'Mental Health Act Commission

Schedule 1 – in the House of Commons at 5:15 pm on 26th October 1995.

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16A. In section 121 of the Mental Health Act 1983, in subsection (4) leave out from the word "the" on the fifth occasion where it occurs to the end of the subsection and insert—

  1. "(a) the exercise of the powers and the discharge of the duties conferred or imposed by this Act so far as relating to patients received into guardianship or after-care under supervision under this Act; and
  2. (b) the care and treatment, or any aspect of the care and treatment in hospitals and mental nursing homes of patients who are not liable to be detained.".'.

The amendment would modify the Secretary of State's powers to extend the remit of the Mental Health Act Commission. It would not require him to extend its responsibilities, but would allow him specifically to require the commission to have a responsibility towards patients who are placed in aftercare subject to supervision and who are received into guardianship. There are ample reasons to believe that the commission should have responsibility for protecting the interests of patients in the community as much as those of patients in hospital

First, we have seen from recent reports what can be the tragic and catastrophic consequences of neglect, maladministration and the incompetent care of patients living at home. Is the Minister not prepared to see the connection between the poor standards of care and services that those independent investigations have revealed and the absence of any standing body of experts with legal powers to investigate complaints of poor care?

Secondly, the new legal powers are likely to affect not a handful of patients. but as many as 3,000 at any one time. If, as may be predicted, certain patients remain under supervision for long or indefinite periods, the total will rise well beyond that number. If the Minister justifies the policy behind the Bill by observing that care and treatment has shifted from hospital to the community, the logic of that argument should mean that patients in the community, especially those subject to legal powers, should have the same protection as that afforded to those in hospital

The third justification for the change is that the commission itself wants this added responsibility because it believes it to be necessary, not simply desirable. It is necessary because the Bill introduces new coercive powers, and the use of those powers should be overseen by an independent body with powers to investigate complaints from patients or from carers. It is one of the important checks and balances that make the difference between law that is fair and law that is unfair

We know that the Government have no principled objection to such a role for the commission, since in Scotland they are to extend the role of the Mental Welfare Commission to patients subject to community care orders. It is not enough for the Minister simply to distinguish Scottish law from that in England, and to use that as justification for a different approach. We can well imagine how his objections to the amendment would be regarded by those who may be among the 3,000 patients subject to new powers, desperately needing the assistance of the Mental Health Act Commission

In Committee and today, Opposition Members have drawn attention to the flaws of the drafting and procedure of the Bill. We are most concerned that, in practice, the powers may be used unfairly, often to support poor practice and defensive and unimaginative styles of working, rather than humane and effective care. In our view, such concerns provide all the more reason why the commission should have responsibility from the outset for monitoring the way in which the Act is used—not from a distance, but by being able to receive and consider complaints from patients and others acting on their behalf

Photo of Mr David Atkinson Mr David Atkinson , Bournemouth East

While I have no objection to what is proposed in paragraph (a) of the amendment, I must question whether the Opposition have considered the consequences and especially the cost of what is proposed in paragraph (b), which extends the remit of the 1983 Act to all patients, not only those who are detained under the Act. That must be at the expense of the patients to whom the Act applies. We are all aware of the challenges before the commission at present, in fulfilling its responsibility to patients who are detained, let alone extending the scope of the Act to those who are not.

The amendment is not any substitute for what is needed now: a complete review of the 1983 Act, which is now 13 years old. I do not think that the amendment is the way forward.

Photo of Mr John Bowis Mr John Bowis , Battersea

I am grateful to my hon. Friend for his last point. Indeed, we have said on occasions that in due course we shall consider that.

I am grateful to the hon. Lady for tabling the amendment, which raises a debate that we had at some length in Committee and in another place. Before even a permissive power is taken, the full implications need to be properly thought through, and proper consultation should take place. On that basis, it would not be right to accept the amendment.

I base my view on three factors. The first relates to the priorities for the use of the commission's resources. The commission was set up expressly to safeguard the interests of detained patients. Having been deprived of their liberty, they have a particular claim on the commission's protection. Any extension of its remit to other groups, whether now or in the future, must not be at its expense.

