Mental Health (Care and Treatment) (Scotland) Bill: Stage 3

– in the Scottish Parliament at 3:29 pm on 20th March 2003.

Alert me about debates like this

Photo of Murray Tosh Murray Tosh Conservative 3:29 pm, 20th March 2003

The next item of business is a debate on motion S1M-4024, in the name of Malcolm Chisholm, that the Mental Health (Care and Treatment) (Scotland) Bill be passed.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 3:37 pm, 20th March 2003

Today marks the culmination of an inclusive and extensive process that has shown our new Scottish legislative arrangements working at their best and has delivered a landmark bill that places patients and their welfare at its heart.

That is exemplified by a coherent set of principles to which anyone discharging functions under the bill must have regard; a new mental health tribunal that will combine professional, legal and practical experience in deciding what is best for patients; a new compulsory treatment order, which will allow care and treatment to be tailored to the personal needs of each patient, whether in hospital or in the community; duties on local authorities to promote the well-being and social development of all persons in their area who have, or who have had, a mental disorder; additional safeguards in the use of certain medical treatments; a strengthened Mental Welfare Commission for Scotland to ensure that the mentally ill are properly protected; novel provisions to ensure that advocacy is available to all persons with mental disorder; and mechanisms for the nomination of a named person with significant rights to represent the patient's interests.

I am grateful to everyone who has contributed to the preparation of the bill and its proceedings. I thank again the Millan committee of four years ago. The mental health legislation reference group played a significant part in the preparatory work, both in the development of the policy statement, "Renewing Mental Health Law", which preceded the bill, and by acting as a sounding board and a source of sensible advice on issues that have arisen as the bill has progressed. One of the amendments that I moved this morning followed late advice from that group.

The Mental Welfare Commission and the Law Society of Scotland have also been particularly helpful in bringing a keen and experienced eye to the bill. A large range of voluntary organisations, such as the Scottish Association for Mental Health and the National Schizophrenia Fellowship, have, by their tenacity and persistence, kept us on our mettle and ensured that the patient's perspective was always clearly recognised. I thank all those bodies, mentioned and unmentioned.

On the Health and Community Care Committee has fallen a huge burden, so I give a warm thanks to its members, its clerks and everyone who gave evidence to it over a period of several weeks. The bill is by far the largest to have been considered by the Parliament. With the consideration of some 1,400 amendments at stage 2, the committee's energy and commitment to the task were clearly demonstrated. The committee's efforts have resulted in a number of significant changes to the bill. Indeed, many amendments that we have considered in the past two days were lodged in response to the committee's views at earlier stages of the bill.

Last, but by no means least, I thank the officials in the bill team. Given the complexity and length of the bill, theirs was a particularly difficult and arduous task, so I place on record my thanks to them.

The outcome is a bill of which we can justly be proud. As I said, we will proceed to push forward the implementation process. Work to that end is already in hand. I am pleased to say that the mental health legislation reference group has agreed to continue to make its expertise available in the implementation phase. I am grateful to the group for its continuing commitment.

I can announce today that our preliminary date for the commencement of the bill's main provisions is October 2004. Some free-standing provisions, such as the amendment to the Mental Health (Scotland) Act 1984 to allow for the appointment of a new chief officer to the Mental Welfare Commission and the provision that was added at stage 3 concerning the burden of proof, will be brought into operation as soon as possible. However, we wish to be certain that the infrastructure is in place to ensure that this superb legislation is implemented in a way that does justice to its provisions.

Presiding Officer, how long do I have? Is it five minutes or seven minutes?

Photo of Murray Tosh Murray Tosh Conservative

According to my script, you have 10 minutes.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Ten minutes. I have already omitted some of my speech on the assumption that I had only five minutes, but there we are. I should have found out before I started.

In implementing the bill, we will work with everyone who has an interest in mental health law in Scotland to ensure that we achieve the benefits for users and carers that the bill makes possible.

We will establish a tribunal system that makes good decisions and that promotes the participation of users and carers. We will develop guidance and a code of practice on the bill to help professionals to deliver quality care. We will put in place arrangements for monitoring and evaluation to ensure that, in the future, we know how the legislation is working and why and how we can make it work as well as possible. We will work with service providers to help them to prepare to meet the responsibilities that the bill places on them.

Our intentions are that, before the end of this year, we will have appointed a president of the tribunal to oversee the latter stages of preparatory work, we will have announced the location of the president's office and we will have issued a draft code of practice for formal consultation. I hope and expect that the Parliament will maintain a close interest in that important process.

The amendment from the Scottish National Party is unnecessary. As it repeats what I have said on many occasions, clearly I have no reason to oppose it. On 14 November 2001, in the debate on the white paper, I made it absolutely clear that adequate resources would be made available for the implementation of the bill. I give that commitment again today. At stage 1, I said that I was

"setting in train a comprehensive assessment of existing mental health service provision. That will enable us better to determine how the current range of facilities, augmented by the substantial additional resources that we are making available, will be able to meet the bill's objectives."—[Official Report, 11 December 2002; c 16205.]

On 5 February, I duly announced that Dr Sandra Grant had agreed to carry out that assessment. I have asked her to complete her report, which will be made publicly available, by 31 August. We look forward to receiving Dr Grant's report, which will give an objective and comprehensive perspective of current service provision and will inform the steps that we are taking to ensure that the implementation of the bill is adequately resourced.

The amendment would therefore be more accurate if it said that the Parliament "supports the view expressed by many giving evidence on the Bill, by three committees of the Parliament and by the Minister for Health and Community Care that the aims of the Bill will not be met unless services and facilities are adequate to meet the demands placed on them." However, we shall not quibble at this stage; we shall accept the amendment in spite of the fact that it is unnecessary.

