Notes from meeting: 17 January 2006

A meeting of the Mental Health APPG in association with the APPGs on Ageing & Older People, Autism, Carers, Children, Disability, Drugs Misuse, Associate Parliamentary Health Group, Learning Disability, Primary Care & Public Health and Prison Health, to discuss:

THE MENTAL HEALTH BILL

Speakers included:
Lord Carlile of Berriew, Chair, Joint Committee on the Draft Mental Health Bill
Professor Sheila Hollins, President, Royal College of Psychiatrists
Liz Main, Service User representative
Lord Ashley (Chair of the All Party Parliamentary Disability Group) opened the meeting and introduced the speakers.

Lord Carlile, Chair of the Joint Committee on the Draft Mental Health Bill

Lord Carlile expressed his disappointment that the Minister was unable to attend, as he was keen to find out whether the Government intended to proceed with the Bill this session. He was pleased to see so many people in the room and felt this reflected the importance of this legislation to the public. He felt privileged to have chaired the Joint Committee and noted that many Committee members were in attendance at the meeting. He thanked those who had given evidence to the Committee and noted that the report had received unanimous support from the members.

Lord Carlile’s Committee report highlighted that the process of reforming the 1983 Act had already been through many stages since Professor Richardson’s expert committee first reported on the Act and that the Joint Committee had felt on balance that the Government should take the opportunity to reform the Act though with many recommendations for change. The main concern he had was that the Bill should be focused on mental health rather than social control. Many people raised issues around learning disability during the Committee’s work and they concluded that people should not be included in the scope of the Bill due to learning disability alone.

Lord Carlile noted that the people with mental health problems needed a clear expression of their rights in legislation and therefore that principles should be on the face of the Bill as in the Scottish legislation.

Lord Carlile said that he did not expect the Bill to be published this session as time is running out but that when it comes it is likely to be published in the Commons first as it is controversial. His Committee would be very unhappy if the Government published a Bill ignoring the recommendations made in his report.

Liz Main, service user

Liz Main thanked Lord Carlile for his report and for listening to the views of many service users. She felt the Bill was very influenced by the Home Office and overly concerned with locking people up. Ms Main said that she had experienced compulsory treatment but at the time was a danger to herself but to no one else.

Ms Main expressed particular concern about the Government’s proposals to extend compulsory treatment into the community with Non-resident Orders/Community Treatment Orders. She explained that there was no evidence that CTOs work in other countries (such as Australia and Canada) and that the best place for compulsory treatment is hospital. She noted that the restriction of people’s freedoms under the Mental Health Bill was comparable with the recent debate about terrorism laws and she hoped that these parallels would be raised when the Bill reached Parliament. CTOs can only function with the support of the police to enforce them and if people don’t comply they will simply be taken back to hospital. She felt that this process could be very damaging to people’s mental health and spoke of the example of a friend. His door was broken down when he didn’t answer, he was asleep having taken his medication. As a black man he faced stereotyping by the mental health professionals who thought he was dangerous and was treated badly and this made his condition worse.

Ms Main also expressed concern that the new tribunal system, the most important safeguard in the Bill may be watered down because the current system lacks the capacity to take on all the new work.

Professor Sheila Hollins, President of the Royal College of Psychiatrists

Prof. Hollins thanked Lord Carlile for his report which had overlapped with many of the College’s own recommendations. The College has aimed to maintain a constructive position throughout the process of reform but hasn’t been afraid to criticise Government when necessary.

Prof. Hollins expressed concern that the Bill would extend the use of compulsion and the implications this would have on the workforce. She noted that the College is working with the Department of Health to encourage more medical students into psychiatry but need 10% of all medical students to choose the speciality to fulfil the requirements of the new Bill, when the current level is 4%. The provisions of the new Bill may also discourage people from becoming psychiatrists and others may leave the profession if the relationship with patients is damaged through the focus on compulsion.

Prof. Hollins said she was particularly interested in learning disability, which is her field of work, but also her son has a learning disability. She agreed with Lord Carlile that people with learning disability should not be covered by the Act unless they also have a mental disorder. She also raised concerns about the treatability clause being removed from the legislation.

Q&A

Lynne Jones thanked the speakers and began the Q&A by asking how much the Government moved in their response to the Joint Committee’s report. Lord Carlile noted that the Government had not conceded very much but hoped that they would look again at CTOs and tribunals. He also noted that the Government needed to resolve the Bournewood Gap to ensure that people who are currently under “quasi detention” in hospital are given the full rights and safeguards of those who are formally detained.

Lord Rix spoke about learning disability in the Bill and had been dismayed that the Government rejected the Joint Committee’s recommendation that learning disability be excluded from the Bill. He felt that this could lead to enormous difficulties for people with learning disabilities who might be placed in inappropriate care.

Other points raised included stressing the importance of the unity of the mental health field on this campaign, particularly the professionals working with the charities. Also that tribunals need to be better qualified to recognise when people are inappropriately detained.

Baroness Murphy highlighted the unintended consequences of increasing the use of compulsion, particularly the likelihood that more people from BME backgrounds would be detained.

Angela Browning stated that people with Autism Spectrum Disorder should not be included in the Bill unless they have a mental disorder and was concerned that the Government had rejected this. She also noted that evidence from the Royal College of Psychiatrists had shown that up to 5,000 people would have to be detained to prevent one homicide and that this was unacceptable.

Other points raised included that professionals needed to take better care of the physical health of people under compulsion, those who become physically ill or who suffer side effects from the treatments need particular help. Adrian Whyatt said that psychiatrists needed to be better trained to recognise learning disabilities. Another speaker noted that the public needed to be better informed about what was happening to mental health legislation and the impact it could have on their lives. Lord Carlile noted that it is very hard to get the media and public interested in mental health, it is far easier to raise awareness and raise funds for other medical issues.