The second reason is connected with the fundamental changes that the commission is already facing. The commission is undergoing a major reorganisation of its structure and approach to its current remit, and that needs to be allowed to settle before an extension can be considered. Thirdly, it would make more sense to consider the commission's remit in relation to the operation of the Act, as my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) is also suggesting. We shall want to consider that in due course, when it is possible to assess the impact of supervised discharge in the context of all the other initiatives that we have taken on the care of severely mentally ill people.

That does not mean that in the meantime the Mental Health Act Commission will have no locus at all in reviewing the use of the new power. Given its general responsibility to protect the rights of patients who are liable to be detained, it will be able to review the procedures for making a supervision application, since the patient at that point must be liable to be detained. The commission's involvement will be similar to its monitoring of section 117 aftercare procedures before a patient is discharged. The extension of the commission's remit in that area is certainly not ruled out for all time, but now is not the right time to be considering it. In the light of that, I hope that the hon. Lady will withdraw the amendment.

Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Women)

I add only to my opening remarks concerning the conclusion reached by the Mental Health Act Commission. In its public policy statement on the Bill, it said: Without some extension to the remit of the Commission to enable it to monitor the use of the new powers, and to ensure that the new statutory controls are only used strictly in accordance with statutory requirements, it considers both patients and community may not derive the full benefit from its provisions. I listened very carefully to what the Minister said and welcomed his rather veiled undertaking to ensure that the commission keeps those matters under review. The hon. Member for Bournemouth, East (Mr. Atkinson) knows that Opposition Members have long called for a comprehensive review of the Mental Health Act 1983 for the reasons that he outlined. We remain committed to that review and, from what the Minister said, it sounded as if he was at last being persuaded of the need for it.

In the light of the Minister's rather tentative assurances, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn

Order for Third Reading read

Motion made, and Question proposed, That the Bill be now read the Third time.—[Mr. Bowis.]

Photo of Nick Brown Nick Brown Opposition Deputy Chief Whip (Commons) 5:26 pm, 26th October 1995

The Bill was primarily motivated by the public concern about the plight of people with serious mental illness who are discharged into the community. The plight of such patients has been highlighted by a series of terrible incidents, a disturbing number of which have resulted in fatalities.

Stephen Laudat stabbed and killed a man in 1994, only eight months after being discharged from a psychiatric department. Jason Mitchell was discharged by consultants and within days had killed his father and an elderly couple—also in 1994. John Rous, a paranoid schizophrenic, killed an untrained volunteer hostel worker, Jonathan Newby, in Oxford in 1993. Christopher Clunis, a patient who had been in and out of psychiatric and social services care for most of his life, stabbed and killed Jonathan Zito on the London underground in 1992. Peter Robak, suffering from a severe personality disorder, killed Anthony and Barbara Rawlings and their 15-year-old son just 11 days after being discharged from hospital in 1990.

Those cases show the dangers that are posed to members of the public by a very small number of severely mentally ill people who develop serious personality disorders. We are united with the Government in wanting to see better care for such patients and better protection for the public. The inquiries and reports that followed the tragedies tell us what action could have been taken to prevent the killings. They also make a number of clear recommendations concerning the implementation of the policy of caring for mentally ill patients in the community.

The literature is plentiful: the Ritchie report on the care and treatment of Christopher Clunis; the Royal College of Psychiatrists' Boyd report on homicides and suicides among the mentally ill; the Audit Commission's report "Finding a Place"; "The Falling Shadow", a report by Louis Blom-Cooper and others into the events surrounding the killing of Georgina Robinson; and the 1994 report of the Select Committee on Health into community care for people with serious mental illness.

In each case, the authors point to the same problems: lack of liaison among care agencies, and lack of resources to provide care and treatment in psychiatric departments and in the community, which is particularly serious in deprived inner-city areas. There have also been failures to act on warning signals, sometimes with terrible and tragic results. Every report recommends improvement in those areas as a top priority.

Those are the recommendations that the House should consider, and upon which the Government should have acted when they drafted the Bill. They are recommendations which, if taken up, would both provide better care for severely mentally ill patients and allay public concern about safety.