I have great pleasure in commending a bill that revolutionises mental health law in Scotland, that puts the patient at the centre of treatment and care decisions and that ensures that their well-being is and will be paramount.

I move,

That the Parliament agrees that the Mental Health (Care and Treatment) (Scotland) Bill be passed.

Photo of Murray Tosh Murray Tosh Conservative

I now call Shona Robison to speak to and move amendment S1M-4024.1. You have up to seven minutes. Quite a lot of members want to take part in the debate, so it would be helpful if time could be saved from the opening speeches.

Photo of Shona Robison Shona Robison Scottish National Party 3:45 pm, 20th March 2003

I will certainly do my best.

I begin by thanking all the Health and Community Care Committee clerks, who have worked so hard on the bill. They were still working on the bill until well after midnight last Friday, which really is beyond the call of duty. I also thank everyone who gave evidence, particularly service users, many of whom shared personal experiences with us. We appreciated that very much.

Suffice it to say that the bill has been a long haul for everyone involved. We have to learn lessons from the way in which the legislation has been handled. The initial delay in introducing the bill due to drafting problems was the start of the difficulties. Then there was the unprecedented number of amendments lodged at stage 2—more than 1,300—again due to drafting problems. Finally, more than 700 additional amendments were lodged at stage 3.

I do not want to dwell on that too much but, as I said yesterday, I fear that there might be problems with the legislation that will come back to haunt us. There might be a need for an amending bill in the near future, although I hope not. We must ensure that our new Parliament reflects on what improvements can be made to our legislative process so that we can avoid such problems happening again.

The amendment to the motion goes to the heart of the concerns that have been expressed at all stages of the bill. I believe that those concerns have to be expressed again. I am pleased that the Executive has, even if a little grudgingly, said that it will accept the amendment. The bill will work and deliver its aims and objectives only if the services and facilities exist to meet demand. I will come back to that issue in more detail.

I broadly welcome the content of the bill, although I still have some reservations about elements of it. On the principles of the bill, it was important to try to keep service users on board with the legislation. It is fair to say that their biggest disappointment was with the failure to include the principle of reciprocity. That remains a concern and it is unfortunate that our suggestions on that point were not accepted.

Some unease remains about community-based CTOs, despite the safeguards that have now been included in the bill. I would have liked more safeguards but, now that we are where we are, it is important that there is effective monitoring of the numbers of community-based CTOs and swift action to investigate any unforeseen rise in the use of such orders. That would go some way towards reassuring the people who are concerned.

There has been a lot of compromise with the bill, which is always a good thing. I was reassured by what was said about electroconvulsive therapy this morning, as I am sure many service users will have been. I was particularly pleased when the amendment on age-appropriate services was passed yesterday. With only 35 in-patient beds for adolescents throughout Scotland when there should be 80 to 100, that measure could not have come at a better time.

For me, the most satisfying aspect of the bill is that is enshrines in statute the right to appeal against excessive security. The Crichton family's evidence about their experiences was powerful. For a young man to spend three years of his life in a maximum-security setting when he did not require to was a failure of the system. Rehabilitation should start at the earliest opportunity, not three years later than it has to.

As a number of members said this morning, we now need to focus on appropriate alternative services, with local medium-secure units where rehabilitation and recovery can begin. We should talk about that more. At the moment, those facilities are inadequate—we need more of them. However, the public have to be given full information on what such units are about, otherwise opposition will develop based on myths and fear. It is imperative that community resources are developed for the next stage in people's rehabilitation into the community. If that does not happen, a bottleneck will develop in medium-secure units.

That brings me back to resources and the reason for my amendment. It has been said throughout the process—by three committees of the Parliament and by nearly all the people who gave evidence—that there is concern in all quarters about resources. There are outstanding issues of resources for staffing and finding the staff to fill posts. I hope that those problems can be overcome.

The proof of the pudding will be whether the services and facilities that are required by service users are sufficient. Only by ensuring that that is the case will the aims and aspirations of the bill be met. At the moment, I am afraid that the jury is out.

However, the Parliament has a huge role to play in monitoring the development of those services. I am sure that service users will work with us to ensure that that happens.

I end by talking about the context of the bill. Although most of us will never need compulsory treatment or need to be detained, one in four of us will suffer from a mental health problem at some point in our lives. Therefore, it is in all our interests that appropriate services are available when and where people need them. Too often, that is not the case and by the time a person comes into the system their condition is much worse. Preventive work must be the key to ensuring that we have good mental health in Scotland. Mental health services must cease to be the cinderella services and must reflect the fact that mental health is supposed to be a key clinical priority.

I urge the Parliament to support my amendment to the Executive motion on the bill. I am pleased that the Minister for Health and Community Care has accepted it, as that means that he will not experience the anxiety that he felt last week.

I move amendment S1M-4024.1, to insert at end:

"but, in doing so, supports the view expressed by many giving evidence on the Bill, and by three committees of the Parliament, that the aims of the Bill will not be met unless services and facilities are adequate to meet the demands placed on them."

Photo of Mary Scanlon Mary Scanlon Conservative 3:52 pm, 20th March 2003

I, too, thank the clerks for their incredible work. Like Shona Robison, I noted the time of midnight on e-mails from last week.

The Scottish Conservatives will support the SNP amendment, even though it states the obvious—it repeats what many people have said at every stage of the bill. However, if nothing else, it puts down a marker that we need continually to monitor what we are trying to achieve through the bill and that we must ensure that services are provided.

