 House of Commons |
Session 2006 - 07 Publications on the internet General Committee Debates Mental Health |
Mental Health Bill [Lords] |
The Committee consisted of the following Members:John
Benger, Committee
Clerk †
attended the Committee Public Bill CommitteeTuesday 24 April 2007(Afternoon)[Ann Winterton in the Chair]Mental Health Bill
pm
Clause 2Learning
disability Amendment
proposed [this day]: No. 40, in
clause 2, page 2, line 4, after
‘disability’, insert ‘or an autistic spectrum
disorder’.—[Angela
Browning.] 4.30
pm Question
again proposed, That the amendment be
made.
The
Minister of State, Department of Health(Ms Rosie
Winterton): May I first say what a pleasure it is to see
you in the Chair, Lady Winterton, not least because of your
surname?
Returning to the amendment, the
point that I made earlier is that there is very little case law that
would help us to say precisely what abnormally aggressive or seriously
irresponsible would mean.
Ann
Coffey (Stockport) (Lab): My hon. Friend’s remarks
are also pertinent to the clause as a whole, which deals with learning
disability. In view of that, I find it difficult to understand why it
is in the Bill at
all.
Ms
Winterton: My hon. Friend makes a good point. However, as
I explained earlier, the reason we have kept in clause 2, on learning
disability, is that there has been a historic attachment to saying that
learning disability should be included in the Bill in this way, and I
am afraid that there is no getting away from that. We took the clause
out of the 2004 draft Bill, but there was heavy pressure to reinsert
it, not least from the pre-legislative scrutiny Committee. In view of
the points that were made, and the fact that hon. and right hon.
Members and peers felt that we needed to be responsive to them, we said
that we would agree with the pre-legislative scrutiny Committee on
learning disability, because that meant that when we were considering
amending the Mental Health Act 1983, we would be able to leave it as it
was
originally. However,
my point today is that to go further than that would, I am afraid,
cause the difficulties that we have discussed, not only by creating the
potential for uncertainty and the possibility of people not receiving
the treatment that they need, but over and above
that, because people suffering from hyperactivity or obsessive
compulsive disorder could make a very reasonable case for doing exactly
the same thing. That
is why I am afraid we cannot agree to the amendment. I understand
completely the sentiments of the hon. Member for Tiverton and Honiton
and I know that she feels extremely strongly about the issue. However,
at the same time as saying that we do not believe that the amendment is
the right approach for this particular Bill, we want to ensure that we
take on board all the issues that she raised regarding early diagnosis,
and proper care and treatment. Nevertheless, I am afraid that I must
urge the Committee to reject the
amendment. Angela
Browning (Tiverton and Honiton) (Con): May I say what a
pleasure it is to serve for the first time on a Committee under your
chairmanship, Lady Winterton?
I should like to pick up on the
Minister’s final considerations of the clause, not least her
remarks immediately before the Committee rose this morning. Clearly,
she prayed in aid in support of her decision not to add autistic
spectrum disorder as outlined in the amendment. She said that there was
confusion, and she prayed in aid the case of a young man with an
Asperger’s diagnosis who was apparently minded to light fires.
Whether he has an ASD diagnosis or not, I think that we all understand
such activity to be arson. She described how difficult it would be for
the court to decide whether to send him to prison or to hospital. I
have to say to her that the confusion and lack of clarity is with the
existing legislation. It is quite clear that if the words
“seriously irresponsible” are used and if a court
believes that someone is an arsonist, that court has a duty to identify
an appropriate determination of that case. It is up to the court to
determine whether that person, regardless of their diagnosis, is sent
to prison or hospital. Therefore, by identifying seriously
irresponsible conduct, the provision actually clarifies the situation
of a person with an ASD diagnosis who is before a court in those
circumstances. I cannot agree from the Minister’s example that
that would confuse people. I think that it would clarify the current
situation.
Ms
Winterton: I admit that it is an extreme example. I
was trying to make the point that because there is little case law, the
court would have to look at each case and decide whether the action was
serious and irresponsible. By adding ASD in those circumstances, we are
putting another hurdle in the way of getting treatment to
people.
Angela
Browning: I do not want to pursue that individual
case too much, but I think that the example the Minister gave before
lunch made my case for me more succinctly than anything I had said in
my hour-and-a-half-long presentation to the Committee. The Committee
was extremely tolerant, and I am grateful to everyone. However, the
Minister’s pointis that if somebody was before a court
in those circumstances, the court would have difficulty deciding
whether the action was seriously irresponsible. If it even considers
prison to be an appropriate sentence, then by definition the action is
seriously irresponsible.
If it was not seriously irresponsible, the option of
a custodial sentence would not come into the court’s
considerations. I have heard the Minister’s answer, but I must
ask her to revisit that case. What is being proposed would clarify
matters and not obscure them.