However, the Government have ignored the recommendations. Instead of listening to expert opinion and learning from the mistakes of the past, they have succeeded in drafting a Bill that misses the point, is unpopular with those who work in mental health and will do nothing to improve patient care. Indeed, it could well make matters worse. The Bill fails to take the action desperately needed to improve the care provided for the small proportion of severely mentally ill patients who pose a potential danger to themselves or to members of the public.

A new concept of supervised discharge is the central proposal in the Bill. Supervision orders are to be made in respect of a patient who would represent a substantial risk of serious harm to himself or herself or to others. A supervision order will last initially for six months, and subsequently for periods of a year at a time.

As part of an agreed aftercare programme, people under supervision may be required to reside at a specific place or to attend for occupation, education or training. A supervisor, who must be a person professionally involved in the patient's care, will be appointed to monitor the supervision order.

Many people will hear that and think it a good idea. Some patients need extra support and attention while recovering from treatment for serious mental illness, especially if they have a tendency not to comply with their care programme. But such a form of aftercare supervision already exists, and it is known as a guardianship order.

Many people who work in mental health community care are at a loss to understand the need for a completely new order when the existing power of guardianship offers an almost identical provision. Although it is used rarely, perhaps because of the strain that it puts on scarce resources, guardianship is effective in the small number of cases in which some form of statutory supervision is required. It facilitates community care, while offering protection to the patient.

The key difference between a guardianship order and the proposed supervision order is contained in the Bill's most controversial and most strongly opposed proposal—the power to take and convey. The need for a power to convey a person under supervision to a place of treatment, training, education or residence specified under the terms of the supervision order is highly questionable. I do not understand how such a power, which may be exercised by anyone nominated by the patient's supervisor, is appropriate to a co-operative and humane approach to community care.

If the power is exercised against a patient's will, it is highly unlikely to encourage compliance with his or her treatment plan. There is also a danger that the coercive elements of the new arrangements will compromise the important relationship of trust that should exist between patients and carers. It is important to emphasise the fact that one cannot care for people in a community environment without some consent and trust between the person being supervised and the supervisor.

The power to take and convey has been opposed by many groups and organisations, including the Law Society, the Association of Community Health Councils for England and Wales, MIND, the British Association of Social Workers, the Mental Health Foundation, the Community Psychiatric Nurses Association, SANE, the Royal College of Nursing, Unison, Survivors Speak Out and Liberty.

In Committee, the Minister failed to make the case for the power to take and convey, and several hon. Members have shown their opposition to it by signing early-day motion 1487. The power constitutes a significant erosion of civil liberties, with no conceivable benefit to patients.

The Bill allows the patient's supervisor to nominate any other person or agency to take and convey the patient. The supervisor does not have to obtain any additional authority before delegating the power. The application of the existing provisions for "arrest" laid down in sections 6 and 137 of the Mental Health Act 1983 is subject to strict criteria and numerous safeguards made clear in the code of practice. That code contains guidelines for best practice and sets out the rights of patients, and the responsibilities of care professionals to safeguard those rights—safeguards that are absent from the Bill as it stands.

We had hoped that the Minister would accept the widening of the remit of the Mental Health Act Commission to include patients receiving after-care under supervision. That would have reduced the likelihood of the power to take and convey being abused, or used to reinforce worst rather than best practice. The idea was backed by the Royal College of Psychiatrists, the Law Society, MIND and a range of other organisations, including the commission itself, so it is disappointing that the Minister has rejected it.

The Minister has not been consistent about how the power will work. In another place Baroness Cumberlege said: Clearly this power to convey would be used only in times of emergency."—[Official Report, House of Lords, 4 April 1995; Vol. 563, c. 156.] That begs two questions. What constitutes an emergency? And what kinds of emergency does the Minister believe are not already covered by sections 6 and 137 of the 1983 Act?

The Minister suggested that the power would be used in different circumstances. He told the Committee: We are providing for a reserve power, as it were, which would be available to the supervisor of that small group of vulnerable and sometimes unpredictable patients, in order to overcome a temporary unwillingness to co-operate."—[Official Report, Standing Committee F, 6 July 1995; c. 94.] Baroness Cumberlege said that the power would be used only in emergencies, yet the Minister said that it would be used to overcome temporary unwillingness to co-operate. The two sets of circumstances are different. So nobody will know how or when the power is to be exercised. Perhaps in this final stage, before the Bill reaches the statute book, the Minister will be able to dispel the confusion and make a final and authoritative statement on when the Government intend the power to take and convey to be exercised.

