MENTAL HEALTH (AMENDMENT) BILL

HC Deb 02 February 1979 vol 961 cc1846-96

Order for Second Reading read.

11.28 a.m.

Mr. Geoffrey Pattie (Chertsey and Walton)

I beg to move, That the Bill be now read a Second time.

This is the first occasion which the House has had to debate any aspect of mental health since the publication last September of the Government's long-awaited review of the Mental Health Act 1959. I wish to remind the House that an early-day motion tabled by the hon. Member for Basildon (Mr. Moonman) and supported by myself and over 70 hon. Members on both sides of the House stands on the Order Paper in the following terms: That this House, recognising the difficulties at present faced within the mental health services, urges the Leader of the House to provide an early opportunity to debate the recent White Paper on Mental Health, as this would provide an opportunity to make the first significant changes since the original Act of 1959. That motion remains the aim of all those in the House who take an interest in mental health and mental handicap. It is essential that time is found for a full debate on the White Paper as soon as possible, and in no way is this Second Reading debate to be seen as a substitute for a White Paper debate. I confess that some anxiety has been expressed in certain professional circles that a debate even on such a modest measure as that before the House today might deflect attention from the major national debate on the White Paper. I regard our debate today as a bonus, or even an hors d'oeuvre, an extra opportunity to focus attention on a subject which has not had a large share of parliamentary time.

I should make it clear that I am not attempting single-handed to amend the entire 1959 Act. The four proposals which comprise my Bill are each drawn from recommendations in the White Paper, and each in turn was included in the earlier consultative document. All seem to have widespread support.

The Bill represents an attempt to enact four small proposals which can be got out of the way before the White Paper debate and any ensuing legislation. In view of the current parliamentary uncertainties, it is anyone's guess when such major legislation will be forthcoming.

Let me at this stage express my appreciation for the assistance and advice I have received in the preparation of the Bill from various quarters. I refer particularly to the Minister of State, Department of Health and Social Security and his Department, and the sponsors of the Bill from both sides of the House. I am also extremely gratified to have the support in the House today of my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith), who, as Minister of Health at the time, was the prime architect of the 1959 Act.

I think my right hon. and learned Friend knows that there is no implication in anything that I say today of fundamental criticism of that Act, but rather a desire to clarify and improve certain sections in the light of 10 years' experience of its working. The Act has worked remarkably well and if in the future I should be regarded as the handmaiden of a measure which stood the acid test of time as well as the 1959 Act has done, I should be well pleased.

Let me now describe the four proposals in the Bill. The first clause seeks to reduce by half the period of detention or guardianship under sections 26 and 60 of the 1959 Act. Clause 2 seeks to amend section 65 to make clear that the essential purpose of the restriction orders is to protect the public from serious harm. Clause 3 provides that where the restrictions are placed on a prisoner transferred to hospital on grounds of mental disorder, those restrictions should cease on what would have been the patient's earliest date of release had he remained in prison. The final proposal, in clause 4, repeals section 134, thereby removing control over the mail of mentally disordered patients who are not subject to detention.

Perhaps I may deal in detail with each of the proposals. The first concerns admissions to hospital under sections 26 and 60. The present position is that such admissions last for one year in the first instance, with the first renewal being for a further year, the second renewal being for two years, and, thereafter, renewals taking place at two-yearly periods.

The consultative document reports that both the Royal College of Psychiatrists and MIND wish these periods of detention to be shortened, the Royal College saying that the two-year period is too long, tends to be at variance with the liberty of the subject and is out of line with current advances in therapy. The consultative document therefore suggested in chapter 3, paragraph 8 that the present period could be halved to six months on admission, followed by six months on first renewal, followed by one year. This suggestion became a firm proposal in the White Paper in chapter 2, paragraph 47 and has now been translated into clause 1 of the Bill.

Perhaps it might be of assistance to those hon. Members who are not closely familiar with the 1959 Act if I explain that although the admissions of which I have been speaking are carried out under sections 26 and 60, it is section 43 which specifies the actual period of detention, hence the necessity in clause 1 to amend section 43 if the periods of detention are to be halved. The House will appreciate that if this proposal is sustained the detention is not automatically terminated on elapse of the shorter period of time. Rather, the patient has twice the frequency of application to a mental health review tribunal.

Both the consultative document and the White Paper dealt with the question of the number of medical practitioners needed to prolong detention in that, whereas an application for admission has to be based on two independent medical recommendations, only one report from the responsible medical officer is needed to prolong detention.

It was felt, however, that after the patient's detention for a period in a hospital the family general practitioner would necessarily be out of touch with the patient and might also feel somewhat diffident about commenting on the consultant psychiatrist's opinion. The consultative document drew attention to the need to improve health authority monitoring arrangements in an endeavour to avoid renewals being made mechanically. The White Paper proposes a slight stiffening in the requirements for renewals. Chapter 2, paragraph 46 says: Improved monitoring together with a requirement of a likelihood of benefit from treatment and automatic referals to tribunals should, the Government considers, provide sufficient extra safeguards. I am sure that it would be in order to mention here the importance of adequate safeguards for staff, together with a necessity to clarify the legal position where staff are confronted with a violent informal patient. In the event of my Bill receiving a Second Reading, I hope to consult both the relevant unions—the National Union of Public Employees and the Confederation of Health Service Employees. I have already invited them to participate and to supplement the advice I have so far received from the Royal College of Psychiatrists, MIND and the National Council of Community Health Councils.

It is stated in the financial memorandum to the Bill that the reduction in periods of detention is likely as a consequence to increase the number of cases heard by Mental Health Review Tribunals But the consultative document points out in chapter 8, paragraph 10 that too many tribunal members were appointed to begin with because of an overestimate of the number of cases expected. In the early years many of these tribunal members had very little to do, and even allowing for natural wastage over the years it is still reckoned that "perhaps a doubling" in the present work load could be undertaken. Throughout the country there are currently fewer than 1,000 cases a year.

Clause 1 (3) makes it clear that the new reduced periods apply only to existing patients on the first occasion on which authority for detention of guardianship expires or is reviewed. A patient undergoing his first renewal period is not disadvantaged. The worst off will be the patient who has just commenced a two-year renewal. I would be prepared to suggest in Committee an amendment to ameliorate the position of such patients, possibly by providing the review at the end of the first year. A patient already into the second year would continue unaffected.

The second proposal is to amend the wording of section 65 of the 1959 Act. After the words for the protection of the public shall be added "from serious harm." When the Royal Commission on mental illness and mental deficiency, otherwise known as the Percy committee, reported in 1957, it recommended in paragraph 519: The fact that some patients are dangerous does not justify the application to all patients of the sort of compulsory powers and procedures which are necessary for these few patients. It would seem from that and other comments in surrounding paragraphs that the Royal Commission envisaged a much narrower discretion being allowed to the courts than the wording of section 65 eventually provided.

That section reads: Where a hospital order is made in respect of an offender by a court of assize or quarter sessions, and it appears to the court, having regard to the nature of the offence, the antecedents of the offender and the risk of his committing further offences if set at large, that it is necessary for the protection of the public so to do, the court may … further order that the offender shall be subject to the special restrictions set out in this section. The Butler committee in its report of October 1975 criticised the tendency it had discovered from evidence given by the Home Office that these orders are imposed in numbers of cases where their severity is not appropriate. It went on to say: There is no indication of the seriousness of the offences from which the public is intended to be protected by the restriction order provisions and some courts have evidently imposed restrictions on, for example, the petty recidivist because of the virtual certainty that he will persist in similar offences in the future. Butler, in chapter 14, paragraph 24, refers again to the wording of the Royal Commission. The wording is: a real danger to the commission of further serious offences. Larry Gostin in his excellent two-volume work for MIND entitled "A Human Condition", cites in volume II, page 75: Dr. Henry Rollin reviewed 127 abnormal offenders admitted to Horton hospital in 1961 and 1962, (16 per cent. of these were subject to restriction orders). In the following cases, it was difficult to see the need for a hospital order; one person was charged with stealing a box of tomatoes from Covent Garden Market and another with the theft of a bottle of milk; another was charged with fraud involving a sum of £70. There were 51 offences against the public order mainly for 'being a suspected person', 'wandering abroad' or 'begging'. There were five sexual offences all involving indecent exposure. There are many cases of so-called ordinary offenders receiving non-custodial sentences from the courts but restricted patients can spend many years in hospital after conviction for the same type of offence.

