Mental Health Act 1983 — [Ms Karen Buck in the Chair]

Part of the debate – in Westminster Hall at 2:33 pm on 25th July 2019.

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Photo of Kevan Jones Kevan Jones Labour, North Durham 2:33 pm, 25th July 2019

It is a pleasure to serve under your chairmanship, Ms Buck. I put on record my thanks to my hon. Friend Neil Coyle not only for securing the debate but for the way in which he introduced it. I agree with Johnny Mercer that someone speaking so powerfully brings to life what might be dry words on paper in an Act. To hear the experience that my hon. Friend and his family have been through highlights why it is important that we get things right.

My hon. Friend described how the Mental Health Act 1983 gives the state draconian powers to detain individuals and take away their liberty, not because they have done anything wrong but because they are mentally ill. As he said, 50,000 of our fellow citizens go through that process every year. There is something wrong if we are using the Act 50,000 times a year. I am sorry, but I just do not accept that in 2019 that is the only way we can deal with someone in mental health crisis who, rather than being a danger to anybody else, is possibly more of a danger to themselves.

Like others, I accept and welcome Professor Simon Wessely’s report. As my hon. Friend said, some of us remember the 1983 general election. It was a long time ago, but there are some similarities, as he said, with the current political world. Importantly, things have changed, including our attitudes on a whole range of things. The key issue that comes out of Sir Simon Wessely’s report is the need to put the individual at the centre of everything. The hon. Member for Plymouth, Moor View gave a very good example of how, when we get it wrong and do not put the individual at the centre, things are bad for that individual. Clearly, his constituent was treated inhumanely. We must put people at the centre. That is difficult, as people who are in mental health crisis can have great difficulty in making decisions, but that does not mean that they have lost capacity in all circumstances. That is one of the things that Sir Simon raised in the report.

The use of the Act should be a last resort, not the first course of action in dealing with people who are in mental health crisis. As the report says, we also need to involve the individual in decision making. That can be difficult; I accept that people can refuse treatment. However, if it is properly explained and people are involved in the decision, there are better outcomes for them individually and in-patient time will be reduced.

I have spoken before about advocacy. Owing to the draconian powers that the Act bestows on the state, it is important that the individual has access to independent advocacy. I welcome the recommendation for people to have to opt out of having an advocate. That puts the onus on the state to have independent advocates trained and available, and to ensure that people know how to access them.

My hon. Friend the Member for Bermondsey and Old Southwark also raised the issue of family members, which can be very difficult. The report’s suggestion to move towards having a nominated person is the way forward. In the past, assumptions have been made that an individual wants certain relatives involved; on a number of occasions they do not want that, and it may not be in their best interests. The right hon. Member for New Forest East (Dr Lewis) made the point that we need to try to involve family members where we can, because they are an important part of supporting the individual and ensuring that they get the help they require.

I am concerned about a lot of issues related to the Act, including the need for a timetable for implementing the recommendations. A White Paper has been promised. I do not criticise the Minister because, as I have said before, since she has been in post she has been a strong advocate for mental health issues. However, this matter has to be a priority. I know we can get blindsided by big issues regarding Brexit, but the implementation of these changes is important and should be a top priority.

The report states that we need to investigate why the Mental Health Act is used more against members of black, Asian and minority ethnic communities than others. I accept that there may be a stigma attached to mental health issues in certain BAME communities and that it might give rise to particular questions, but that topic needs an inquiry all of its own. Unless we get answers to why the Act is being used more in those communities, we will not be able to make the necessary changes.

Why is the Act being used more? Perhaps there is a simple answer. Ever since we closed the asylums in the early 1980s, we have put neither the investment nor the policy in place to support people with long-term enduring mental health conditions in the community. That is about money to pay for the support that individuals need, but it is also—my hon. Friend Kerry McCarthy raised this point—about pathways, how people get into the system, and the disconnect between the various agencies with which people come into contact.