It is all the more important that the Minister makes such a statement, because the Bill is silent about what will happen once the patient has been taken and conveyed to the specified place. It appears that he cannot be forced to stay there against his will, and it is difficult to see how an unwilling patient, who has probably been further aggravated by being taken and conveyed, can be forced to take part in occupation, education, training, or whatever else he is supposed to do.

The threat will undermine the relationship of trust that must exist between carer and patient. My hon. Friend the Member for Dulwich (Ms Jowell) referred to the views of the registrar of the Royal College of Psychiatrists, Professor Chris Thomson. In an article in the British Medical Journal, Dr. Nigel Eastman, the head of forensic psychiatry at St. George's medical school, expressed even stronger reservations about the power to take and convey: A highly detrimental therapeutic effect is likely to arise from community psychiatric nurses forcing unwilling patients into their cars and taking them to day centres or hospitals where they are then asked to take treatment that they have (presumably) already refused. We believe that the proposition is unworkable.

In introducing the Bill, the Government have acknowledged that community care for the seriously mentally ill is not working effectively. We are united on that point. However, they have not realised the scale of the problem, nor identified the solutions correctly. Coercion is not a substitute for co-ordination and co-operation. Statutory powers are no substitute for well-resourced and focused community care. As a consequence, the Bill will not achieve in practice what it sets out to achieve.

Photo of Mr David Atkinson Mr David Atkinson , Bournemouth East 5:39 pm, 26th October 1995

I welcome the Bill in its final form, as does the National Schizophrenia Fellowship. We are grateful for the fact that many of our amendments have been accepted. I should also like to take this opportunity to welcome the Minister of State's pre-emptive response in August to the recent report of the social services inspectorate and the clinical standards advisory group, when he called on health authorities to get their act together in three months, to bridge the gap between the theory of community care for the mentally ill and the reality, when it falls short.

That stark reality was brutally exposed by last month's report of the Woodley inquiry into the death of Stephen Laudat, to which the hon. Members for Newham, North-East (Mr. Timms) and for Newcastle upon Tyne, East (Mr. Brown) referred. Woodley recommended better co-operation between health authorities and social services, the provision of more day centres, better training in risk assessment and management and a complete avoidance of bed-and-breakfast accommodation for homeless mentally ill people. All those recommendations echo long-standing concerns of the fellowship—to which I would add the need for a wider recognition of mental disability as well as physical disability in the benefits and allowances that are available for the disabled.

The implementation of this legislation will undoubtedly assist the care programme approach to the mentally ill, by providing more powers and greater flexibility for the supervision of discharged patients. I fear, however, that it will serve only to highlight further the shortfall of psychiatrists and key workers, whose case loads just do not allow enough time for their patients.

Still, although the Bill represents no substitute for a complete review of the 1983 Act, which was conceived against the background of a bygone age for the mentally ill, I welcome the fact that the Minister has confirmed again this evening that the Government are giving thought to a review of the Act. The Bill confirms that the community care approach to the mentally ill is here to stay, and I look forward to the undoubted contribution that the Bill will make to public safety, which must always be paramount.

Photo of Mr Archy Kirkwood Mr Archy Kirkwood Liberal Democrat Chief Whip 5:41 pm, 26th October 1995

The hon. Member for Newcastle upon Tyne, East (Mr. Brown) said a few moments ago that coercion is not a substitute for co-operation. Bearing in mind the job to which he is moving in a few months' time, I am sure that many of his right hon. and hon. Friends will remind him of that statement. I can think of no one better than the hon. Gentleman to replace the hon. Member for Jarrow (Mr. Dixon)—and if the hon. Gentleman uses the power to take and convey as effectively as the hon. Member for Jarrow has done, he will be a great success.