The Butler Committee found that in 1974 the average period of detention under a section 65 order was four and a half years, and detention could last for life.

I emphasise that although the proposals in this Bill are designed to assist patients, it is essential to bear in mind the rights of staff and the protection of the public. I have already indicated my wish to consult closely with the unions and the Royal College of Psychiatrists, but we must also have in mind the legitimate right of the public to protection.

As I am proposing in clause 2 the inclusion of the words in section 65 of the Act "from serious harm", it might assist the House if I outline what I have in mind by that wording.

Butler, in chapter 14, paragraph 24, makes it clear by exception that serious offences are homicide, attempted homicide, sexual offences, other offences against the person, and criminal damage.

Although the courts are now less eager to use section 65, Butler felt that the wording of section 65(1) should be more tightly drawn to indicate its true intention, namely to protect the public from serious harm. A more restrictive wording of the section would help the courts in making the difficult decision whether it is appropriate to impose this severe form of control. I have in mind that where there is a risk of violent behaviour or serious indecent assault—especially where children are concerned—or arson, the courts will continue to have discretion to consider imposing a section 65 order. I also have in mind the possibility of psychological injury as well as direct physical injury to the person.

The White Paper's proposal, which is now embodied in clause 2 of my Bill, can be found in chapter 5, paragraph 15.

The third proposal in the Bill involves the amendment of section 75(3) of the Act, which refers to the transfer of prisoners to hospital. As the law stands at present, a patient who is subject to a transfer direction under section 72, accompanied by a direction restricting discharge under section 74, remains subject to the restrictions until the expiration of his sentence. This is defined by the expiration of the period during which he would have been liable to have been detained in prison if the transfer direction had not been given. As there is no legal right to remission of sentence, any references to the period of detention must refer to the full sentence as passed by the court.

The White Paper explains, in chapter 5, paragraph 47, that the MIND proposal has its support. This proposal is that the restriction direction should cease to have effect on the date on which the patient could have been discharged from prison on remission of part of his sentence under the prison rules—that is, the earliest date of release. This proposal in clause 3 of my Bill means that a prisoner will henceforth be detained under civil powers only once he reaches his EDR.

Clause 4 provides for the repeal of section 134 of the Act and takes away any control over incoming and outgoing mail of informal mental patients. The argument for this proposal is well set out in chapter 8 of the White Paper. I quote from paragraph 5: The question of security does not arise in relation to informal patients; and any justification for distinguishing between such patients and non-psychiatric patients (whose mail is not … subject to any restrictions) as regards withholding incoming correspondence, the possibility that they might receive letters which distress them or have a disruptive effect on their treatment. In practice, however, the pattern of modern communications—in, for instance, use of the telephone—is now such that withholding correspondence would be sealing oft only one form of communication and is unlikely to be effective in isolating informal patients from distressing or disruptive information. It is questionable, also, whether it is helpful to protect such patients, most of whom nowadays only stay in hospital for a few weeks or even days, from distressing news or conflicting viewpoints which they are in any event likely to encounter on discharge. Hospital practice, also, has changed significantly. Shorter and repeated admissions, the marked increase in out-patient and day-patient treatment and the sharing of day hospital services by in-patients and day-patients have blurred the distinction between in-patients and other patients. Increasingly, patients are being treated in psychiatric units of general hospitals, and freedom of movement of patients in these units, and in traditional psychiatric hospitals is now widespread. These factors make it difficult to exercise effective control over patients' correspondence. Out-going letters from patients which might cause distress to recipients would seem to provide the main argument for considering a form of control. Psychiatric patients are of course not the only people who might send such letters, and there is no sound evidence that they display a propensity towards this. Indeed some patients, for example the mentally handicapped, may be considerably less capable of composing distressing or abusive correspondence than others. Concern on these grounds in relation to a small minority of patients does not seem sufficient to counter the arguments against depriving the vast majority of patients of a right to unhindered correspondence, nor to justify setting up elaborate machinery to overcome the practical difficulties of exercising effective control over the correspondence of informal patients. I am bound to say that consultations that I have had with psychiatric social workers have borne out that they have no problems with this proposal.

I have brought this Bill to the House as part of a wider campaign to focus more attention in the growing numbers of the mentally ill and their problems. In a Health Service that is beset with problems and underfunding, the needs of the mentally ill and the mentally handicapped are always at the end of the queue. It is our responsibility, as Members of this House, to show our compassion, our understanding and our awareness of this group of our fellow-citizens who do not happen to be one of the big voting battalions in our society. I am confident that the House will grant them the modest measure of assistance which I claim is to be found for them in this Bill.

11.38 a.m.

Mr. Eric Moonman (Basildon)

I warmly support the way in which this Bill was presented by the hon. Member for Chertsey and Walton (Mr. Pattie). The hon. Gentleman is attempting to explore the weaknesses of the previous Act and is also trying, in a most creative way, to put right immediately some practical issues in the mental health service.

It may seem to many in the psychiatric hospitals service that the House of Commons has taken leave of its senses in debating the future of the service and of the law when more immediate needs concerning treatment and care have become part of the industrial relations battle between the various groups.

Nevertheless, the hon. Gentleman is right to remind the House that whatever the present predicament in the psychiatric services, and whatever the tragic inconvenience being felt by patients and nursing staff today, it has to look beyond that situation, which we hope is temporary, to see how far the fundamental questions that he has raised with regard to the original Act and with regard to ways of improving the liberty of psychiatric patients can be taken up. Therefore, it is bold, not foolish, to do so. It is forward-looking and has the support of the all-party committee on mental health.

Not a week goes by but that we receive a telephone call, a letter or representations from social workers who bring to bear on us the importance of making the adjustments to the Act that we heard described. The cases range from the smaller items—the difficult, irritating cases to which the hon. Gentleman referred—to the questions of individual liberty, which were expressed by the hon. Member for the Isle of Wight (Mr. Ross) on behalf of his constituent, Diana Irons.

I do not wish to generalise on that case during the discussion on this Bill. However, the collage of tragic events associated with that girl and the fact that she is now in a state of turmoil in Broadmoor pinpoint the efforts made by the hon. Gentleman to stress the significance of liberty and correct justice for the psychiatric patient. Apart from what might happen in the way of a new Act of Parliament on mental health, if some of these clauses and the thinking behind them had been in operation, I guess that Diana Irons would not be in Broadmoor today. It is right to pay a tribute to the work of the hon. Gentleman.

Clause 1 seeks to halve the period of detention under sections 26 and 60 from one year to six months. It has been argued that it provides greater flexibility. However, it does something else. I am impressed with the argument that it would require greater monitoring by the area health authorities. No one who studies the psychiatric service can be satisfied that monitoring—the ongoing appraisal of the service—is being carried out either competently or at all. Whether the area health authority or the general practitioner at a casebook level is involved, this is implied in this clause, which is well worthy of being introduced.

It was intended in the 1959 Act that the general practitioner would play a much greater role in the development of the after-care of the psychiatric patient on discharge from hospital. I recall a former Member of Parliament, a great battler for the psychiatric patient—the late Bessie Braddock—saying, after the Royal Commission and the Act, "We shall depend fundamentally on what the general practitioner does, not necessarily in his surgery, and on whether he is prepared to go into the patient's home on release from hospital."

I see little evidence that the general practitioner has given this matter priority. That is a generalisation. From all the evidence I have—and indeed through the all-party committee—we see good will from some GPs and from others a desire to learn more about how to cope with the psychiatric patient. However, in the main, this degree of monitoring has not taken place. This clause would enable monitoring to be carried out on those two levels. I hope that the clause and the sentiments of the hon. Gentleman will be taken up in a realistic way.

Clause 2 is a reflection of the White Paper. It embodies the intentions of it. It also sharpens up the references.

Clause 3 is intended to amend the law on restrictions on the discharge of prisoners and patients who are removed to hospitals. This means that we enter the area of civil powers. This always required improvement. Indeed, it was the basis of a number of cases recently before the committee.

