—that as they grow and develop, they change quite dramatically. Some aspects remain remarkably the same, but other elements grow and change. Their emotional, physical and intellectual aspects, along with their capacity to stick with things, all change profoundly, but they do not do so all of a piece. Some young people develop emotionally at a completely different pace from their cognitive, intellectual development, while others develop impulse control much more slowly, or in some cases with precocious speed—which usually leads to other problems. Earlier a noble Lord mentioned the example of someone aged 40 with a mental age of 10. It is an interesting rule of thumb, but it is completely meaningless because there is no such thing as a mental age of 10. In any case, does it mean someone’s intellectual age, their emotional development, or something else? Furthermore, someone who reaches the age of 40 will have developed beyond the age of 10 in a whole series of ways. So the idea of a "mental age of 10" is a meaningless concept from the psychiatric point of view, and indeed from the factual one as well. What we have is young children growing up and developing different components of their personalities. By the age of 10, some will behave like 15 year-olds, while some at the age of 18 will behave like 12 year-olds. Indeed, some 15 year-olds will behave this minute like 13 year-olds, but in five minutes’ time like 21 year-olds, and then a bit later to behaving like three year-olds. None of this is consistent, as development in young people is a fluid thing. The idea that we should ignore this and treat everyone as if they were 21 year-old adults or, worse still, 45 year-old adults, is not just. It does not recognise the reality of human development. If what we are about is creating law, that is all very well, but if what we are about is trying to make the law just, then we have to recognise the reality that people do not develop all of a piece and that by the age of 10, they are not functioning as they will at the age of 14, 15, 17, 21 or 50. That is why the amendments bring into the Bill the notion that not everybody is fully developed, and furthermore that the development may be impaired as part of the normal function of growing up. There were times when we behaved and thought more immaturely than others at the same stage at school. There may also be a falling back, a stunting or a disability that we need to regard as well. Some of the amendments are trying to point up that this notion of developmental immaturity may not necessarily be the same as a medical condition. That is the point. It is not all about illness. Whenever someone gets pregnant and has a baby, being pregnant is not a medical condition—it is not an illness—but many people who get pregnant also get illnesses. That is why there is such a crossover. We should not treat normal development as thought it were a medical condition; and yet, in a sense, that is the only way that they can plead. That is one element of it. The second element is that when people fall ill with certain kinds of mental disorders or psychosis, their perception of reality becomes disturbed. Sometimes that is terribly obvious; the person is clearly psychotic, acutely so, suffering from a schizophrenic illness of some description that is acute and severe. They completely misunderstand what is going on. That situation is relatively simple and straightforward. But there are also other situations where the person may be disturbed in their thinking right from the beginning; they are completely rational, but from a disturbed base. Indeed, one of the cases that Freud treated and wrote about was a judge who suffered from a condition like this, who was perfectly able to operate rationally in respect of everybody else, but inside they were disturbed. If we do not take these things into account, we will not produce a just outcome—not for children who are not fully developed; not for those who have developed, but not completely when they are adults; and not for those who fall ill with a mental illness. In the Bill, as has already been mentioned by the noble Baroness, Lady Murphy, "medical condition" is identified. I subscribe to this tightening, clarification and removal of the eccentricities and the idiosyncrasies of certain expert witnesses. I would seek from the noble Baroness a clarification that "medical condition" also means psychiatric conditions. I suspect that she will have little difficulty in reassuring us on that, but it is important to have it on the face of the Bill, so that people are absolutely clear about it. There is much more that one could say about this Bill, but I will finish with one particular component; the plea of insanity. This has always seemed to me to be a particularly peculiar legal notion. The whole point about somebody being seriously mentally ill with a psychosis is that they do not have insight. They do not know they are mentally ill. They believe that the explanation that they are applying to the disturbed situation is a correct appreciation of reality. When you say to them, "I think you ought to plead insanity", they say, "You must be mad. I am not insane; it is you who do not understand what is going on". The irony of it is that the person who pleads insanity is less likely to be suffering from a psychosis than the person who has really got a psychosis, because they do not understand it and have no insight. I trust I have at least said enough to demonstrate that if lawyers are from Mars, psychiatrists are not from the moon. They are dealing with real people and real problems. Our responsibility is to try to ensure that the laws that pass through this place and to another place encode justice in the capacity for their implementation, and not merely a set of rules that may be convenient but does not apply to the complexity of humanity.