This is an important Bill, but I share some of the worries expressed about it by hon. Members on both sides, most recently by the hon. Member for Bournemouth, East (Mr. Atkinson). The Government will get their legislation. Certainly, they could not afford to ignore some of the terrible tragedies to which the hon. Member for Newcastle upon Tyne, East rightly referred. But I do not think that this is the right measure; I remain to be convinced that it is. The Government's argument was probably the best they could muster in the circumstances.

I commend the Minister's handling of the Bill throughout its stages, but I sincerely hope that he will take away certain clear messages from the whole process. One is that the opportunity should have been taken fundamentally to review and reform the Mental Health Act. I was interested to hear the hon. Member for Dulwich (Ms Jowell) say that Labour would give the subject priority in the new Parliament, should it have any influence in it. And I know the hon. Member for Dundee, East (Mr. McAllion) well enough to know that, when we have a Scottish Parliament, it will be high on our agenda there, too. I hope, in the meantime, that the Minister—or his successor—will not forget the undertaking that he has given. The urgent need for reform has been expressed by many pressure groups and by hon. Members of all parties, and I hope that the Government will tackle it constructively.

As I said on Second Reading, I still feel that we need to deal with the problems not so much of the high-profile tragic cases as of the people who might commit suicide or engage in self-neglect, who make up the vast burden of the cases with which the professionals have to deal. I do wonder whether the Bill will help them; I remain sceptical whether it will. The hon. Member for Newcastle upon Tyne, East listed some of the professional bodies that remain unconvinced as well.

It is not a shortage of powers that is the problem: it is a shortage of resources. We need more appropriate accommodation and more employment, training and recreational resources. That is not to say that a blank cheque should be offered, but these are the sort of issues that we would have liked to hear more about from the Department during the passage of the Bill.

I also fear that there will be a diversion of resources within the provision of mental care and the treatment of mental illness, owing to the new Act. I hope that the Minister will look into that carefully and that, if he finds evidence of people having to divert resources from other equally urgent needs in the treatment of mental illness, he will respond urgently. Moreover, I cannot help but think that the Bill will impose a new raft of responsibilities, of a kind that the Government have not foreseen, on mental health nurses.

More than anything else, the Bill is a lost opportunity. We shall give the Minister his Bill; in return he must monitor it carefully, and not use it as a substitute for a thoroughgoing reform in the future.

Photo of Mr John Gunnell Mr John Gunnell , Leeds South and Morley 5:45 pm, 26th October 1995

I want to ask just one question: why has the Bill caused so much disquiet in communities that include many mentally ill people or people who have suffered from mental illness at some stage but have been restored to good health? The power to take and convey is responsible for that disquiet, yet it is clear from the Bill that it can be applied only to limited numbers of cases. It is certainly clear, judging by the cases cited by my hon. Friend the Member for Newcastle upon Tyne, East, that it is necessary to have powers to protect the public; but the concern is much more widespread than just among those to whom the Bill may apply.

There are many people on what I might term the fringes of mental illness. They may have spent some time in an institution but have since been integrated fairly well back in the community. But they still entertain uncertainties at the back of their minds about these powers—they trouble them. Surprisingly, perhaps, certain groups of people have been anxious for a change in the powers without really having understood them.

I agree with my hon. Friend the Member for Newcastle upon Tyne, East that there has been no satisfactory response on the issue of the Mental Health Commission. It could perhaps have been a voice of independence, but there has been no movement on that. People have therefore concluded that there has once again been a lack of consultation and that the Government have been unwilling to compromise on the detail. That only adds to people's fears. There are many people to whom the Minister does not intend this measure to apply, but they still harbour fears—perhaps because at times in the past they have been unable to control their behaviour. They therefore suspect that the Bill's powers might ultimately be applied to them.

There is a second reason for the disquiet that the Bill has caused. It would be fine if the people whom I have described were set to gain something from the Bill, but it is, as others have said, a lost opportunity. It does not tackle the real problems of community care for the mentally ill. When the Bill was first presented it became clear that it would be unaccompanied by additional resources. One recognises that now limited additional resources have been provided, but those resources have understandably been directed to a small minority of mentally ill patients because the Bill focuses on them. However, the Bill contains nothing for the vast majority of people.