The final clause, which sounds straight-forward and full of common sense, deals with the cause of a great deal of annoyance to patients and families. This method of communication has been overcome as a result of circumstances and other events. The question of providing protection to the family rests on a false assumption about the basis of the psychiatric service. If the family needs protection, it may well be that a wider understanding or case conference should take place with the family if the family is so vulnerable that it must not be threatened by, for instance, mail. If there is an exchange of mail, this will be beneficial to the development and encouragement of the patient. Too often only one part of the problem is dealt with, namely, that of the patient who enters hospital, leaving the underlying difficulties in the home. If anyone imagines that the two parts of the problem could be isolated by preventing the mail or making it that much more difficult for the mail to get through, that shows a lack of understanding of what is likely to happen.

We are dealing with the question of putting something right that perhaps was not fully understood when the previous measure was passed. That is no criticism of those who produced the Act. It is a reflection of change, social desires and the understanding of what we have experienced in Parliament, the social work agencies, the hospitals and the psychiatric profession.

We must recognise that part of the case for the Bill is that we are much more aware of the problems. That is the reason for the Bill. Therefore, I am pleased to be a sponsor. We are much more aware of the power and force of the case for the Bill.

The hon. Gentleman said that there were no votes for the psychiatric. I do not accept that. To put it crudely, when we think of the sheer numbers of people involved we realise that there are certainly voices there. People are desperately anxious about what happens to family and friends when they go into psychiatric hospitals for treatment. This is no longer a minor matter. Each year in England 24 million working days are lost by people suffering from mental ill health. Five million people consult their GPs about mental health problems and are referred to specialist psychiatric services in England each year. In England and Wales 88,000 hospital beds are devoted to the care of mentally ill patients and 51,000 beds to cases of mental handicap.

That sounds to me as though we are putting forward a Bill which has wide ramifications in a large part of society. One woman in six and one man in nine are treated for psychiatric disorders at some stage in their lives. The hon. Gentleman, in his modest way, perhaps did not give sufficient impact to that number and the great scale of the operation. According to a recent conservative estimate, one-fifth of those seen by GPs in practice suffer predominantly from psychiatric disorders.

I stress the importance of clause I to the role of the GP. I do not believe that it is enough for the GP merely to provide a prescription. There must be a greater and closer relationship with the other people who provide help in the community.

The need for the Bill becomes greater when we realise that in the 1970s the staff of mental hospitals have increasingly refused to accept difficult patients whom the courts wanted to send to them. I refer to the seriously disturbed patients who, three decades ago, would have been given asylum in our mental hospitals. Today they are denied it, not because they are dangerous but because they are difficult, unco-operative, uncontrolled or unsocial, drink, take drugs, upset other patients, or break the rules of the institution.

In a hospital with open doors those patients are more awkward to handle, and as hospital staff increasingly turn them away the hospital skill at handling such disturbed patients is disappearing. Some people had optimistically hoped that the special secure units which the 14 health regions were instructed to set up would solve the problem. That is another story: there have been real difficulties in getting that system into operation.

Finally, the Bill does not lessen the importance of having a new mental health Bill. This will come. The present Bill is an attempt to improve on what has already been done.

Reflecting on the provisions of the Bill and on what yet needs to be done to help to safeguard the interests of the mentally sick and the mentally handicapped in our society, I believe that we have started to bring to the attention of the House and the public the fact that, by showing that these modifications are so urgently needed, we have done no more than make it clear that the day cannot be long off when a full-scale Bill will come before the House to ensure that so many of the things that we have learned and need to improve upon from the original Act will at last be achieved. I warmly support the Bill.

12.1 p.m.

Sir Derek Walker-Smith (Hertfordshire, East)

It is 20 years, almost to the day, since I moved the Second Reading of what is now the Mental Health Act. I should like to start by expressing my warm appreciation for the kind and characteristically generous references of my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) to that Act and to the part that I was privileged to play in placing it upon the statute book.

I should like also to express my pleasure at the fact that the Minister of State, the right hon. Member for Lewisham, East (Mr. Moyle), is on the Front Bench to reply to this debate—more particularly because his father, Arthur Moyle, who was so dear and respected a friend of mine, played a notable part from the Opposition Benches in the proceedings on the then Bill.

The Mental Health Act 1959 is a truly massive Act, comprising 154 sections and 8 schedules. It repealed 15 Acts in whole and 37 in part. It substituted for the intricate and idiosyncratic mosaic of the old law a new and comprehensive code, simpler to understand and apply and in line with contemporary thinking and social and medical advance.

On Third Reading of that Bill, the late Mr. Sorensen, a very good and respected Member of those days, said: … for all time … the Bill will no doubt he known as the Walker-Smith Bill."—[Official Report, 6 May 1959; Vol. 605, c. 464.] He was a false prophet: it is not so known. The haibt of calling Acts after the names of the Ministers who sponsor them has fallen into desuetude. I think that the last was probably the Butler Act—the Education Act of 1944—but even that is rarely referred to today in that way.

Nevertheless, I take a not wholly inappropriate pride not in any modest contribution that I was privileged to make but in the Act itself, product as it was of the collective widsom and experience of many. I am proud that it has been thought to require so little amendment over the two decades of its operation and that such amendment as it has received so far is mainly of a procedural or consequential nature.

But nothing is perfect, of course, and that does not mean that the Act does not require and should not receive, like all other legislation, continuous surveillance with a view to achieving improvement in its content and operation. It is of course receiving such scrutiny, the latest manifestation being the White Paper to which reference has been made.

It is very much to the credit of my hon. Friend the Member for Chertsey and Walton that he has given to the Act and its workings such careful and conscientious scrutiny; that he has used his good fortune in the ballot to seek an improvement of the Act; that he has identified respects in which further advance in the liberalisation of the law can be made without jeopardy to the public interest; and, of course, that he has given so lucid and persuasive an exposition of his Bill. I hope that the Bill speedily becomes law and that, contrary to the trend to which I have just referred, it becomes known as the Pattie Act.

A satisfactory structure of mental health law, of its nature, must contain checks and balances. In particular, there are three main considerations which can sometimes be in conflict—the therapy of the patient, the liberty of the subject and the protection of the community. All three of those basic considerations and the necessity to reconcile them apply in those sections of the Mental Health Act which the Bill seeks to amend and improve.

I refer in particular to section 43, which clause 1 seeks to amend and which is concerned with the duration of authority for detention or guardianship and the discharge of patients. The philosophy underlying the 1959 Act was that as much treatment as possible should be given on an informal and voluntary basis and that there should be provision for that unfortunately inevitable residual category of cases where compulsion is necessary in the interests either of society as a whole or of the patients themselves.

Section 43 reflects that philosophy in its approach to the question of detention. It marked two significant advances on the old law. First, it introduced improved renewal procedures for compulsorily detained patients, that is to say, a review at the end of the first, second and fourth years and thereafter at two-yearly intervals if the detention should be required that long. Those shorter periods were substituted for the previous periods of review at the end of the first, second and seventh years and thereafter at five-yearly intervals, with an additional review for the mentally ill, as distinct from the mentally handicapped, at the end of the fourth year.

Secondly, whereas this renewal procedure was an important improvement by way of degree, the second advance constituted a difference in kind. That was the introduction of an appeal to a mental health tribunal. The setting up of those tribunals and the conferring on the patient of the right of appeal to them was an innovation of the 1959 Act. It was a new concept of considerable value which time and experience have justified—the appeal to a mixed tribunal comprising medical men, lawyers and laymen, presided over by a lawyer and constituted on a regional basis.

The Bill is concerned to improve these procedures by further reducing the periods of review to six months and one year in place of the one-year and two-year periods in the Act, and leaving intact, of course, the right of appeal to the tribunal. Experience to date justifies this further advance and it is certainly to be welcomed.

I need not refer in specific detail to the other proposals described by my hon. Friend and by the hon. Member for Billericay (Mr. Moonman), who takes such a close and constructive part in mental health matters. Sections 65 and 75, the subject matter respectively of clauses 2 and 3, are basically Home Office concerns more than those of the Department of Health and Social Security.

I conclude by expressing the appreciation which I am sure we all feel to my hon. Friend for his constructive initiative in this context, and join him in the hope that the White Paper will be debated so that the whole subject of mental health may be reviewed and the whole working of the Act considered, with a view to its further improvement where necessary. Meanwhile, I invite the House to accord a warm welcome to the Bill.

12.10 p.m.

Mr. Christopher Price (Lewisham, West)

I congratulate the hon. Member for Chertsey and Walton (Mr. Pattie) on bringing in the Bill and doing what I believe to be the really appropriate task which the Private Member's ballot affords Members of Parliament. That is to find some area where one can get all-party and ministerial agreement to put forward reforms which there would not be time to put forward in Government time.