In conclusion, I fully
understand why the Minister does not want a large pick-and-mix list of
other conditions that might be appropriate to tag on. I hope that in
the report of my submission this morning, I will have outlined many
cases in which treatment and consideration of ASD is also appropriate
for people with learning disabilities and vice versa. The conditions
are different and it would be wrong in many circumstances to lump them
together. For the purposes of the legislation, we know from what we
have learned in recent years—how the condition presents itself
and its appropriate management—that that is an area that is not
being addressed at the moment.
The Minister has said that
learning disabilities are included because there is an historical
reason fordoing so. That is quite true; it is a matter of
record. Instead of looking at history, the Minister now has an
opportunity to make it. There comes a point when people must say that
there is sufficient evidence to change in legislation what has changed
around us. What has changed around us in recent years is the
recognition and management of treatment of
ASD. I do not intend
to press the amendment to a vote, not least because the Minister has
been incredibly generous in agreeing to a meeting on Thursday, after
the clause has been debated, with me and representatives from the
National Autistic Society, including a doctor with a lot of experience
in managing such cases. I hope to have another opportunity then,
perhaps in a slightly quieter environment, to talk her through the more
salient points. I beg to ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn. Clause
2 ordered to stand part of the
Bill.
Clause 3Changes
to exclusions from operation of 1983
Act
Ms
Winterton: I beg to move amendment No. 15, in
clause 3, page 2, leave out lines 22 to 30
and insert— ‘“(3)
Dependence on alcohol or drugs is not considered to bea
disorder or disability of the mind for the purposes of subsection (2)
above.”’. The
amendment will remove the exclusions added in the other place. Again,
it might be helpful for me to give some background to the history of
exclusions. The Mental Health Act 1959 contained only one exclusion,
stating that nothing was to imply that anyone could be dealt with under
the Act as having a mental disorder by reason only of promiscuity or
other immoral conduct. Such a provision is quite understandable in the
context of the times, as there was still a recent history of the law
being used—or, as I am sure we all agree, misused—to
detain women, in particular, not for health care reasons but for moral
ones, such as having a child outside
marriage. When the
1959 Act was overhauled in 1982, two more exclusions were
added—one for alcohol and drug dependence and one for sexual
deviancy. The latter was agreed with virtually no debate, but we think
that its main target was homosexuality. It is probably worth
remembering that even as late as 1982, homosexuality still appeared in
the international classification of diseases as a mental disorder.
Today, of course, we do not think of it as a disorder at all, nor as
sexual deviancy. When
we came to the current reform of the legislation, our starting point
was that the needs of patients and the risks posed by their disorders
should determine whether powers of compulsion should be used where
there is no other way of getting people the treatment that they need. I
am afraid that exclusions get in the way of that principle. They are
essentially arbitrary and do not necessarily say anything about the
needs of the individual. However, we listened carefully to what was
said to us, took account of the recommendations of the Joint Scrutiny
Committee and agreed that we should keep an exclusion for alcohol and
drug dependence.
4.45
pm There is no
doubt that such dependence causes a lot of harm, but we do not have a
history of using mental health legislation to force treatment for
dependence alone, and we were persuaded that there was no compelling
case to start doing so now. By contrast, we remain convinced that the
exclusion for sexual deviancy should
go. Chris
Bryant (Rhondda) (Lab): I am sorry that I have caught the
Minister a sentence after she said the word “alone”. She
will note that in the exclusions that the House of Lords has given us,
the emphasis is on the word “solely”. For example, there
is an exemption for people who might be detained solely on the grounds
of substance misuse. There is no such word as “solely” in
the Government’s amendment. Would she consider changing
that?
Ms
Winterton: That is an interesting point. I suspect
that, because of the way in which the reference to dependence on
alcohol or drugs is phrased, we will have been advised that the use of
the world “solely” is not necessary. However, I take on
board what my hon. Friend has said and I will look into whether it
would clarify the point that we are trying to get across, which is, as
he has said, that treatment should not be forced on people for
dependence alone. I take on board the point that I think he is making
about the way in which the Bill reads, and I shall come back to him
about that. As I
said, we remain convinced that the exclusion for sexual deviancy should
go. Paedophilia and various other paraphilias can constitute mental
disorders and there may well be treatment that can be offered. If a
person with such a condition meets the criteria for detention under the
Act because of the risk to themselves or to others, we believe that it
is important that the Act is available. The fact that a mental disorder
that can be treated happens to be related to sexual deviancy, or
whatever one wants to call it, does not render it somehow not a real
mental disorder.
Mr.
Tim Boswell (Daventry) (Con): As the Minister will know, I
am a comparative newcomer to some of these areas, but can she consider
the case of sex addiction, which I suspect is a term of art rather than
necessarily a precise term, and whether someone canbe addicted
to committing sexual acts in the sameway as to alcohol or
other substances? If so, and if somebody’s dependence is of that
nature, what is the criterion for their inclusion when the alcohol or
drugs addiction is
excluded?
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