I welcome the fact that the Minister for Health and Community Care has put Dr Sandra Grant in charge of the review of service provision. If her review is as good as her Scottish Health Advisory Service reports, it will be an excellent piece of work.

I also thank the witnesses. For me, the most memorable users who came along to the Health and Community Care Committee were Maggie Keppie and Marcia Reid from Elgin. As I have been speaking in the past two days, much of what Marcia said about ECT and so on came back to me.

I am pleased that Health and Community Care Committee members succeeded with their amendments, particularly Margaret Jamieson and Bill Butler, who doggedly stuck with the issues at all points in the bill. They have to be commended for that. Shona Robison is to be commended for her amendment on the inclusion of psychology as part of medical treatment. Although the issue came to us late, we welcome the success of that amendment. Of course, I commend myself for the amendments on medium-secure units.

The bill was due at the Health and Community Care Committee at the end of January 2002. We received the draft bill of 89 pages in June 2002. The bill as introduced grew to 168 pages; committee members received it in September 2003.

Photo of Mary Scanlon Mary Scanlon Conservative

Sorry, there are so many figures.

After 1,357 amendments at stage 2, the bill grew to 242 pages. A further 756 amendments were lodged at stage 3. If I do nothing else in this speech, I would like to put on record—especially as the convener of the Procedures Committee is in the chair—a plea to have an updated version of the explanatory notes made available when such a great number of amendments are lodged. I would have found that helpful when I was struggling with the more than 2,000 amendments with which we had to deal.

In the week before the dissolution of Parliament, it is almost with a sigh of relief rather than with the pride that I should feel that I contemplate the passing of the bill. Many serious questions about the resources that are available to us when we pass legislation have arisen from our experience of the bill. When I see the ministers at committee meetings with their armies of civil servants and their speaking notes for their amendments and replies to members of the committee, I contrast that sight with the experience of members of Opposition parties on the Health and Community Care Committee, who have no such resources or support yet also carry the burden of the responsibility for scrutinising legislation. I am not putting the case for having a second chamber, but there are arguments for one—indeed, there could be no greater justification for having one than our experience in passing the bill.

Like the minister, I believe that the Parliament owes a debt of gratitude to the Law Society, the Mental Welfare Commission and the Scottish Association for Mental Health. The responsibility for scrutinising the legislation fell to them, because I had to assume that, if they raised no concerns, it was okay to agree to certain points. The problem was that, at stage 3, because the bulk of the 755 amendments were submitted at around 4.30 pm last Friday, those organisations did not see the text of the amendments until the business bulletin was published on Monday, which was far too late to discuss, consult on or measure the full impact of many of the proposals. That cannot be acceptable from a democratic Government.

I want to put on record the fact that the Health and Community Care Committee took a non-party-political stance throughout the consideration of the bill. There has been no political point scoring. Given the complexity of the bill, the process has shown the workings of the Health and Community Care Committee at their best.

However, the legislation will be effective only if health boards and local authorities give it the priority that it deserves. Time and again, concerns about that have been raised in the committee and in the chamber. I share the view that was expressed about the fact that Carstairs has 29 blocked beds. We also heard that the Orchard clinic could not move people on because there were insufficient numbers of supported accommodation places, day centres, certified paediatric nurses and so on. For example, there are currently 29 vacancies for psychiatrists in Scotland and, in order to implement the bill, we will need an additional 28 psychiatrists. That means that we need 57 consultant psychiatrists. Furthermore, we face shortages of psychologists, psychiatric nurses, social workers, care workers, mental health officers and people to support general practitioners, 30 per cent of whose patients have mental health problems.

I struggled more on the subject of advance statements than I did on any other issue. I even fell into the danger of becoming a Liberal by supporting both sides—only for a short time, I must add. It was extremely painful not to be able to make a decision. I am glad that I am a Conservative, as we can usually see things clearly.

The Mental Health (Care and Treatment) (Scotland) Bill is undoubtedly the largest and most complex bill that the Scottish Parliament has dealt with. I have carried out my role in relation to the bill in good faith. I hope that the amendments that I have agreed to on behalf of the Scottish Conservatives will be beneficial to patients and supportive of good clinical practice. Given the size of the bill, the huge number of amendments and the time limitations, I can only hope that we are passing a good bill today. Time will tell.

Photo of Margaret Smith Margaret Smith Liberal Democrat 3:59 pm, 20th March 2003

If ever I was going to be tempted by a Conservative, it would probably be by Mary Scanlon. I think that she would make not a bad Liberal Democrat.

I would like to thank several people—the fact that they have been thanked already does not make my thanks any less heartfelt. Our clerks have done a tremendous job on the bill. At some point in the discussions that I had with the Executive on Friday, I said that what was being asked of our clerks was inhuman—I think that I chose my words well.

I thank the committee's stage 1 adviser, Jacqueline Atkinson, the other committees that took stage 1 evidence and the ministers, particularly Mary Mulligan for the way in which she dealt with our concerns. I also thank the bill team, whose members worked tremendously hard on what is a complex but incredibly important piece of legislation.

I have further thanks to give to those who gave oral and written evidence to the committee and who stuck with the task of keeping us up to date with their views and concerns as the great number of amendments were lodged. I thank in particular the Law Society of Scotland, the Mental Welfare Commission for Scotland, the Scottish Association for Mental Health and the other groups who support mental health service users, without which the committee would not have been able to do the work that was undertaken.