I also welcome the fact that the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) continues to take an interest in his child, as it were. But I think that there is now a fourth consideration to add to the three that the right hon. and learned Gentleman talked about, which are therapy of the patient, the liberty of the patient and the protection of the community. I think that the rights and welfare of staff in psychiatric hospitals are now a very important fourth aspect which has been rather ignored in the past and must be taken into account now. It is in that context, and in the context of the hon. Gentleman's coming discussions with the Confederation of Health Service Employees and the National Union of Public Employees and other institutions, that I want to speak.

Sir Derek Walker-Smith

I think that we would all accept the hon. Gentleman's fourth consideration as an addition to the three basic considerations that I mentioned. I did not refer to it because it is not specifically the subject of legislation in the same sense. But I accept what the hon. Gentleman says.

Mr. Price

I take the point, but I feel that this aspect may increasingly have to be the subject of legislation.

I think that the Mental Health Act 1959 has stood the test of time extremely well. Many of its provisions have not had to be used at all. Almost the biggest section of the Act deals with what happens if a Member of this House becomes incapable of carrying on his duties and with the number of occasions when one has to bring in the president of the Royal College of Psychiatrists before such a Member is finally asked to leave. That provision has not been used yet, and I hope that it will not be. But there is an enormous protection in the Act for that sort of patient, and I think that this modest Bill will give a little more protection to some of the rather more humble patients who form the mass of the people in our psychiatric hospitals.

I am glad that the hon. Gentleman is to have talks with NUPE and COHSE. A new situation is developing amongst staff in psychiatric hospitals in relation to their rights, a situation for which the Department has been at least partly responsible. I do not blame my right hon. Friend the present Minister of State, because it took place before his time. But when the Department issued instructions some years ago about how staff should deal with violent patients it made the serious mistake of consulting the Royal College of Nursing but of forgetting to consult properly COHSE and NUPE. That situation has been put right now, but the incident rankles with COHSE, whose members make up the vast proportion of those workers in the psychiatric wards who bear the brunt of the work to be done. I hope that that sort of incident will not occur again.

When the hon. Gentleman has those discussions, various points will come up, and one of them will be the problem of increased "sectioning". The aim of the 1959 Act was to have as many informal patients as possible and as few "section" patients as possible. It may be that we have gone a little too far. Some of the complaints coming forward about informal patients being detained or given medication against their will may arise because there is such a reluctance to put patients "under section" so that perhaps patients who ought to be "under section" are not being treated in that way.

It is important for patients to know exactly where they stand and what their rights are, and it is also important not to allow that sort of half-way house to grow in our psychiatric hospitals, with patients who are theoretically informal but are actually subject to a great number of restrictions. If we were to see the proportion of patients "under section" rising a little, I do not think that that would be anything to worry about particularly.

Mr. Pattie

The hon. Gentleman is shrewdly pointing to one almost concealed element in the informal category, which is those who are "invited" to go in on an informal basis, on the clear understanding that otherwise they will be "sectioned", and there is a certain latitude in the course of treatment allowed on that basis. The hon. Gentleman's point is well taken.

Mr. Price

I am sure that the staff will want to discuss this with the hon. Gentleman because they, too, want to know where they stand with patients. It is just as hard on the staff as on the patients if they do not know what their rights are.

Another point which I am sure will arise in the discussions with COHSE and NUPE, and which the White Paper discussed extensively but which is perhaps unamenable to legislation, is the whole problem of medication. I never lose an opportunity to raise this matter because I believe that we should pay more attention to it. Perhaps some hon. Members saw the programme "Tonight" on television last night. It referred not to hospitals but to the prison service and the volume of medication of the kinds used generally in psychiatric hospitals—such as chlorpromazine and largactil—which is flowing into our prison population.

This is a problem over which nursing staff—sometimes quite junior staff and nursing assistants—are put in a difficult position. The doctor may prescribe medication, sometimes for a reluctant patient, and once again the staff in the hospitals want to know exactly where they are, what their rights are and what their duties are. If there is anything that the hon. Gentleman can do after his discussions to clear up their position, he will be doing a service not only to the staff but to the patients, because all the reports that we have had about abuses in psychiatric hospitals—the most recent one near my constituency being at St. Augustine's, in Canterbury—display a quite widespread misunderstanding at various levels in the hospitals of what people's rights are.

I am glad that the Bill goes a little way to improving the rights of formal patients to go to a mental health review tribunal. The more we can do to make clear what formal "section" patients in our hospitals are allowed to do and what they are not allowed to do, the better.

Parliament and the country have deceived themselves in their approach to mental health since the 1959 Act by saying that their aim is to return as many patients as possible to the community, thus emptying the hospitals and keeping patients there only for the short time when they need treatment. However, I applaud the sentiment and believe that it is right.

The community does not make available the resources to cope with the difficult problem of community care for patients. I believe that both major parties bear guilt in that regard. Far too many people believe that community care is a cheap alternative. It should not be Patients should be returned to the community not because they need less care than in hospital but because it is better for them to regain more easily their dignity and health within the community. The community then becomes used to the fact that patients should not be shut away in a far-off asylum and that they have a great deal to contribute.

We want patients to return to the community, but time and again, when arrangements are made for them to be discharged from hospital no proper facilities are provided. I believe that those who say that we have gone too far in this respect are justified in saying that we push patients out of hospital without finding anywhere for them to go.

However, having made those general remarks, I support the elements in the Bill upon which the hon. Gentleman has obtained Government agreement. I wish that the Bill was as thick as the White Paper. There is much more that could be included in the Bill, but, as far as it goes, it should be welcomed by hon. Members on both sides of the House. I hope that it passes speedily through both Houses and becomes legislation before any untoward accident occurs to this place.

12.23 p.m.

Mr. Charles Irving (Cheltenham)

I join other right hon. and hon. Members in congratulating my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on the compassionate way in which he presented the Bill. While I agree with much of what was said by the hon. Member for Lewisham, West (Mr. Price), I believe that a Bill is not necessarily good because it is thick. There are plenty of thick things around which would be better if they were thinner. I believe that the concise way in which the points are made in the Bill illustrates the urgency of the problems in psychiatric and mental hospitals.

I welcome the Bill on two main grounds. First, it seeks to improve the position of patients undergoing treatment in psychiatric hospitals. I believe that is important at personal and individual levels. Secondly, it enlarges the rights and freedoms of a disadvantaged group, and that is of importance and benefit to all of us who live in a society where bureaucracy and administrative convenience present an unthinking threat to liberty.

It is vital at a time when human rights are high on the agenda of international politics that we should pay particular attention to the plight of involuntary psychiatric patients. I have not heard anyone suggest that psychiatry in this country has been subverted to the ends of political control, but our ability to draw attention to such abuses elsewhere must rest on the knowledge that we are acting to reduce to a minimum any needless restriction on the rights of even the most disordered members of the community. Therefore, I am pleased to support a Bill that moves in that direction.

Clause 1 effectively halves the period for which patients may be detained involuntarily before being able to challenge their detention. To put it the other way, their opportunities for appeal against continued detention are doubled. I hope that the Bill will not be seen as the last word on the issues that it affects and that the clause is a step towards the establishment of an open right of appeal. I would need persuading that such a system would lead to a significant level of abuse. I believe that it will contribute powerfully to the atmosphere that the Bill aims to promote.

Clause 2 addresses itself to the grounds on which Crown courts impose restriction orders on offenders committed to hospitals under section 60 of the Mental Health Act 1959.

A great scandal of our penal system is the number of people languishing in prison who are suffering from mental disorders that warrant detention for mental hospital treatment but for whom no beds can be found. Prison medical officers have estimated that on 30 June last year nearly 600 such people were in the prisons of England and Wales.

The 1976 report on the work of the prison department said: Apart from the inhumane aspects of committing mentally disordered offenders to prisons and borstals, it is not possible to provide many of these unfortunates with the medical and nursing care that their condition requires. No Member can fail to be acutely aware and disturbed by the overcrowding in our prisons. If the system were changed—the Bill will help that—it would be possible to relieve prisons of people who should not be there under any circumstances but who should be treated in hospital.