The Mental Health Foundation has produced a list of the needs of mentally ill people. It says that they need an appropriate place to live, an adequate income, a varied social life, employment and other day activity, help and support, respect and trust, choice and consultation. All those are absent from the Bill. The Audit Commission report made clear how important was a secure place to live for mentally ill people. The Bill does not tackle that issue. The people who have expressed their fears to me feel that they have lost something. They are uncertain about their ultimate freedom in certain circumstances, but they feel that they have gained nothing from the Bill. What is more, the Bill has been accompanied by a squeeze on the benefits system, which has hit some of the same people who will not benefit from the Bill.

I launched a report in the House some months ago for the Matthew Trust. I am sure that the Minister has seen the document. It contained a list of cases and individuals. Amounts such as £25 or £70 can make an enormous difference to such people, but the benefits system somehow misses them out. People fall through the safety net. A new power is being introduced with which they are unhappy. Their real problems are not dealt with. The squeeze on Government funding and benefits makes their circumstances even more adverse.

Many of the people to whom I have spoken feel that there is discrimination against people who have mental illness. They have certain difficulties if they live in the community without support. People taunt them. Their appearance may be a little unusual. They feel that there is no anti-discrimination legislation in place to protect people who have mental illness, although legislation exists to protect against discrimination on the basis of race or gender.

People feel that the Bill threatens their freedom even though, looking at it rationally, we might say that it does not. I have tried to explain that to some of the people with whom I deal, but they do not want to see the measure on the statute book and they would like to see changes.

The Bill is a lost opportunity, but in a sense it is more than that. The Government have been intransigent on some of the matters that have been raised. Even if in practice those matters make no difference to mentally ill people, that intransigence is seen as a definite Government programme which could just include them. It is hard to bring rational thinking to people who have such fears.

We have seen papers which support the legislation and argue that the provision of transport is a good thing. One can talk to people along those lines, but one cannot convince them that the measure does not provide an all-powerful body with a power that could reach down and touch them in their communities.

The Bill is a lost opportunity. I am glad that my hon. Friends on the Front Bench have said that a thorough review of the Mental Health Act 1983 will take place under a Labour Government. I hope that proper resources will be provided for the mentally ill in our community because the need is certainly great.

Photo of Stephen Timms Stephen Timms , Newham North East 5:53 pm, 26th October 1995

In the earlier debate on the new clause, I drew attention to the criticisms of the Bill in the Woodley report published last month on the killing of Bryan Bennett by Stephen Laudat in Newham. The critical point is that the Bill does nothing to provide desperately needed additional resources for mental health care. As several hon. Members have said, the Bill could make matters worse.

I have received a letter from Dr. Ruth Taylor, a Newham GP, in which she commented on some of the criticisms levelled by the Woodley report at a Newham psychiatrist referred to in the report as Dr. B. She says: In 1993 three consultant psychiatrists covered the Newham population of 230,000. Dr. B covered a population of 90,000—approximately three times that recommended by the Royal College of Psychiatrists. She carried this burden for ten years … Help was requested from the management of the psychiatry services … but none was forthcoming. In 1992 the general manager and chief executive were warned in writing by the Newham consultants … that their excessive workload made their standards of practice unsafe. No effective change was brought about to alleviate the problem … when professionals are given an impossible workload, disasters are daily waiting to happen. That is the reality of mental health care and the Bill does nothing to help. The family of Mr. Bennett are angry. The family of Mr. Laudat, the perpetrator, are angry. The system failed for both of them and it must be radically reviewed, as hon. Members on both sides of the House have said.

Things are getting worse. The health authority and local authority in my area, despite shocking reductions in their funding, have managed to set aside additional resources for mental health care next year in the light of the Woodley report, but East London and City health authority projects a £7 million deficit next year. The Woodley report highlights the need for extra resources in east London to avoid more incidents such as the one to which I have referred. So why is it proposed to withdraw large sums of money from the district health authority?

That is asking for disaster. I urge the Minister to ensure that those threatened draconian cuts to the East London and City budget do not go ahead.

There is growing anger in east London on mental health matters. On Sunday, several hundred people attended a festival organised by the Newham needs campaign to highlight the problems of inadequate funding for health services in Newham. Fifty-nine people sent electronic mail messages of protest to the Prime Minister and many more sent postcards to the Secretary of State.