My final thanks go my colleagues on the committee. I echo Mary Scanlon's comments about the fact that there was no party-political point scoring or manoeuvring on the committee—nothing of that kind happened during our scrutiny of the bill. The questions that we wrestled with were questions of conscience, balance and judgment. It made no difference to our deliberations which party we were a member of. That is why I am delighted that the minister is accepting the SNP amendment to the motion, as the amendment makes a statement of fact. It is also important that the motion that we agree on at the end of today's business represents a united front on the bill and that there is no difference between us—we have been together on the bill all the way through.

Although I plan to pass on to the Procedures Committee the concerns that I raised with the Executive on a number of occasions, I will put them on the record this afternoon. The concerns relate to the fact that we had to deal with 1,400 stage 2 amendments and 750 stage 3 amendments. We had loads of time at stage 1 to do our job properly in terms of consultation. However, at the critical point when we needed to consult people to find out whether amendments would make a difference and whether we should support the provisions, there was no time to do that. It is important that we remember the strain that that put on the small non-governmental organisations that attempted to keep up with the legislative process.

The Mental Health (Care and Treatment) (Scotland) Bill is a prime candidate for early review. The bill is complex and, even with the best will in the world, MSPs and bill teams can make mistakes. There were times when we were considering sections of the bill and had to make very close judgment calls. We took decisions this morning and yesterday when in our hearts we did not know whether we had done the right thing. It would be worth while monitoring the legislation in a couple of years' time to see whether it needs to be reviewed. That would allow the Parliament to see whether we had taken the right side of the argument on, for example, advance statements.

That said, I welcome the bill—it contains a lot of good stuff and is long overdue. We are introducing a new flexibility into the system so that people can have the least restrictive alternative made available to them. People should not have to be taken into hospital when it might be better and less disruptive for them and their families if they were to remain at home.

The bill needs monitoring and its implementation needs resources and staff. I welcome the establishment of the independent tribunal, as that will take a difficult role away from sheriffs. The bill will lead to improvements in respect of patient involvement, through the right to advocacy, named persons and advance statements.

We have had a constructive debate over the past two days and indeed throughout the bill process. I am pleased that, at stage 2, the Executive took on board a number of points on issues such as ECT safeguards and the inclusion of the principles in the bill. I am also pleased that over the past two days we have seen some significant changes to the bill, as they represent an important move forward.

I enjoyed the way in which the members of the committee who progressed work on amendments saw their labour bear fruit. I am particularly grateful to the committee's deputy convener, Margaret Jamieson, for her support throughout the process. I was delighted that her amendment 34, on age-appropriate services, was accepted yesterday.

I meant it when I said yesterday that, if the Scottish Parliament is to mean anything, this is the kind of issue on which we have to do the right thing. We did the right thing yesterday in respect of amendment 34. We also did the right thing by Bill Butler, who doggedly stuck to the issue of resources for mother and baby units. I also welcome the fact that we did the right thing by his amendment 106.

Shona Robison has done some great work on ECT and I hope that she will accept the minister's assurances on that issue. Indeed, I hope that those people in the gallery who will examine the legislation will do the same and take comfort from the new safeguards that have been included, partly through the committee's work. I also pay tribute to Mary Scanlon's work on the bill.

Our approach to the issue of excessive security serves as a good example of how the committee, civic society, the bill team and the Executive can work together to come up with a piece of legislation that we all feel happy with and that will make a significant difference to people who are, but should not be, incarcerated in Carstairs.

As we have said before, the bill is good and principled, but money and people are needed to make it happen. I welcome the fact that that matter is under review and that the Executive has taken on board the SNP amendment. We all know what has to be done; we should now make it happen.

Photo of Margaret Jamieson Margaret Jamieson Labour 4:06 pm, 20th March 2003

I am grateful for the opportunity to speak in the debate. In the past, mental health has not had the attention that it rightly deserves; indeed, it has been referred to as the cinderella of the NHS. However, the Mental Health (Care and Treatment) (Scotland) Bill, which we have debated over the past two days, clearly reverses that lack of attention.

We would not have had the opportunity to debate the bill if it had not been for the collaborative approach that was adopted by the many individuals and organisations that advised committee members, ministers and their officials throughout the process. I want to record my thanks to them all for their patience and understanding when we sometimes struggled to reach decisions on aspects of the bill with which we were unfamiliar. I am personally indebted to Children in Scotland for its assistance and support in pursuing with me amendment 34, which was eventually accepted by the Executive.

I must especially mention and thank the Health and Community Care Committee clerks: Jennifer Smart, Peter McGrath, Graeme Elliott and Hannah Reeve. They ensured that committee members received papers on time; that witnesses were available; and that the grouping of amendments was clearly set out for us. It is unfortunate that not many members of the press are here to record that. Those people worked for many hours beyond 5 o'clock, even on a Friday, and their work has allowed us to debate the bill over the past two days.

Many have said that we have had insufficient time for proper scrutiny, but I do not share that view. The committee listened, read, made visits and discussed matters, and, as we have seen, very few divisions were required at stage 3. There has been no political posturing during the bill's progress from its publication to this stage 3 debate. All committee members set aside their political views in the interests of those who stand to gain from this updated piece of legislation. The Millan committee set the tone for us and I sincerely hope that its members welcome the approach that we took to achieve what I believe is a welcome piece of legislation.

It will be some time before the legislation is fully implemented and more work is required on work-force planning for the future. Funding streams must be explored to find out what is being provided by whom and to whom. That necessary examination will provide a sound basis upon which to implement the bill, and I am confident that the legislation will serve well those who have mental disorder.

I support the motion, as amended, to pass the bill.