Largely, the solutions to this tragic problem, for example, the establishment of secure hospital units, as recommended by the Butler committee, are outside the scope of the Bill. However, by tightening the criteria for imposing restriction orders on mentally abnormal offenders, the Bill will help to reduce the reluctance of some hospitals to take such men and women.

The White Paper on the review of the Mental Health Act 1959 pointed out that The problem is sometimes increased when the court has added a restriction order under section 65. Some doctors feel that their hands are too much tied by thee restrictions, the effect of which is to require them to seek the Home Secretary's consent before allowing a patient out of hospital for any period or discharging or transferring him; it can also lead to a situation where they may have to continue to take responsibility for a patient for whom they feel they can offer no further treatment. The Bill echoes the proposals of the Butler committee, which recommended that the law be amended to indicate that the purpose of a restriction order is to protect the public from serious harm. That is perfectly correct. But the committee had evidence from the Home Office demonstrating that these orders are sometimes imposed in cases where their severity is clearly inappropriate. For example, there have been instances of restriction orders being made on offenders convicted of frequenting, soliciting, disorderly behaviour, shoplifting, petty theft and drunkenness.

It is hardly surprising, therefore, that the White Paper agreed that There can be little doubt that restriction orders have been imposed on occasions where they are not really justified by the nature of the offence or by the offender's previous criminal and medical history. The Bill would help to limit restriction orders to genuinely serious cases in line with the original intentions of the Mental Health Act.

Lastly, I should like to comment on the withholding of mail from informal patients. By repealing section 134 of the Mental Health Act, which enables mail to be withheld from informal patients, the Bill would bring the position of these patients into line with that of non-psychiatric patients. The security considerations that justify control over the correspondence of some serious offender patients do not arise in the case of voluntary patients. The only possible argument for withholding their mail is a concern that they may receive distressing letters which would have a disruptive effect on their treatment.

However, as the White Paper pointed out, The pattern of modern communication—in, for instance, the use of the telephone—is now such that withholding correspondence would be sealing off only one form of communication and is unlikely to be effective in isolating patients from distressing and disruptive information. It is questionable also whether it is helpful to protect such patients, most of whom nowadays only stay in hospital for a few months or even days. It is worth bearing in mind that in Northern Ireland, for instance, there is no provision for withholding patients' private correspondence, and that does not seem to have given rise to any special problems.

Moreover, by bringing the position into line with that of non-psychiatric patients, the Bill would help in a small way to reduce some of the stigma associated with admittance to a mental hospital.

I am very happy to support these proposals.

12.34 p.m.

Mr. Robin Hodgson (Walsall, North)

I join in the general congratulations to my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on the Bill which he has introduced today.

Most hon. Members who have spoken in the debate have concentrated on the valuable way in which it would help to ease restrictions on mental patients and improve their civil rights in the broadest sense. I am not an expert on mental health to the same degree as my hon. Friend or, indeed, the hon. Member for Basildon (Mr. Moonman), both of whom have taken a great interest in these matters. Therefore, the few remarks that I wish to make are more in the form of a request for further illumination than specific criticisms of the Bill.

My first concern is the effect that the provisions in the Bill may have on those who are not committed to mental hospitals. I am thinking of the unfortunates in our society—the homeless, the vagrants and the alcoholics—who live in a twilight world who have nowhere to go and have no future ahead of them.

I have been greatly impressed, when looking at various reports, by the relationship between mental illness and people in that condition. A study in Birmingham of the admittance of homeless people to hospital indicated that 75 per cent. had previously been in mental hospitals.

If we make it more difficult for people to be committed for treatment and provide that they are committed for shorter periods, is there not a risk that society, through the courts, will wish to wash its hands all the more readily of these unfortunates, in that it will be said "It is all very well committing these people, but, because the period of committal is so short, the possibility of being able to carry out effective treatment or undertaking any remedial action is very much reduced"? I therefore question whether, if we shorten the period of detention too much, the courts will feel that it is not worth while committing such a person in the first place. Therefore, we shall be unable to help the dross of society, about whom we must all have great anxiety.

Mr. Pattie

It is important not to confuse two of the Bill's provisions. Clause 1 proposes that the period of detention of people undergoing courses of treatment should be reduced by half. That is for the obvious reason that they will have twice the oportunities of having their cases reviewed by a tribunal than is the position now. With regard to the unfortunates—the vagrants and so on, described by my hon. Friend—I hope that these provisions will force society to say" If we cannot commit these people to some kind of limbo, what are we to do with them?" I think that society will have to address itself to the problem in that way.

Mr. Hodgson

I am delighted to hear that that is what my hon. Friend hopes to achieve. I am sure that all hon. Members hope that that aim will be achieved as a product of this measure.

I am concerned about the definition of "serious harm" to which my hon. Friend referred in his introductory remarks. So far, most hon. Members, with the exception of my hon. Friend, have referred to "serious harm" in physical terms. In some cases in my constituency "harm" has taken a different route. I am thinking of two separate cases. I come back to the vagrant or semi-vagrant who wanders around the community, existing in shops and libraries, because those are the only places which are warm and comfortable, and causing a great deal of nuisance, though not of an offensive kind, in public and semi-public places. Perhaps that is not an insurmountable problem.

More important are the offensive acts of harm, though not of a physical nature. In one case in my constituency, a mentally disturbed person visited old people's bungalows at night, rattled windows and doors and pressed his face upon the windows. That did not cause any serious harm. I do not think that he had any evil physical intent against the old people in those bungalows. However, it was very frightening for elderly people to find a strange face peering through their windows at half-past two in the morning.

I hope that in Committee further discussion will take place of the definition of "serious harm". I think that there is a psychological aspect to it for some members of society, particularly the elderly, who are less able than others to protect themselves.

My final point concerns the effect on public opinion. I do not know how fast public opinion is moving with regard to public disclosure, discussion and treatment of the mentally ill. I fear that it is not moving ahead as fast as many of us would wish.

My hon. Friend the Member for Chertsey and Walton described his measure as an hors d'oeuvre—I think that was the phrase he used—and a prelude to a larger and more detailed review of the Mental Health Act 1959. If we pass this measure—as indeed I hope we shall—and some nasty and highly publicised case arises out of one of the measure that my hon. Friend has put in the Bill, there is a danger that this might set back public opinion and cause a reaction against the wider and broader review that we hope will soon take place. I have, therefore, some slight doubts in my mind.

If by ill chance—and it would be ill chance—as a result of this worthwhile measure some highly publicised case appeared in the News of the World—a newspaper with enormous national circulation—that could lead to many hon. Members receiving lots of letters from constituents asking them to make sure, when the wider review takes place, not to remove too many restrictions. This would set back the cause of the mentally ill which is so admirably advanced by this Bill.

What I think is certain is that public opinion about mental health will advance only if it is educated and informed. I am sure that an excellent by-product of my hon. Friend's measure will be to encourage wider discussion of the problems of the mentally handicapped, and the reporting of today's debate will take the issues into the minds of people who, until now, have not considered these matters. It is because of this practical political advantage, as well as the humanitarian aspects of the Bill, that I am pleased to support it.

12.41 p.m.

Mr. Tom Litterick (Birmingham, Selly Oak)

I take great pleasure in welcoming this Bill, as other Members of this House have done. As with the hon. Member for Walsall, North (Mr. Hodgson), my principal reason for doing so is that the Bill gives the House yet another opportunity to communicate to the public the difficult, sensitive subject of mental health and mental ill health, in an attempt to come to grips with the numerous social hang-ups that surround the subject. I have a constituency interest in that I have more than my fair share of institutions that handle people in various stages of treatment for mental disorder and mental disability of various kinds. I shall refer briefly to that later.

The idea of a Bill that enhances the rights of people is, as I think the hon. Member for Cheltenham (Mr. Irving) said, quite rightly, one that no one here is likely to contest. However, I am quite sure, as the hon. Member for Walsall, North said, that somebody in the Sunday press will do a shock horror story in connection with the Bill. I hope that any hon. Member who gets a shock horror reaction from the type of press coverage on this subject, which is all too familar to us, will reply vigorously and not pussyfoot around with such people. It is too easy for journalists to write frightening stories about loonies, and so on, as they do and have done about institutions in my constituency.

