Mental Health Bill [HL]

Part of the debate – in the House of Lords at 3:45 pm on 19th February 2007.

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Photo of Lord Adebowale Lord Adebowale Crossbench 3:45 pm, 19th February 2007

My Lords, I declare an interest as chief executive of Turning Point social care, which provides a large number of mental health services in England and Wales. I will speak briefly but, I hope, strongly in support of the amendment. The noble Lord, Lord Carlile, has already mentioned the Scottish position, and I want to bring home, in case we hear again that principles will confuse practitioners, the reality of having principles on the face of the Bill, as applies in Scotland. I quote from Dr Mark Taylor, a consultant psychiatrist in Glasgow, who has worked on a number of tribunals, both before and after the new Act. He was seconded to the Scottish Executive to help with mental health Act training. He believes that,

"it would be helpful for all parties to have principles".

The principles promote best practice. For example, a lawyer can question a psychiatrist as to whether he has adhered to the principles as far as he can, and this in turn encourages the psychiatrist to consider in advance of a tribunal any issues raised by the principles.

I will refer to an example of how the principles of "present and past wishes" and feelings translate into practice in Scotland. When Alex was admitted under compulsory powers, he was acutely unwell but had a degree of insight about his previous experience of mental health care. Taking note of the principle, the clinician specifically asked him about which treatments he felt had been particularly helpful or unhelpful in the past. As the clinician used this information as the basis for his care plan, Alex was far more inclined to co-operate with his subsequent treatment. Because of the inclusion of principles, trust underpins the whole operation of the Scottish Act. Principles would help to foster trust in the mental health system in England and Wales. Two people using Turning Point's mental health crisis services illustrate the lack of trust in the current system. They had no hesitation in telling me:

"Because of my experience in hospital, I do not tell any of my workers when I am feeling unwell. I don't ask for help in case I am sectioned. Being sectioned is intrusive rather than supportive".

In short, the more service users have confidence in the system and in the people working with them, the more likely they are to be engaged in their treatment, leading to better outcomes for them and for society as a whole. Trust is especially important, as we have heard from many noble Lords, for those from BME backgrounds. For example, for African and Caribbean communities, discrimination and mistrust mean that contact with mental health services is more likely to be coercive, as we have heard from the noble Lord, Lord Patel of Bradford, and involve the police, making it more difficult to develop therapeutic clinical relationships with patients. Those poor clinical relations lead to less compliance with treatment and poor outcomes, leading to increased use of coercion and increased distrust. It is a vicious circle. We need a step change in the way in which mental health services are perceived. If this Government are serious about increasing confidence and engagement—I believe they are—principles cannot be left to the code of practice. They must be given the weight, visibility and priority that can come only with inclusion in the Bill.