Another matter raised by the Woodley report has not been picked up by the Bill. Recommendation 5.20 of the report recommends that the Department of Health harmonise guidance on Section 117 registers, proposed Supervision registers, and the Care Programme Approach with Community Care Assessment and Care Management in respect of people who have a severe mental illness and their carers. Such guidance should include clarification of clinical, management and practitioner responsibilities and the importance of choice by the service user in who their psychiatrist or key worker is to be for the purposes of sustaining a therapeutic relationship. That guidance is urgently needed. It has been discussed for a considerable period. Can the Minister give the House an assurance that it will soon be issued?

Great efforts are being made in Newham jointly by the health authority and the local authority to learn the lessons of the report. A detailed joint action plan has been drawn up. My plea to the Minister is at least to stop taking resources away from east London and other areas like it, which is what is proposed for the health authority and the local authority for next year. This cannot go on. I urge the Minister to act to change things for the better.

Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Women) 5:58 pm, 26th October 1995

The Bill faces in two directions—backwards to the 1983 Act to correct serious anomalies and forward to the new challenges that community care must face. Very rarely is mental health legislation debated on the Floor of the House. It is complex and often controversial. It involves careful balancing of many interests. It raises issues of personal liberty and professional accountability. It touches on the responsibility of public services to provide adequate and effective care for some of the most vulnerable people in our society.

The law is only one, of a number of influences that must be engaged for good community care to work in practice. The others are the services themselves, the skills and competence of professionals responsible and, of course, ministerial guidance to authorities on the nature and extent of their duties and to professionals on their practice. It is the role of Government and Government alone to determine the respective importance of each of those influences and to orchestrate their working together.

Public confidence in community care has been badly shattered by recent highly publicised tragedies and that adds a new context to our consideration of legal and policy changes in the area. We can no longer discuss and decide such issues beyond the public's view. For a new contract of trust to be forged with the public, services need to be in place, together with an effective legislative framework, enabling people with mental illness to be properly contained and treated when they are a risk to themselves or to others.

As drafted, the Bill will be unfair and probably unworkable. Where it needs to be certain and unambiguous, it remains unclear and open to wide and varied interpretation. The Bill needed to gain the confidence of those who will experience added restriction and interference when placed under supervision. It can do so by providing clear and effective rights and entitlements to services, but it offers nothing new—nothing more than the present vague and unenforceable section 117 of the Mental Health Act 1983.

The picture painted by recent reports on mental health services suggests that Ministers have profound and persistent illusions, or indeed delusions, about the real world in which people with mental illness and those who care for them have to cope. Certainly, we see little sign of a system in practice in which the guarantees and assurances made by Ministers are on offer.

The Bill needed to win the support of hard-pressed health and social services professionals. It has failed to do so. It merely imposes on them heavy legal and personal responsibilities and furthermore suggests that services to some patients will have to be reduced or discontinued to meet the needs of patients being targeted as a result of the Bill. I hope that the Minister will assure us when he sums up that no one receiving services will have them taken away to enable such targeting.

The Bill should recognise the need for fairness and equity in the use of coercive powers such as "take and convey". It can do so by making professionals clearly accountable when they use them. As we discussed, the Bill omits important checks and balances. Enhancing the role of the Mental Health Act Commission would be a step towards doing that.

The Minister should be encouraging the use of existing powers and legal provisions, such as guardianship. Such an aim should be shaping the contents of the new legislation. Instead, as part of the Government's piecemeal approach to tinkering with what is largely obsolete legislation, they intend to create unnecessary and confusing additional powers.

Many organisations that represent professional staff who will have to use the Bill and those who will be made subject to it have also voiced their concern. They include the Royal College of Psychiatrists, the Royal College of Nursing, the Community Psychiatric Nurses Association, the Mental Health Foundation, the National Association for Mental Health—MIND—and Survivors Speak Out. The support and confidence of such organisations are essential for this legislation to succeed.