Photo of Adam Ingram Adam Ingram Scottish National Party 4:10 pm, 20th March 2003

It would be churlish of me not to give the bill in its finalised form a warm welcome, even though I believe that we have missed opportunities to redress the balance of power between service users and care professionals, whose writ has always loomed large in this area.

The Minister for Health and Community Care has given us assurances regarding the use of community-based CTOs and that advance statements will not be casually overridden. I am sure that whoever is responsible for those matters in the second session will be held to account on those pledges.

I am pleased that the bill, when enacted, will represent a break from the traditional approach, which focused on the need to maintain public safety at the expense of individual rights and freedoms—or, more crudely, the lock-them-away mentality. The emphasis in this bill is on providing care and treatment—it is right that that is reflected in its title—while, of course, still ensuring that the safety of the seriously ill patient and the general public is assured. It is important to acknowledge that the bill deals with people who are in extremis and among the most vulnerable and stigmatised in our society. I believe that the bill's provisions are progressive and enlightened and will help to roll back the dark tide of fear, ignorance and prejudice that has engulfed people with mental illness and, of course, their families.

A great deal of credit must be given to the Millan committee, whose careful consideration of the issues and wide consultation, undertaken over a two to three-year period, provided both the intellectual underpinning and much of the detailed work that were required to draft the bill. That is not to say that the first draft of the bill when it reached Parliament did not have major flaws and omissions. I commend warmly the work of the Health and Community Care Committee, as well as the ministers' willingness to compromise, for the restoration of the rest of Millan's recommendations for the most part.

The big concern that remains centres on the principle of reciprocity and the question whether sufficient resources will be allocated to ensure that the bill's provisions will be properly resourced and fully implemented. I find it difficult to believe that the implementation of the bill will not come without enormous pressures on the resources required. Having looked at the evidence that was given to the committees, particularly to the Finance Committee, I realise that I am not alone. The British Medical Association stated in its evidence:

"the costs of the implementation of the Bill to NHS Scotland have been significantly underestimated."

It also said that there are

"significant hidden costs associated with the Bill, principally arising from an increase in workload."

Recurring issues that were highlighted by all those who gave evidence included the costs of more mental health officers, psychiatrists and psychologists, the provision of training and whether sufficient funding will be allocated to local authorities.

Photo of Murray Tosh Murray Tosh Conservative

I will have to hurry you, Mr Ingram.

Photo of Adam Ingram Adam Ingram Scottish National Party

I will just wind up.

At last year's conference in the Hub, which coincided with the launch of the bill to Parliament, a staggering 88 per cent of delegates from across the mental health community expressed the view that we do not have a sufficiently comprehensive range of services to deliver reciprocity. That scepticism must be dispelled and, for that purpose, I commend Malcolm Chisholm for accepting Shona Robison's amendment to his motion. I also press the minister to support the establishment of a mental health task force, along the lines of the task force that we have for cancer care, to drive forward implementation and provision of comprehensive community services.

Photo of Janis Hughes Janis Hughes Labour 4:14 pm, 20th March 2003

I associate myself with the remarks thanking the committee clerks for their sterling efforts on this gargantuan bill. I am sure that they are delighted that they can finally get their lives back, now that the bill is coming to its conclusion.

As Margaret Jamieson mentioned, the number of organisations that contributed along the way is probably unprecedented, certainly when compared with any bill that I have been involved with. Thanks must go to those organisations for the amount of work that they put into providing us with information and for trying, on behalf of the people whom they represent, to shape the future of mental health care in Scotland.

I thank the witnesses who came to the committee, who gave some of the most poignant evidence that I have heard. Their evidence was extremely useful to us in shaping how we saw the bill develop at its later stages. They must be thanked for their efforts and for their courage in appearing at the committee, which must be quite a daunting experience the first time. The bill will make a fundamental difference to the lives of those with mental illness.

I will focus on a couple of issues. The principle of compulsory treatment orders caused considerable consternation, and gave committee members some difficulty. However, there was great consensus in the committee. I supported the principle of the orders, and the committee felt likewise, but we needed a good deal of discussion about, and assistance with coming to terms with, some of the issues involved. We must recognise that for some people, being treated in the home is not always the best solution. A significant number of people view hospital as the appropriate place for treatment, and see the home as a sanctuary. We heard that expressed eloquently at stage 2. We should not underestimate that factor, and I am delighted that we have now amended the bill to take account of it. I appreciate that one size does not fit all; we must judge each case on its merits.

Another issue that I felt strongly about was the need to provide age-specific services; I spoke about that yesterday. We heard at length about some of the consequences of not providing such services. I am delighted that, when it is passed today, the bill will ensure the provision of age-specific services. As we heard from Children in Scotland, one in 10 children under the age of 16 will experience a mental illness severe enough to affect their daily lives. It is vital that we help and support those children and young people through their problems.

Entrapped patients have been mentioned. In the 21st century, the fact that patients are looked after in high-security facilities, when it has been agreed that that level of security is not necessary, is a disgrace. The bill gave us an opportunity to deal with that situation, and I am not saying that it was all plain sailing, but we have now agreed to amend the bill and, in the fullness of time, we will end the plight of entrapped patients.

There is much more in the bill to be celebrated. It creates new flexible and user-centred orders for compulsory care and treatment, as well as establishing mental health tribunals and stronger rights for service users to be involved in decisions about their care. The bill gives us an opportunity to improve the lives of Scots and is the most radical reform of mental health law for 40 years. It was vital that we got it right, and I believe that we have done. I commend the bill to the Parliament.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 4:18 pm, 20th March 2003

In supporting the bill, I add my thanks to a number of people. First, I thank my colleagues on the Health and Community Care Committee. In particular, I thank Shona Robison, who has done a power of work on the bill and has been successful in achieving significant amendments, especially those on appeal against excessive security and on including psychological interventions in the definition of medical treatment. Secondly, I thank all those who gave evidence during the course of the bill. In particular, I thank the service users who spoke frankly to the committee about their experiences. We should be grateful for that. I also thank the clerks, who worked round the clock. We are all indebted to them for their support and advice to committee members.