The all-party parliamentary group on social work has just conducted an inquiry on that subject. I am not going to steal the thunder of my hon. Friend Alex Cunningham, who chaired the inquiry. It was very informative, and I was privileged to be involved in it. The disconnection and lack of integration between local councils and the health service is clearly an issue, and it is not necessarily just down to money; it is also to attitudes. The system needs to be put back together. It is no good telling somebody who is in a mental health crisis, “I’m sorry, but you are not my responsibility; that is a local authority issue,” if they present to the NHS or vice versa. That needs to be put right.

In County Durham we have a very good integrated system of local government and NHS care, which works very well. If we are to put that wraparound care around individuals such as the mother of my hon. Friend the Member for Bermondsey and Old Southwark, it must be integrated; it must be joined up. It cannot be fragmented.

Is the problem all about the availability of beds? I would say no, it is not. The right hon. Member for New Forest East is right that we have cut beds back too quickly, thinking that we do not need them and that we can manage people in the community when we cannot. The argument that follows is, “The answer to this is more beds.” Well, I am sorry, I do not think it is, personally. What I want is a good community-based model to support people in the community. That is going to take money. It needs a clear, worked-through policy. It has to include local authorities and it has to include housing. One of the biggest issues that people leaving in-patient beds face is the question of where they will live, and it is not surprising that many of them end up on the streets in our communities. We need a joined-up approach.

As I said earlier this week in another debate on mental health, we must have a joined-up local system that includes not just the agencies I have mentioned, but the community and voluntary sector. If we are going to support people in the community, in my experience it is often best done by voluntary and community sector organisations. As my hon. Friend the Member for Bermondsey and Old Southwark said at the beginning of the debate, many of those organisations are under pressure because grants are being cut. We need a joined-up approach.

While I am on my hobby horse about the voluntary and community sector, can such organisations bid for contracts from clinical commissioning groups and local authorities? In many cases they cannot, because they are not big enough. The contracts are drawn up in such a way that they are not available to those organisations. In terms of value for money and local input, that would be very important.

We must also support and develop staff in the sector. During the inquiry, we met some amazing, inspiring young people who were entering social work and majoring in support for people with mental health issues. In Durham a few weeks ago, I had the privilege of meeting some of the young people who were taking part in the Think Ahead programme—I think it was started by one of the Minister’s predecessors—which aims to get social workers trained in mental health work. Most of those I met said it was a very rewarding field to get into, when it was properly supported.

What about other Government policies? We need joined-up policy at the local level to support individuals, but we also need to make sure that mental health is hardwired into Government policy. I have said that on a number of occasions, and I will do so again. For example, if someone in the community has a long-term mental health condition, fails her personal independence payment assessment and is sectioned—I handled a similar situation a few weeks ago—what does that cost the taxpayer? It is no good for the individual and it is no good for the taxpayer. Under mandatory reconsideration, the PIP was reinstated. We have to make sure that consideration of mental health issues is built into policy and that the policies of other Government Departments are not creating problems for individuals.

Finally, as we know, many individuals in prison have mental health problems. The current system for transferring individuals from prison to mental health facilities is not working. That is another issue that I have raised previously. Those on indeterminate or fixed sentences who come up for assessment by the Parole Board face a double jeopardy situation. They have to have a mental health assessment by both a mental health tribunal and a Parole Board. That cannot be right. It leads to, on average, an extra 18 months in prison, where proper treatment and proper planning is difficult. It does not help them or the system, and it costs more to keep them in prison. We need a system where one single assessment would be enough to make sure that those people get the support they require.

This is about money and it is about reforming the existing system, but we must also ensure that both national and local policies enable a joined-up, wraparound service. With the right investment and the right political will, we can get there. We are not going to go back to putting people in institutions or asylums; people should be able to live a happy, contented and safe life in the community, with the wraparound care that they deserve. That is what we should be providing, as a decent society.