I frequently listen and talk to people who are in touch with and using community care services. For five years I was a member of the Mental Health Act Commission and for 13 years I was assistant director of MIND. All the accounts force us to the same conclusion that we find when reading the recent flood of reports on community care—the Ritchie report on Christopher Clunis, those of the Mental Health Foundation, Sir Louis Blom-Cooper and the Audit Commission and now those of the social services inspectorate and the Clinical Standards Advisory Group, which were published in the summer. They tell us that the crisis affecting care in the community has little to do with the law and much to do with the attitudes, skills and resources of professionals and the very limited community opportunities available to those with enduring and intractable mental health problems. To the extent that problems result from the present state of the law, they will not be addressed by the limited and unambitious measure that we have been debating.

Before concluding, I must remind the House of the contents of the report that led to this Bill. It was the Department of Health's internal review of legal powers on the care of mentally ill people in the community, which was published in August 1993. It presented the Government with their options for legal change in that area and the principles that should provide the framework for any change. The report said: if … a new power is introduced it is absolutely essential that account is taken in framing it of the criticisms and fears expressed by many of those who gave evidence to us, and that it is applied in such a way as to minimise the dangers they foresaw". The review also offered a series of principles to frame the new power. It said that the power should be applied so as to ensure the least restrictive form of care consistent with safe management; that it must have adequate safeguards to ensure appropriate use; that it must be so defined as to minimise the risk of its being wrongly applied to patients who do not need this form of legal constraint; and that it must not discriminate in principle or in practice against particular ethnic or other groups. It also said that it must be recognised that the use of the power implies a reciprocal obligation on the statutory services to provide the support that the patient needs.

We take the Government back to those principles when judging the legislation before us. They must stand judged by their refusal to accommodate in the legislation the principles emanating from their own review.

The Bill was an opportunity to rebuild the contract of trust, which is the essential foundation of community care, between the patient, families, professionals and the public. The Government have failed to take that opportunity and it will now fall to a new Government—a Labour Government—to introduce a new mental health Act, to inspire and recreate that contract of trust.

Photo of Mr John Bowis Mr John Bowis , Battersea 6:06 pm, 26th October 1995

I am tempted to say, "Are you sure?" to the hon. Member for Dulwich (Ms Jowell). I suppose that I should be flattered. I do not know if it is a parliamentary record for two Opposition spokesmen to have to contribute to the same debate to balance a Minister. I appreciate the fact that I am to be balanced and that this is a subject on which we need balance. I also appreciate that, recently, the Leader of the Opposition had to stand in to help out the spokesman on the shadow Home Affairs team, but I have never before heard of a spokesman standing in to help out a leader, which is what we have seen today.

The House has given the Bill the thoughtful, thorough and critical attention that it deserves. Despite the rather sad little speech of the hon. Member for Dulwich, I am grateful to hon. Members on both sides of the House who have contributed to our discussions at all stages. They have been good, constructive and, on the whole, good-humoured debates.

My hon. Friend the Minister of State, Scottish Office and his team have worked closely with us to draw up a package of measures that will ensure that some of the most vulnerable patients receive the follow-up care that they need. That is in the interests of the patients, their families, their professional and informal carers and their local communities.

The introduction of supervised discharge and community care orders is complemented in the Bill by provisions on leave of absence and absence without leave. The scrutiny in both Houses has refined and improved the Bill. Our mental health legislation has evolved over many years and will continue to do so. That is a pledge that I can certainly make to the hon. Member for Newcastle upon Tyne, East (Mr. Brown). We shall be studying carefully how the new powers are used alongside the existing power of guardianship, but for now we are committed to acting positively to help patients, their carers, families and the professionals responsible for providing services and personal support.

I should add that this Bill brings to an end the time of yet another Opposition Front Bench health team. As they take their bow and leave the stage, rather like the Von Trapp family in "The Sound of Music"—perhaps the Trappist connotation is appropriate in the case of the hon. Member for Newcastle upon Tyne, East (Mr. Brown)—I wish them well in their new roles.

I believe that these measures will strengthen the care and support of vulnerable people with severe mental health problems. The Bill must be seen in the context of all the investment in services, hospitals and the community that has brought new hope to mentally ill people and their families. We stand four-square behind them and behind the community as a whole, which rightly demands this strengthened level of care and supervision. I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read the Third time, and passed.