Further points were raised about the importance of a strong tribunal service and the significance of treatability under the old Act which protected many disabled people from falling under the Act purely because of their disability. Julian Seymour noted that the Government needs to focus on a total care package to help recovery and aid “revolving door” patients.

Philip Dixon-Phillips noted that the Bill would be in place for a generation and so it was vital that Parliament amended the Bill appropriately. Clive Evers raised the Bournewood Gap and the thousands of people under “quasi detention” in care homes.

Paul Farmer, chair of the Mental Health Alliance summed up the debate by highlighting how passionately people feel about the reform of the Act even after seven years of the process. The Alliance has brought many diverse groups together including the BMA, NUS and Local Government Association. Compulsory treatment is very damaging and upsetting to all involved, the service users, families and the professionals and its use needs to be kept to a minimum. He stressed the importance of working together when the Bill reaches Parliament so that members realise that the Bill will affect every constituency in England and Wales and will also have human rights implications.

Lynne Jones then asked the speakers to sum up. Liz Main said that it is important that people feel able to approach professionals when they feel their mental health is suffering but that people will be afraid to engage with services if the Bill is passed as it stands. She also noted the importance of training for the police. She noted that it was important that people recognise that mental illness is a disability.

Prof. Hollins said that there are many good things happening in the mental health service but that this was not linked to the Bill and this had a very negative impact on how people view the legislation. She said that the physical health of people with mental health problems was a priority for her as President. The training for psychiatrists now requires the involvement of patients and carers. Recruiting enough psychiatrists to fulfil the new Act will be difficult and the profession wouldn’t be happy if they were forced to do tribunal work.

Angela Browning MP summed up for Lord Carlile who had to leave early. She said that the Joint Committee had really appreciated the quality of the evidence they had received and that Lord Carlile had been an excellent chair. She hoped that the Government would adopt more of their recommendations and noted that there would be a fight when it reached Parliament.

Lynne Jones thanked the speakers and noted that the Minister would be invited to a future meeting to respond.

Attendees

Lynne Jones MP
Lord Ashley
Lord Carlile
Lord Carter
Lord Rix
David Drew MP
Angela Browning MP
Sandra Gidley MP
Paul Burstow MP
Evan Harris MP
Lord Alderdice
Baroness Murphy
Lord Turnberg
Baroness McIntosh
Baroness Stern
Baroness Eccles
Liz Blackman MP
Maria Miller MP
Des Turner MP
Janet Dean MP
Tim Boswell MP
Baroness Howarth
John Hayes MP
Baroness Massey
Tim Loughton MP
Lord Northbourne
Baroness Greengross
Madeleine Moon MP
Patrick Hall MP
Lord Jones of Cheltenham

Observers:
Barbara Herne, Lisa Payne, Zoe Renton – NCB
Alison Linsey - Group secretariat, APPG Children
Dr Ian Hall – Royal College of Psychiatrists
Dr Roger Freeman – Royal College of Psychiatrists
Dr Ian Harwood – Barts and London Medical School
Helen Kirrane – Office of Paul Burstow MP
Mary Walsh – HSBC
Tim Giles – WCI
Agnes Wheatcroft – Group secretariat, Mental Health APPG
Bethan Collins - Group secretariat, Disability APPG
Robert Yuille, NAS
Fiona Burt – Carers Surrey/UKABIF
Paul Farmer, Jane Harris – Rethink/Mental Health Alliance
Neera Sharma – Barnardo’s
Martin Wakeling – Headway
Simone Aspis – British Council of Disabled People
Adrian Whyatt – DANDA
Amanda Allard – NCH
Patricia Still – PPIF
Dr Geraldine Holt – Guy’s Hospital
Joan Penrose – carer
Helena Ware – NAGALRO
Philip Dixon-Phillips – UK Federation of Smaller Mental Health Charities
Farham Hanoui – Bruised
Fiona McKinstrie – YoungMinds
Clive Evers – Alzheimer’s Society
Jim Dawton – Pearson Matthews
Kim Woodbridge, Chiara Samele - SCMH
Tony Solomons, Janet Solomons – Voice UK
Cedric Federick – PentaHact
Annette Lawson – Judith Trust
Ali Smith – APPG Autism Advisory Group
Rebecca Seden – Respond, Ann Craft Trust, Voice UK
Iris Steen – National Treatment Agency for Substance Misuse
Len Holland – Valuing People Support Team
Caroline Hawkings – Turning Point
David Stone, Aileen – Mind
David Tombs – Service User
Jean Collins – Values into Action
Janet Whybrow – Department of Health
Joanna Morrison, Adam Healthfeld – Pfizer
Sian Davies, Veronica King – National Union of Students
Ros Meek – Wyeth
Martin Ball – Together
John Metcalfe – BASW
Stephen Springer – John Grooms/Radar
Christine Daly – Children’s Legal Centre
Sue Silk – Janssen-Cilag
Mark Pearson – Association of Family Therapy
Neil Balmer – Lib Dem Whips Office, House of Lords
Jonathan Coe - Witness
P Hall, Peter Staff, Neil Mainprize – APHG
Lucy Cork, Group secretariat, APHG
Robert Okunnu – BMA
Anjuli Veall – Parkinson’s Disease Society
Kate Archer – Butler Kelly/Prison Health interest
Hannah Pearce – Age Concern, Group secretariat, APPG Older People
Jenny Cook, Henry French, Nicolay Sorensen - Adfam