We all support the intention and principles of the bill, and I for one am happy to see it pass into law. It modernises outdated mental health law and, in many respects, it places the interests of patients at the heart of the new framework. I am particularly pleased about the establishment of the mental health tribunal, which is a far preferable way of dealing with mental health cases than the current sheriff court system. That is one very positive new development, and there is a whole host of others.

Members have expressed concerns about the process of the bill. I do not want to labour what they have said, but I should say that the sheer volume of amendments and the complexity of the bill will mean that careful post-legislative monitoring will be necessary. We have said much about cross-party consensus, but I will bring that to an end by giving a commitment on behalf of the soon-to-be-elected Executive that we will ensure such scrutiny after the election. Mary Scanlon will be glad to know that I have a sense of humour.

As the minister said, the SNP's amendment is similar to an amendment that the SNP lodged at stage 1, which the Executive supported. It reflects the almost—if not completely—unanimous view of those who gave evidence that the provisions of the bill would not be adequately resourced. There is a lingering concern that a shortage of money, facilities and staff in key areas might undermine the operation of the bill. A repeatedly expressed concern about the new community-based CTOs was that they might be misused in some circumstances as a result of pressure on resources. The concern that the amendment expresses has been raised at every stage of the bill, but that makes it even more appropriate for us to raise the concern again at the final stage so that we all agree that adequate resources are essential to ensure that the bill works in the way that it is intended to work.

The final point that I want to make is similar to a point that Shona Robison made. One in four people in Scotland will suffer a mental health problem at some stage in their lives, which probably makes the bill one of the most important bills that the Parliament has considered in its short life. We should all be proud of its passage into law.

Photo of Bill Butler Bill Butler Labour 4:22 pm, 20th March 2003

The bill that we are about to pass is a vital and long-overdue reform of the current legislative framework. Colleagues will know that there has been no reform of Scots law on the compulsory care and treatment of people with mental disorders for more than 50 years.

Members have correctly said that the bill will be one of the most important pieces of legislation that the Parliament has passed in its brief life. It deals with highly complex matters and, given the difficulty of the subject, has raised ethical dilemmas that have not been easy to resolve—Mary Scanlon spoke eloquently about those.

However, the bill that is before us is fit for purpose. It is designed to create new and flexible orders for compulsory care that meet people's needs and it provides a framework of stronger patients' rights for involvement in decision making about their care. When the bill is enacted, it will establish a legislative structure that is essential to make available a service that more effectively meets the needs of mentally disordered offenders, while ensuring community safety.

I want to say a little more about some issues that have exercised members of the Health and Community Care over many months. A majority of witnesses supported mental health tribunals and, like my colleague Nicola Sturgeon, I think that such tribunals will be a welcome innovation. They will help to destigmatise the process and will be less intimidating. As a result of their composition and membership, they will be capable of making informed and sensitive decisions. It is essential that their performance is closely monitored, especially in the light of the less-than-comforting performance of tribunals in England.

I reiterate my support for the provisions relating to patient representation, which I voiced in the stage 1 debate on the bill on 11 December 2002. The provisions clearly signify a real improvement on the current situation. I also warmly applaud the provisions relating to people who are detained in conditions of excessive security. Those provisions are imaginative and enlightened; I believe them to be good and believe that they will do good.

I do not want to fail to record my appreciation for the indefatigability of the committee's clerks, who are ably led by Jennifer Smart. The huge amount of work that those officials have undertaken is worthy of the highest praise. More than 1,000 amendments were processed at stage 2, which is no mean feat. That was vital to the passage of the bill.

I also acknowledge the way in which the ministerial team worked in tandem with the committee to meet the many concerns and complex issues that arose in the course of the committee's deliberations. All committee members appreciated the Executive's positive approach. If Bruce Millan is the father of the Mental Health (Care and Treatment) (Scotland) Bill, then Mary Mulligan, the Deputy Minister for Health and Community Care, is most assuredly its midwife.

The chamber should welcome the bill whole-heartedly and approve it unanimously at decision time. It is the result of much hard work by many people. Their efforts have produced a piece of legislation that will improve the lives of many of our fellow citizens. It is a signal example of the Parliament at its best.

Photo of Richard Simpson Richard Simpson Labour 4:26 pm, 20th March 2003

Before I begin, I must ask whether I need to make a further declaration following the one I made at stage 2.

Photo of Richard Simpson Richard Simpson Labour

Thank you.

Passing this bill will be the end of a long process that has had the unparalleled involvement of civic Scotland. Together with the Adults with Incapacity (Scotland) Act 2000, which was passed early in the parliamentary session, the bill demonstrates clearly the worth of our Parliament. The shift that the bill represents is absolutely massive. At the beginning of my working life, as a student, there was a system of institutionalisation and an authoritarian approach to patient care that contrasts markedly with the values and mores of the bill. I remember that when I was a student in the Murray royal infirmary in Perth in the 1960s, I was immediately handed a large bunch of keys, because all the wards were locked. How far have we moved in that time?

We owe a duty of thanks to the Millan committee for the major piece of work that it undertook. It produced a report of considerable vision that also ensures that the changes are evolutionary and do not destabilise our system.