If it is any comfort to hon. Members who might have doubts about matters such as these, I can tell them that I was involved in a lengthy case, the details of which I shall not repeat to the House—in particular, I assure the hon. Member for Plymouth, Drake (Miss Fookes) to that effect—which lasted for some years, involving an institution where people who had been undergoing treatment for mental disorder stayed on a hostel basis for varying periods of time.

A local dispute arose about this institution, but in spite of the fact that there was a bitter dispute—which is still going on—the attempt to use the fact that mentally disordered people living in that institution were living in an ordinary street did not succeed, because the residents of that street responded positively. They did not say, as the Sunday press would have them say, "We do not want these loonies living in our street". They said "These people are living in our street and we are concerned about them as residents of the street", and proceeded to form themselves into an action group, which fought—perhaps that is too strong a word—or agitated and tried to influence the system on behalf of the people living in that institution.

That, I think, is very encouraging. That took place, and is still taking place, in an urban area which had suffered, and still suffers, from the familiar manifestations of urban decay—an area where one would expect the worst kind of social prejudices to be foremost. That did not happen. I hope that no one in this House will object if I specifically name these people. They are the residents of Trafalgar Road, in Moseley, and they are to be complimented on resisting attempts to stir up old-fashioned, antique and quite savage prejudices about this subject.

That case raises another aspect of the Bill. What happens to people when they are no longer in hospital? If they are released more readily, what will society do about them thereafter?

My relatively recent experience of this—here I address the Minister, not for the first time, on this subject—is that society is not doing very much. We are slowly learning that people do not need to be incarcerated in secure areas of hospitals, or whatever, for indefinite periods of time simply because they suffer from some mental illness or mental handicap.

Recognising that, so far we are not doing very well at realising that these people need some special attention from society if they are not to be in a total environment such as a hospital or, indeed, a prison. They need a half-way environment—a half-free environment, if one likes—but certainly one where there are care and facilities offered by people who are not mentally disordered. We know that one of the consequences of being mentally disordered is that one is less competent and cannot do simple things such as cooking, washing and earning a living.

In my constituency we are unfortunate in having inadequate facilities for people who are no longer treated on an inpatient basis. That is an unfortunate omission. We do not have mandatory legislation that obliges local authorities to provide certain minimum facilities for people who have recently been in mental hospitals and who may or may not recover all normal faculties after a period of time within the community. Their chances of doing so would be enhanced if they left hospital and entered a reasonably safe environment within wider society. That, in turn, depends on those people being able to enter places such as hospitals, preferably run by people who have some knowledge and skill in terms of understanding the habits and requirements of the mentally disordered.

In our city we are not well off in this respect, and the involvement of the local authority is, to say the least, inadequate. As I believe was mentioned in the House recently, Birmingham is worse off than all the other large cities of our country. That is only one aspect of the situation. The provision of facilities for such people varies in quality and adequacy throughout the country.

That brings me back to the purposes of the Bill. Quite rightly, the hon. Member for Chertsey and Walton (Mr. Pattie) seeks to ensure that people who are in hospitals as involuntary patients because they are mentally disordered should be able to seek their freedom. He maintained that their chances of being freed are doubled if this Bill gets on to the statute book, but I suggest that that is not enough if what happens to them after that means that they are at risk, and they will be at risk if they cannot enter an environment outside hospital which provides a certain minimal security in terms of their mental welfare, their physical well-being, their job prospects, and so forth.

Mr. Charles Irving

Does the hon. Member agree that it is a continuing national scandal that there are thousands of people in mental hospitals throughout the country who have no reason to be there other than that they have nowhere to go? Although successive Governments have tried to find a solution, it appears that some means must be found for encouraging local authorities to devote small units of council accommodation to patients who are likely to be assisted by voluntary bodies. MIND has done a superb job in this respect. This is a very much less expensive course than keeping hospital beds occupied by those who do not need them.

Does the hon. Member agree also with my hon. Friend the Member for Walsall, North (Mr. Hodgson) that it is pointless to put these inadequates and petty offenders into highly expensive psychiatric accommodation? I have in mind the man or woman who goes round tapping on windows. Recently in my constituency there was a man who was going round pinching ladies' knickers. He had done it 95 times, and was in great trouble. Whereas some ladies like having their bottoms pinched, no lady likes having her knickers pinched. But what is the sense of putting such a man into highly expensive psychiatric accommodation when hostels which are now growing in number could be expanded to provide not secure accommodation but adequate supervision to ensure that the public were not caused distress by that sort of totally unacceptable behaviour? Would not that be better than what we are doing at the moment?

Mr. Litterick

I agree wholly with the hon. Gentleman. I think, too, that the effectiveness of clause 1 of the Bill is almost entirely dependent on whether society provides facilities outside hospitals.

If there is no significant change from present policies—I am talking about the policies followed by the State and those followed by the various local authorities—clause 1 will be virtually inoperable, for the reasons that the hon. Member for Cheltenham quite rightly highlighted.

I was speaking from experience in my own patch. I am aware that the hon. Member for Cheltenham is not inclined to push as hard as I am in this direction, but I hope that he will at least come some way along the road with me in suggesting that more of us should urge the Government to bring forward new legislation placing unavoidable obligations on local authorities to provide proper facilities for these people.

However it is done, it is now clear from our experiences in our constituencies that mandatory obligations or legislation is now necessary. How far we go with that legislation is a matter that we can argue among ourselves here at the appropriate time, but from the bitter experience of Moseley, clearly there is a crying need for legislation which will supplement this Bill, and I am sure that there will be a subsequent Bill providing us with the additional pages which the present one lacks.

If legislation such as this is to be successful, it is vital that society at large responds with resources and trained people. What is needed now is a willingness to impose obligations on local authorities rather than, as has happened in Birmingham, having the mentally disordered and mentally handicapped made into political footballs because a given local authority has a certain view of a particular type of expenditure. As the Minister knows, the types of local disputes which arise from that kind of issue are pretty sordid and squalid.

I wish to assure the hon. Member for Chertsey and Walton that I support his Bill wholeheartedly. I hope that we shall see him back next year with another amending Bill and that, in the meantime, the Minister will come forward with appropriate supplementary legislation.

12.56 p.m.

Mrs. Lynda Chalker (Wallasey)

Like every other hon. Member who has spoken, I welcome the Bill, and I want especially to congratulate my hon. Friend the Member for Chertsey and Walton (Mr. Pattie) on bringing it forward, limited though it may seem to be to some hon. Members.

The work which is done by the all-party group for mental health—by my hon. Friend and by the hon. Member for Basildon (Mr. Moonman)—is one of the most successful collaborations in trying to review and bring up to date the law of the land in relation to one of the most neglected groups of people in our society. All hon. Members should be grateful for the work that MIND does in supporting our all-party mental health group and to all the various other voluntary bodies which bring to our notice continually the way in which the 1959 Act has now become out of date.

It is important to place firmly on the record that my hon. Friend's Bill is seen as the start of a comprehensive revision of the 1959 Act. It is hoped that in due time the Government will bring forward all those other measures which have come to our notice in recent years.

Before discussing my hon. Friend's Bill, perhaps I may be allowed to say a few words on the wider issue. My hon. Friend referred to the early-day motion as expressing the underlying wish of this House—by many more right hon. and hon. Members than those who signed it—that we should have a much wider debate on the subject of mental health before any further legislation is introduced. Not only have we had the White Paper, Cmnd 7320 published last September, but there has been a plethora of other reports, some of them Government reports and others from outside bodies, none of which has had a full discussion in this House.

Our last debate on this issue was two or three years ago when we discussed the Butler report, and even that was not a very extensive debate. Many people outside the House believe that a full-scale debate is necessary. My remarks in this connection, therefore, are really directed to the Leader of the House. The bringing forward of this Bill by my hon. Friend the Member for Chertsey and Walton and the discussions that we shall have on it in no way absolve the House from a debate on the wider issue of the mental health White Paper and the Government's introducing in due course some legislation to revise the 1959 Act.

Simply because of the increasing numbers who suffer mental illness, we are constantly aware of our need to get to grips with this problem and to keep all these matters under control. It is evident from the speeches of a number of hon. Members that although the problem never seems to be one's own, it is constantly making different groups in our society aware that perhaps we are not dealing with some of the consequences of mental illness in the way that we should like.

It is well known that the 1959 Act introduced by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) has been a good one but that the modifications required to it are now so extensive that, however welcome amending Acts are, we cannot go on making small amendments and must deal with the problem much more comprehensively.

