Lamb calls on the government not to remove amendments to the Mental Health bill and Horwood highlights the need for the careful wording of the bill to ensure the civil liberties of those affected by the bill are protected.

Norman Lamb, Liberal Democrat Shadow Health Secretary

Mr Lamb said; “The proposed legislation has had a tortuous journey to get to this point, and the Bill that we have before us, as amended in the other place, is a good one that will have Liberal Democrat support. The sadness is that the Government will seek to unravel the good work that has been undertaken in the other place. Like the Conservative spokesman, I pay tribute to the extraordinarily well-informed debate in the other place and the scrutiny of the Bill that took place there.”

“The only point where consensus has been achieved is on the need to reform mental health law. There is widespread acceptance of the fact that the Mental Health Act 1983 needs updating, but nine years on from the Government’s appointment of an expert committee back in 1998, it is remarkable that far from building consensus and support for new legislation, we will have a greater divide between the Government’s position and that of most people working in mental health services. The Government make a lot of the amount of consultation and debate that has taken place?the Secretary of State mentioned it in her speech?but the problem is that they give every indication of rejecting all the evidence and advice that has come as a result. That evidence and advice have come from a remarkable alliance of organisations working in mental health services?an alliance of, I think, 79 organisations, covering service users, psychiatrists, social workers, nurses, psychologists, lawyers, voluntary organisations, charities, religious groups, research bodies and carers groups. Together, they have expressed their concerns and maintained their opposition to the Bill as originally presented to the other place. The Government ought to take careful note of such a powerful alliance of concern.”

Mr Lamb continued; “I want to deal with the amendments passed inthe other place which, in the view of the Liberal Democrats, must be preserved. First, there are the exclusions from the definition of mental disorder. The right hon. Member for Sheffield, Brightside talked about exaggerated language being used by those who oppose the Bill, but some of the exaggerated and misleading claims made by the Government have been enormously damaging to what should be a good, high-quality debate.”

“At the Local Government Association conference last month, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) said that

“by adding a range of unnecessary exclusions, the changes forced through by the Lords will inevitably open up new avenues for patients and their lawyers to use to try to secure the premature discharge for some of the most dangerous patients.”

“That is scaremongering. The exclusions are about making sure that the powers are not used inappropriately. Similar exclusions exist in most comparable jurisdictions, including Scotland, and there is no evidence of dangerous people roaming the streets as a result of those exclusions being put in place in the Scottish legislation.”

“I want to deal next with the amendments on impaired decision making. The Bill, as amended, prevents the compulsory treatment, including detention, of people who are fully able to make their own decisions about the provision of treatment. The Government claim that this will result in people who need treatment not being detained, putting them and others at risk. First, the Scottish legislation contains a similar provision and, again, there is no evidence of it causing a danger to individuals or to the public. Secondly, if someone with a physical health problem has the right to refuse treatment, should not the same rule apply to someone with a mental health problem? I think that the hon. Member for South Cambridgeshire (Mr. Lansley) made that point earlier. Thirdly, the Government’s own expert Committee, the Richardson Committee, supported an impaired decision making test, as did the Joint Scrutiny Committee. Fourthly, mental health clinicians advise that a person with a mental disorder who is suicidal or who poses a risk to others because of their condition would inevitably be found to have impaired decision making, and so come within the scope of the legislation. So the amendment is a safeguard of real importance to the citizen’s human rights, and does not leave individuals or the public at risk.”

“Next, I want to deal with the treatability test. The Minister made an extraordinary claim on this in her speech to the Local Government Association. She said:

“This safeguard has, on occasions, been misrepresented as meaning that patients can only be detained if they can be cured, rather than treated. This confusion has led to too many patients with personality disorders, which can be treated but not cured, being turned away from services.”

“If that is the case, the answer is surely to ensure that professionals interpret the law correctly, not to change the law in a fundamental and dangerous way. The amendment addresses the Government’s concern to ensure that someone with a personality disorder is covered by the Bill. It is a balanced amendment, and it should stay.
The amendment on the renewal of detention is intended to provide a safeguard that is hard to dismiss other than on cost grounds. A medical practitioner would be required to examine the patient and to agree to their continued detention. Other health professionals have argued that the amendment goes too far, and we will take account of their arguments in Committee.
The Bill is not perfect. We want core principles to be set out in it, and I see no reason why that should not happen. I agree with the hon. Member for Stafford (Mr. Kidney) that those facing compulsion should have the right to an independent mental health advocate, and should be made aware of that right. But if the Government insist on driving through the removal of clauses added in the other place that provide safeguards for vulnerable individuals, they will make a very serious and dangerous mistake.”

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Martin Horwood, Liberal Democrat MP for Cheltenham

Mr Horwood said; “The current law is, by common consent, flawed, but the need to guard the civil liberties of some of the most vulnerable citizens in our communities means that any amendments to it must be carefully worded. That will be a difficult task, particularly in the case of personality disorder, even the definition of which is difficult to grasp. In the words of Mind,

“Slotting people into neat categories is almost impossible, because each individual is unique and personality is very complex. It’s a mistake to assume that giving people a diagnostic label means knowing more about them, and it’s too easy to use these terms in a judgemental way.”

“That was certainly so in the circumstances that applied in the case - now, I am afraid, the very public case - of one of my constituents. It seemed to me that he was unable to access the treatment that he needed because, in a sense, he did not have a proper mental illness, having been diagnosed with personality disorder. I should like to take a moment to pay tribute to the care, dedication and perseverance of the Green family?Les and Jackie, James’s parents, and particularly Daniel, his brother, who has championed his case tirelessly.”

“My constituent had a long history of difficult, sometimes very aggressive behaviour involving self harm and of threats to harm his family. As he grew older, he increasingly said that voices were telling him to harm himself and his parents, and he wanted to be admitted to somewhere where he would feel safe. Again and again, though, the situation was that his medication was reviewed and even if he was admitted for a short time he was returned to his family, sometimes with community support but making life increasingly difficult for them.”

“In July 2005, James set fire to his house, endangering the lives of his parents and his neighbours. He was prosecuted for arson and recklessly endangering life and sentenced to seven months in prison. That was the beginning of a prolonged relationship with the criminal justice system.”

“It is typical that my constituent’s case reaches something of a climax tomorrow when he appears before a judge for sentencing, not before a doctor for treatment. However, the family hopes for the outcome that his assessment and treatment at a unit called Kneesworth house in Cambridgeshire will become a more permanent arrangement. James has – eventually - benefited from treatment, which has been more psychological than pharmaceutical. I compliment the staff at Kneesworth on their work with him. They have demonstrated two fundamental truths.”

“First, no one should be excluded from treatment because of the form of words used in their diagnosis. The Bill, even as amended, appears to prevent such exclusion. It is clear that it covers personality disorders. The draft illustrative code of practice, which would not be affected by the amendments, clearly specifies that personality disorders will be covered.”

“Secondly, Kneesworth has demonstrated that, even with difficulty and after years of trying, the current system can provide treatment, with a treatability test in place. The Bill, as amended, would provide a much better and clearer legislative environment, in which we all agree that people with personality disorder should get the treatment that they need.”

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