The absence of the Millan principles from the face of the bill was a lost opportunity to trumpet core beliefs that were and are worth stating as the essentials that underpin the bill and the principles on which interpretation by the courts must be based.

The bill differs in a number of respects from the draft English mental health bill. Its tone reflects partnership and respect for the individual, but it does not forget public protection, which seems to be the paramount element of the draft English legislation.

Of all the principles, for me, reciprocity is perhaps the most important. It will be a lasting testament to the first session of the Parliament. We may have argued over the precise words, but the intention of the whole Parliament—the minister no less than party spokespersons or other members—was clear. If the state has to deprive an individual of their liberty, the duty of care that it owes them is greater than usual—and the care that it provides must be the best. As the minister has acknowledged, the challenge is to drive forward the mental health framework. I acknowledge that substantial progress has already been made in shifting resources to the community.

In particular, I welcome the role that the bill gives to advocacy, which I sought to introduce to the Adults with Incapacity (Scotland) Bill. I welcome the fact that the Executive has introduced it to the Mental Health (Care and Treatment) (Scotland) Bill. We will need to keep a close eye on developments in that area; in particular, we will need to ensure that adequate training is provided.

I thought that the Adults with Incapacity (Scotland) Act 2000 should have made provision for advance statements, but they are recognised in the Mental Health (Care and Treatment) (Scotland) Bill. It is appropriate that we do not give such statements legal force at this time, but I am sure that they will play a major part.

Many members have wrestled with the issue of entrapment, which is the opposite of the principle of the least restrictive approach that underpins the bill. Progress has been made on that issue. The entire Parliament recognises that medium-secure units must be developed as soon as possible.

At each stage of the bill, I said that the jury was out on community orders. I welcome the Executive's undertaking to monitor and research the orders and ask it to go further by asking Professor Jung, the chief scientist, to ensure that there is a full, commissioned, random-controlled trial.

I congratulate the Health and Community Care Committee on the extremely difficult work that it has undertaken. I also congratulate the Executive team and the bill team; I know how much effort the bill team had to put in. Criticisms have been made of the speed of the bill's passage, but I believe that the bill is excellent. Today we will pass a significant bill of which the Parliament can be proud.

Photo of Murray Tosh Murray Tosh Conservative

I inform members that I intend to squeeze the brief debates on the Sewel motions that are to follow on the basis that the motions were originally to be taken without a debate.

Photo of John McAllion John McAllion Labour 4:30 pm, 20th March 2003

I add my thanks and congratulations to anyone who had anything to do with the bill, even the ministers, whom I do not usually congratulate on such occasions. In particular, I mention the clerks to the Health and Community Care Committee, who have performed truly heroically during the passage of the bill. Even to my jaundiced eyes, the civil servants who were on the bill team seemed to be trying to help the committee rather than to hinder it. I also thank the users and voluntary sector organisations who shaped the attitude of committee members and, in so doing, the end-product. Those people deserve to be congratulated tremendously on what they did.

There were problems with the timetabling of the bill. During the 12 years that I spent at Westminster, I always believed that bills were handled badly at the committee stage because progress was far too slow and there was far too much filibustering and time wasting by committee members. There was a struggle between the Government, which wanted to get bills through as quickly as possible, and the Opposition, which wanted to slow them down as much as possible.

That does not happen at Holyrood; instead, bills go through too quickly. The debates on amendments at the committee stage are honest, non-partisan and open, but there is insufficient time for them. I do not think that the reputation of the Parliament will be built on the number of bills that we pass in a four-year period; it will be built on the quality of the bills that we pass. I would rather have 30 good bills than 60 bad ones. All of us must take that lesson to heart.

The bill is a good one and some of its measures are excellent. In particular, I am glad that mental health tribunals will be established to safeguard the new patient rights that will be established in law, particularly the right to individual and collective advocacy, which will make a huge difference to many users of mental health services in this country. I also hope that the tribunals will underpin the Millan principles and bring them into the real world. I am concerned not so much about what is written in the bill as about what happens in the real world, and the tribunals will make a great contribution to that.

I am delighted by the success of Margaret Jamieson's amendment 34, which is a huge step forward and which will ensure that there is a statutory right for children to access age-appropriate mental health services.

At the end of the day, the bill provides a legislative framework and sets out rights, duties and responsibilities, but it will not shape the services that are on the ground. Therefore, I am delighted that the minister has accepted Shona Robison's amendment, which is key. It is important that the resources are made available to ensure that all the ideas that are enshrined in the bill become a reality for the patients who will use the services in the real world. I hope that that happens in future.

We had a hard job passing the bill, but the Parliament and the health committee in the next session will have an even harder job ensuring that the bill works in the real world.

Photo of Alex Johnstone Alex Johnstone Conservative 4:33 pm, 20th March 2003

I hope that I do not seem like an interloper, but one of the main things that I have learned by sitting through the past two days is that I am glad that I did not have to sit through the whole process in the Health and Community Care Committee. The process has been a marathon and I congratulate all those who took part in it.

I speak because I think that we can learn lessons from the bill that will stand us in good stead for the future. As an Opposition business manager, nothing would have given me more pride than to steal a bill from the Executive before the end of the session, so it was disappointing that the Mental Health (Care and Treatment) (Scotland) Bill was the one that came closest to the wire. I highlight the fact that the bill is good and that I look forward to voting for it tonight, but that conclusion is based more on the balance of probability than on my having been persuaded beyond reasonable doubt, due to the many amendments that were lodged late in the process.