As the number of mentally ill admitted to hospital has increased from 170,281 in 1966 to 190,358 in 1976 it is noticeable that the consequences have not always been fully recognised. The duration of stay in mental illness hospitals, and sometimes in hospitals for the mentally handicapped, is thankfully shorter than before, but we must be conscious of the problem that we present to the community and the problems faced by those who have had mental illness and who have relapses. These are problems that are not fully taken into account by aspects of other legislation, apart from the 1959 Act.

As the Bill is dealing with only a tiny fraction of the issues that are raised, we are asking for a further and more extensive debate. I hope that the debate will take place between a Monday and a Thursday so that more hon. Members can be educated on the problems of mental illness and the problems of those who have to deal with them, whether they be elected Members, officers or nurses. There is too much ignorance about the problems.

I sincerely welcome the Bill. I do not want my hon. Friend to get the impression that I do not consider it an excellent move on his part to bring it forward following his success in the ballot. However, it deals with only 10 per cent. of patients admitted on orders and only 5 per cent. of detained in-patients. That is a small chink of the total problem.

In Committee we must ascertain whether we can achieve more widespread agreement on two other issues that will further the success of the provisions already in the Bill. It appears from the comments that have been made, whether about staff or the problems of many informal patients—theoretically informal—that we shall be able to improve even this amendment Bill.

Two matters are referred to in the White Paper that are not to be found in the Bill. In paragraph 2.12 the White Paper recommends that section 25 of the 1959 Act should specificially provide for the short-term treatment of patients who go into hospital for 28 days but who are in hospital for observation under the section. Nothing is said about further assessment and treatment. The Bill is concerned with monitoring the progress of persons detained under sections 26 or 60, who often were first in hospital under section 25. We may be able to achieve agreement between the Royal College of Psychiatrists, the Government, the Opposition, MIND and all other interested groups on that recommendation and to improve still further the working of the 1959 Act as it would be amended.

The second issue with which we should be concerned is section 30 and the detention of informal patients already in hospital. Reference is made to that detention in paragraph 2.29. It indicates that it would be a good thing if we could amend section 30 so that an order that detains an informal patient may be signed by not only the responsible medical officer but, in his absence, by his nominated deputy.

In certain areas there is a great problem about the emergency detention of informal patients when the responsible medical officer may not be readily available. Paragraph 2.30 states: Delays occur when the responsible medical officer is not available that make nursing staff unsure of their position in dealing with a patient who needs to be detained to prevent danger to himself or others. We know that occasionally abuses have occurred because the RMO has not been available. Certain abuses have been set out in some public documents. One instance is mentioned in the White Paper. Apparently a stock of forms already signed was kept by the doctor for use when needed. With the new and growing attitude that we take to problems of mental health, we believe in constant monitoring. Practices such as keeping a stock of signed forms cannot be allowed to continue. It seems that a further minor change will receive all-party and all-interest support.

It is an occasion to be welcomed when the Royal College of Psychiatrists writes that it welcomes Mr. Pattie's Bill unreservedly and feels that his amendments are useful modifications to the existing Act. It is to be welcomed when MIND puts forward similar comments. I know that MIND has helped in large measure with the Bill's preparation.

Clause 1 deals with monitoring and renewal. Anyone who needs to be detained is obviously in dire stress and has possibly caused a good deal of disruption and stress in his or her family or to those who wish to help in future. The aim of the Bill to reduce the duration of authority for the initial period of detention to six months is an excellent move. The fact that the subsequent periods will be reduced from two years to one year is a further welcome amendment contained in clause 1.

There is one danger that I should bring to the notice of the House. If the authority to detain is to be renewed twice as often, there is a danger of renewal becoming rather mechanical. We must ensure that the review is thorough and is monitoring progress. The White Paper rejected the idea of requiring a second recommendation for renewal. Although we do not wish to make the process cumbersome, it is important that renewal is safeguarded so that the patient's case is properly reviewed. There may be various ways of doing that. That is a matter that the Committee will wish to consider in detail.

The mental health review tribunals will do more work than in the past. The present work load of the tribunals is under 1,000 considerations a year. If the review body, wherever it sits, is to have a greater work load, we must consider the composition of some of the tribunals and provide up-to-date advice for those who sit upon them. We know that there is a medical man, a legal man and a citizen of some standing. In the complicated issues sometimes produced by mental illness, the tribunals need further advice. That may be even more important if the tribunal's work load is expanded as clause 1 implies.

In other parts of the Bill there is a further need for explanation for those servicing mental health review tribunals.

In clause 2 my hon. Friend seeks to insert the words "from serious harm", and there has been some question about what we define as "serious harm". My hon. Friend the Member for Walsall, North (Mr. Hodgson) and others have said that, where there may be psychological threat, "serious harm" might be considered more quickly to occur to an elderly, frail and lonely person than to someone young and robust. But most of us will readily recognise what a violent physical threat of harm might be.

I have come across a further problem in cases that have been brought to my notice, not only from my constituency but from the country as a whole. It is the question of the psychological harm that a seriously disturbed person may do to children in or around the place to which he returns. That is almost indefinable, and I am aware that here we are in the realms of judgment. But it behoves us to have another look at some of the cases of harm caused to children in this context.

We should also be mindful that this sensible amendment to the 1959 Act should not be allowed to give rise to the situations referred to by the hon. Member for Birmingham, Selly Oak (Mr. Litterick), which excite newspaper headline writers. One crucial way in which misunderstandings occur about mental illness and danger from patients is through the shorthand and sometimes ill-advised reporting of the minor occasions when a person who should be in care is not. If our society is better to understand the problems experienced at some stage in their lives by one in six women and one in nine men, we must make sure that the safeguards are rigorous, well-researched and befitting the current situation.

That is not to say that we do not believe that the amendment to section 65 on public protection should not be made. Disturbed patients can cause serious harm. We have constantly been concerned about the way in which the legal profession has used section 65 to detain a person who, given the right care and attention in the community, should not be detained.

This raises the wider issue of community care for persons who have been mentally ill. The Bill cannot deal with that. But it underlines the need for us not just to encourage the co-operation of the community in dealing with persons who have been ill but to give more financial aid to local authorities to assist them in what this House throws upon them through legislation.

Turning to remission, I have not heard of any voluntary body or other group which believes that the recommendation of the White Paper in paragraphs 538–551, and indeed the Butler report, should not be developed into an Act of Parliament.

The final clause concerning voluntary patients deals with their mail. We are here doing something that has been called for by many bodies. We are relieving staff in our mental hospitals of an often unnecessary and dubious task. I am sure that the Committee will wish to develop this freedom for voluntary patients—if it is seen as that.

Finally, I turn to clause 5, which deals with money, and I have left this until now as it is a difficult matter. Clause 5 refers to the financial provisions for any increase arising directly from the amendments in the Bill. It is being said outside the House that the Government or an individual hon. Member seeking to reform the Act should not be unmindful of the consequences of so doing. The 1959 Mental Health Act is interlinked throughout. That may have a greater implication than that contained in the note on financial effects of the Bill. I shall be interested to hear the Department's thoughts on that, as it throws up a large number of other issues.

This is a good Bill. It may benefit from a couple of amendments in Committee, but we wish it a good speed and hope that, whatever the next few months bring, the Bill will be on the statute book in the near future. I think that from time to time we forget how much we should be concerned with those who suffer from mental illness.

1.18 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I congratulate the hon. Member for Chertsey and Walton (Mr. Pattie) on his good fortune not only in being selected in the private Members' ballot but for having achieved a high place, enabling his Bill to come before the House relatively early in private Members' proceedings. It therefore has a good chance of becoming an Act and surmounting the various hurdles of which Back Benchers are aware. I also express my appreciation and that of my right hon. Friends for the way that the hon. Member has chosen to legislate on these matters.

Right hon. and hon. Members who have heard the hon. Gentleman speak have already divined that the Government support the Bill. This is the first step in the reform and further amendment and adaptation of the Mental Health Act 1959. It has been a great pleasure to have the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) with us today. I appreciate his kindly reference to my late father. I know the way in which he helped him in the primary task of putting the Mental Health Act 1959 on the statute book. I thought that the right hon. and learned Gentleman, was a little self-deprecatory in describing the effects that the passage of time has had on his Bill, in that he seemed to think that time had revealed gaps which must be filled. It is rather more a question of attitudes, ideas and techniques changing over two decades.

