Mr.
Boswell: I am conscious of the time, Lady Winterton.
However, in the interests of time I omitted to welcome you to the Chair
and I now do so. In
some of their exchanges, the hon. Members for Rhondda and for Bolton,
South-East made important points about access to services, which do not
directly arise from this clause, but with which I have sympathy. I find
myself at odds with the Government on the clause. That is not always
the case. However, they have not made the case for simplification. My
colleagues have already spoken eloquently about actual fears,
particularly in relation to black and minority ethnic persons and
potential fears in relation to social control and I strongly endorse
what they have said. I am worried that the logic of the
Government’s position is to make no exclusions, whereas they
bear on the clinical judgment of clinicians in relation to substance
addiction. I am mainly
concerned about the safeguards for the individual faced with compulsory
detention. We should not minimise that. The Minister suggested that
this might all be a lawyers’ row and it would get more difficult
if we defined people. I suspect that she is misadvising herself about
that. If the argument is not tied to the specifics, any good lawyer
would be arguing about something outwith the scope of mental health
legislation and could produce the same set of
arguments. We in the
House are, I hope, concerned about the liberties of the individual and
safeguards from arbitrary detention. The list that is set out in the
clause, as received from the other place, is a pretty good proxy for
the kinds of stigma that, sadly, our society tends to apply—or
has done historically. If I were in that situation, I would take some
comfort from the existence of the list. I believe that tribunals could
and would interpret it entirely sensibly; it would throw out the abuse
of clinical judgment and reinforce good clinical
practice.
6.45
pm Dr.
Pugh: I wish to make a few brief and, I hope, helpful
remarks. We learned this morning that mental disorder is what a
psychiatrist says it is, and that the definition of mental order is
left deliberately vague. Sometimes, when one is not sure what something
is, it can be helpful to say what it is not. I think that that is the
thrust of the exceptions as defined. Tangentially, what is the
Minister’s view on how the definition of mental disorders for
the purposes of legislation affects service delivery in the NHS? If
something is not defined for the purposes of this Bill, does that mean
that it is not a mental disorder so far as the NHS is
concerned—and, therefore, so far as entitlement to treatment
goes—whether or not a person comes under the remit of this
legislation? There
are probably cases in which sexual orientation, religious belief or
political views are so extraordinary that by themselves they make a
prima facie case for someone having a mental disorder. Like the hon.
Member for Daventry, I would expect to see other
associated symptoms. I note what the hon. Member for Bridgend said;
there are cases of genuine religious mania and the like. There are even
cases of people—David Icke, for example—whose political
views are so extraordinary that one might think that there is something
wrong with their health. The nub of the issue is that if mental
disorder is to be what a psychiatrist says it is, we are not entirely
happy to have psychiatrists saying which sexual orientation, which
religious or political belief or which cultural preference is
symptomatic of mental disorder. I think that that is the heart of the
matter. The Minister
mentioned paedophilia. It was discussed on Second Reading as something
that would not be covered or adequately dealt with if particular Lords
amendments were to be agreed. I took the trouble to ask a number of
those who had written to me directly whether they thought that
paedophilia would be considered a mental disorder and whether its
treatment would be excluded under this Bill; whether, as a logical
consequence, it would be defined not as a mental disorder but as
something else. The
BMA replied by saying that it definitely remained a mental disorder,
but unlike autism, for example, it was not a candidate for compulsory
treatment, so it would be excluded from the remit of the Bill. The
Royal College of Psychiatrists said that it could be included, and that
it would be a disorder of sexual preference, though how that differs
from sexual orientation eludes me. For the Department of Health,
Professor Appleby said that it was not necessarily excluded by the
Lords amendment, but that it was excluded from mental disorders that
could be the subject of coercive powers. In that respect, the Minister
is right. The reply from Mind said that it was not intended that it be
excluded by the amendment. Strangely enough, the closest fit in views
was between the BMA and Louis Appleby.
It is not entirely clear what
the exceptions do, but it is fairly clear what they are intended to
achieve. That is to fetter the maximum discretion left to the
psychiatrist, with which people are evidently
uncomfortable.
Ms
Winterton: I want briefly to respond to a few of the
remarks that have been made. This has been a helpful and thoughtful
debate. However, there have been some slightly bizarre contributions.
The suggestion by the hon. Member for East Worthing and Shoreham that
we are proposing to detain under this legislation people who are
addicted to cigarettes fits in absolutely with what my hon. Friend the
Member for Bridgend said. It is very important that we do not
scaremonger; it is unhelpful to the people whom we are trying to get
treated. My hon.
Friend the Member for Rhondda again raised the issue of whether, in the
light of the debate that we have had today, we should have decided to
include drug and alcohol dependency. That goes back to many of the
representations that we received in response to the draft Mental Health
Bill in 2004. It is a difficult issue. Points have been very well made
about the fact that there are, of course, severe implications to saying
that, as a society, we would detain people on mental health wards who
simply had drug and alcohol problems. We have decided not to go down
that route. However, that does not negate the important points
that were raised about how we get dual diagnosis right and how we
improve services so that, on the one hand, services for drug and
alcohol addiction are effective and, on the other hand, when we need to
step in under the 1983 Act and treat the other part of a
person’s condition, which can sometimes be the result of their
addiction, we get that right. Those are two important
points. I say again
that I understand the points that have been made about the use of the
word “solely”. That is simply a drafting matter. As I
have said before, I am prepared to have a further discussion about it,
if that would help to achieve greater clarity. However, in legal
effect, it is really not
necessary. A number of
hon. Members have talked about the Richardson report. It did not
suggest any range of conditions that were not mental disorders. That is
the difference with what is happening now. We are discussing excluding
conditions that are not mental disorders in the first place. That is
why there is a real difficulty in saying that, somehow, we should start
to include those disorders at this stage.
The hon. Member for Romsey said
that we lived in a litigious climate, and that is absolutely true. That
is why I have made the point that, if we open up the Bill to more
exclusions, we will increase the opportunity for
litigation. I would
also like to pick up on what the hon. Member for Broxbourne said when
he talked to me about people’s rights; of course, I absolutely
agree with the importance of those rights. He also talked about the
fact that I had used the phrase “dangerous offenders”. If
I used the word “dangerous”, I am sure that I would have
said something like, “Offenders, some of whom can be
dangerous,” because that is the reality. Going back to what I
said earlier, it is also the reality that some offenders will argue
around these exclusions; that is where the lawyers’ paradise
comes in. The Government amendment will return the Bill to the way that
the Government think that it should be, with only one exclusion for
alcohol and drug dependents, and I urge the Committee to support
it. Question
put, That the amendment be
made:—
The
Committee divided: Ayes 11, Noes
9.
Division
No.
1] Question
accordingly agreed to.
Motion made, and Question
put, That the clause, as amended, stand part of the
Bill:— The
Committee divided: Ayes 11, Noes
9.
Division
No.
2] Question
accordingly agreed to.
Further consideration
adjourned.—[Claire
Ward.] Adjourned
accordingly at three minutes to Seven o’clock till Thursday 26
April at twenty-five minutes past Nine
o’clock.
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