Some people might argue for a second chamber, so that we can revise and review as part of the process, but, for more than one reason, I am not one of those people. Our procedures are robust enough to take care of all the requirements, but the one problem is that we have submitted our legislation to procedures at breakneck speed. In the past few days, I have become light-headed at the rate at which we have passed amendments. I congratulate the ministers, particularly Malcolm Chisholm, who was responsible for the group with 112 amendments—he dutifully went through every one and explained them in detail.

Above all, the lesson that the Parliament and the Executive must learn for the future is that when legislation of such complexity is to be taken through, it needs time and must be given the time for proper scrutiny at every stage. If such scrutiny is given, the demands for second chambers and substantial changes to our procedures will fade into insignificance.

Finally, I will say a few words about the SNP amendment. It has been said by Mary Scanlon and others that the amendment simply states the obvious. I do not think that there is any harm in stating the obvious. The trouble with common sense is that it is not so common. In this case, stating the obvious gives final direction to the bill and will give it the opportunity to achieve the successes in Scottish mental health care that it has the potential to deliver.

Photo of Karen Gillon Karen Gillon Labour 4:36 pm, 20th March 2003

I support the bill and the impact that it will have on the state hospital and the patients and staff there, especially in relation to the provision of appropriate treatment. If many of the patients in the state hospital had received appropriate treatment and early intervention, they would not have found themselves in the situation they are in. The moves that are proposed in the bill and the changes that will be made will enable us to prevent patients from reaching the state hospital, and that is a positive thing.

The second issue is entrapment. As the constituency member, I have probably visited the state hospital more often than any other MSP. There are simply too many people inappropriately detained in the state hospital. Their detention is inappropriate for them and for the other patients. The fact that the patients have such a wide range of illnesses means that it is difficult for staff to provide the appropriate treatment and support for patients who require to be in the state hospital and, at the same time, to deal with those who should be placed elsewhere.

If we are to tackle mental illness head on, local provision of appropriate medium-secure facilities is essential. However, we must ensure that our constituents are adequately consulted. As the member for the constituency in which the state hospital is situated, I can tell members that local people will not be falling over themselves to have medium-secure units in their areas. There are many myths and lies out there about mental illness and many reasons why people say that there is a threat to local communities. As MSPs, we have a duty to ensure that those myths are dispelled, and we have a duty to ensure that people who are under our care are placed appropriately. In a modern society, if someone does not require to be in a facility such as the state hospital, they should not be there.

The Parliament has a collective responsibility to ensure that, in future, the facilities are appropriate. Some of us will have to make difficult decisions and statements and will have to say some hard things when such facilities are built, but if we are serious politicians, that is what we will have to do. I urge all members, for the sake of all patients in the state hospital, and for the sake of all of us who have suffered from mental illness in the past or who will suffer in the future, to ensure that the motion as amended is passed and that the resources are made available to support perhaps the most vulnerable members of our society.

Photo of Mary Mulligan Mary Mulligan Labour 4:39 pm, 20th March 2003

This short debate has crystallised what has been apparent throughout the parliamentary proceedings on the bill. There has been a real consensual desire to do what is best for people with mental disorder.

I take the opportunity to join the tributes that have been made to all those who contributed to the development and preparation of the bill. The bill team put an awful amount of work into the bill and had quite a task in supporting me throughout the process. I am grateful to the team for that. I also thank the many voluntary organisations, health care professionals, social work interests and—as Janis Hughes and others said—individuals who have contributed to the process in a personal way.

Finally, I thank the Health and Community Care Committee for its balanced and constructive input. I am glad that it contributed to the debate at stage 2, which meant that I could occasionally take a break from what were fairly long proceedings. I hope that people will reflect on the outcomes of the bill and feel that it has been worth while.

I think that the Parliament does itself an injustice if it lets the large number of amendments that were considered at stages 2 and 3 obscure the reality that many of those were lodged in response to commitments made at earlier stages or simply to improve the drafting and the bill's accessibility, which is important.

I believe that we have a bill that is fit for purpose and that has a flexibility that will enable a ready response to developments in care and treatment. I know that it is perhaps a cliché to say so nowadays, but in this case it bears repeating: the Scottish Parliament made the bill possible. Again, we are out in front of our colleagues in England and Wales, where mental health legislation has still to be introduced. The Mental Health (Care and Treatment) (Scotland) Bill is another success story for devolution and, with the Adults with Incapacity (Scotland) Act 2000, we now have a corpus of mental health legislation that is the equal of, if not better than, anything else in the world.

Members around the chamber raised the question of resources, as does Shona Robison's amendment. The Executive has done what it said it would do at stage 1. We have launched a comprehensive assessment of existing mental health service provision, which will enable us to determine how the current range of facilities, supported by the additional resources that we are making available, will be able to meet the bill's objectives. Once Dr Grant's findings are published, I am sure that further discussions will be had with the Health and Community Care Committee and that further monitoring will take place.

We have also heard concerns about work-force issues. Those are also being addressed, although I do not have time to go into them in detail. However, we recognise the problems and they are being tackled.

As Malcolm Chisholm said, we will now press ahead with the implementation process. I believe that we can take great pride in the bill, but we cannot rest on our laurels, because there is much work to be done. It is remarkable what we have achieved in this session in the mental health field: a major push on mental health promotion, led by the national advisory group, which Malcolm Chisholm leads; a comprehensive initiative to tackle the scourge of suicide; a major anti-stigma campaign in the shape of the "see me" project; and the breathing space telephone support line, which was set up to help those who are feeling down. The bill is a reflection of the Parliament's resolve. Mental health is truly on the map and we are determined to keep it there.