These days that is rather a long period between one change and another. There is a need, of course, to adjust our legislation to keep up with the times.

I prophesy that the Mental Health Act of 1979 or 1980, or whatever, will not be quite such a marked and radical departure from what went before as the right hon. and learned Gentleman's Act was from the situation that he discovered when he had the responsibility for altering our law on mental health back in 1959.

The Bill has been discussed without a great deal of reference to the background against which it comes forward. It may be helpful to put matters in perspective. In 1976 the Secretary of State for Social Services initiated a review of the Mental Health Act 1959. One of the most pleasant duties that I had when I joined this Department was to take part in a debate and discussion on the way forward from the 1959 Act. That discussion was held at the United Services Club, in Pall Mall. It was a very profound, wide-ranging and interesting debate. All the leading personalities in mental health were there, and from that we proceeded to a general review and received a tremendous amount of evidence, which we then had to digest.

It took a considerable time for the Home Secretary and the Secretary of State for Social Services to consider the whole background and propound the White Paper that we have now put out for discussion. I am sure that hon. Members in all parts of the House will be happy to learn that the White Paper has some green edges. We expect that there will be further discussion and debate.

The four measures that have been put forward by the hon. Member for Chertsey and Walton are, in fact, measures on which there is little, if any, disagreement in the House and among the wider mental health interests outside. The four proposals in the Bill are proposals that the Government put forward in September in the White Paper on the review of the Mental Health Act, as part of an overall programme for reform of that Act. No doubt the hon. Gentleman keeps a close watch on these matters. He has selected four measures for which there is almost unanimous support.

The main effect of the Bill is to bring proposals into force until the much more major legislation to which the Government are committed is introduced. In that respect I can answer at least half of the representations made by the hon. Member for Wallasey (Mrs. Chalker), who asked for a debate on the mental health White Paper. Unfortunately, I am not in a position to say "Yes" or "No" to that. My responsibilities do not extend to arranging the programme of business in the House. I have no doubt that the Lord President will have his attention drawn to her suggestions and no doubt something will be done about it.

The hon. Lady also said that she hoped that this was not the end of legislation on mental health but that there would be a substantial amending Bill. I can promise her that there will be. The timing is a little uncertain, because we want to have full consultations with all the bodies concerned. There are some matters in the White Paper that are highly controversial—for example, the amount of force that can be used to restrain a difficult patient. I am sure the law relating to that will provoke substantial debate between Members representing the staffs of our mental hospitals and others who are equally interested in mental health but take it more from the patients' point of view.

The hon. Member for Chertsey and Walton introduced his measure with lucidity and a clear comprehension of the legal machinery that he was proposing for the solution of the problems involved. He has rightly earned the praise of all hon. Members who have spoken today. He has explained the purpose of his proposals very well indeed. I wish to give some indication of the benefits that the proposals will bring as well as to talk about the legal mechanics of bringing the changes into operation.

In this House there is a general realisation of the need to reduce periods of guardianship and detention for treatment. It is part of the wider movement from care in institutions to care in the community which is going on extensively in the area of mental health. That is in spite of the fact that some of the remarks passed during the debate have indicated that the movement is not fast enough to please all hon. Members.

I should stress that the periods laid down in the first substantial proposal are not really related to treatment as such, or to the periods of treatment as we see them. They are not meant to be treated routinely as a length of time for which a patient should be detained before consideration is given to his discharge. The responsible medical officer is expected constantly to keep in his mind the possibility that any patient within his care who is detained under compulsory powers need not be so detained. That is a continuing responsibility of the responsible medical officer. It would be generally agreed that as a further safe- guard for patients, and to reassure them and their relatives that nobody is forgotten, provision is made under the law for regular revision and review of each case. This is achieved by providing that the detention shall end at a specified date unless it is renewed before then.

When somebody is made subject to the longer-term compulsory powers of the Act, he is being deprived of his liberty. Frequently, under our law, the question of mental health is inevitably involved with that of personal liberty. In the past, though I hope it will be less true in the future, patients in mental hospitals have lost their liberty for long periods of time. This is highly regrettable, and we all feel that the sooner we can reduce these instances the better it will be for the administration of our mental health service.

Mr. John Lee (Birmingham, Handsworth)

Will my right hon. Friend deal with the concomitant problem of cases in which a detained mental patient is removed from a hospital of medium security to a high security hospital and where, in my submission, there is a need for independent adjudication? I know of such an instance, and if I am lucky enough to be called I propose to mention it.

Mr. Moyle

I would be interested to hear of the case that my hon. Friend intends to raise and though I did not intend to deal precisely with that specific problem at this stage I will listen to what my hon. Friend has to say and see what can be done to help. I know that the sphere to which he has drawn attention—the interface between ordinary mental hospitals and special hospitals—is one that inevitably arouses considerable interest on the part of patients and their relatives. What we seek to ensure under this proposal is that powers of detention are not used unnecessarily and for unwarrantedly long periods.

The proposal has two effects. It doubles the occasions when a doctor must formally review a case and satisfy himself that detention is still necessary. It means that there will be occasions when every case must come under review.

Inevitably, as each one of these review decisions is made, the indirect effect will be to increase the opportunities open to patients to apply, or have their case referred, to a mental health review tribunal. Consequently, there will be more pressure on those tribunals. The hon. Member for Chertsey and Walton drew attention to that fact in commenting on the resource implications of the Bill, which I shall come to later.

The Government are sufficiently worried about the pressures on the mental health review tribunals by this alteration in the law to support transitional arrangements whereby the initial impact of this change might be substantially reduced in the initial stages. The Government are most grateful to the hon. Member for Chertsey and Walton for drawing their attention to that point by putting it into his Bill.

It means that some of the benefits of the new clause will be felt by some patients before others. We regret that very much; on the other hand, we are bringing forward these reforms well ahead of the main legislation. If the hon. Gentleman had not put this into his Bill, it is likely that the arrangement would have had to await the later legislation. That legislation might be in the next Session of Parliament or the one following. If it were in the next Session of Parliament, those arrangements would probably not come into operation until some time in the following session. Even though some patients and their relatives may feel that as a result of these transitional provisions they are being held back, the fact is that because of the energy of the hon. Gentleman the Member for Chertsey and Walton the question of liberty is being reviewed much earlier than it otherwise would have been.

Transitional arrangements are necessary in order to relieve the pressure on the tribunals that might result if there were a general flood of proposals coming forward as soon as the Bill reached the statute book, as I am confident it will.

I turn to section 65 of the Mental Health Act 1959, which is the subject of the second main clause. That clause brings the wording of section 65 a great deal closer to the intention of the 1957 Royal Commission. We found during the course of the debate that section 65 did not provide a very satisfactory control mechanism in the case of patients who were eligible for discharge but who did not obtain it. The existing wording meant that people continued to be detained for not very serious offences.

We must make sure, by amending section 65, that restrictions will be imposed upon patients only when it is thought likely that they will be dangerous or cause considerable harm. Detention should not be imposed where the risks are minor, or relate to petty offences. The Act was not intended to deal with that sort of offence; it was designed to cover cases in which serious harm would result if restrictions were lifted.

When offenders are restricted there are implications for their management and security needs in hospital, in that hospitals, because of the increased restrictive management and security regime, sometimes find it difficult to offer suitable places to offenders under restriction. This must be realised, and this is where the third proposal will have its effect. The proposed amendment to section 65 goes some way to ensuring that such restrictions are not imposed unnecessarily.

The proposed amendment of section 74, via section 75, should mean that prisoners transferred to hospital would be subject to restrictions for a shorter period.

This might provide some indirect help in the placement in hospitals of mentally disordered offenders, and provide for some flexibility in the management of such cases. My judgment is that any benefit would be slight, but a slight benefit is better than no benefit. Problems of management in this context are difficult and complex, and any advantage gained will be welcomed.

Concerning the fourth proposal, it is remarkable that where we have informal patients we are still giving powers, to the doctors in mental hospitals, which amount to censorship of mail. I am sure that this offends the sensibilities of all Members who have taken part in the debate. No matter what alleviation we may introduce, there will be individual instances in which an acutely ill patient will send mail that will upset others or be harmful to his own best interests.

I agree with the hon. Member for Chertsey and Walton that the proper solution to the problem lies with discretionary powers, but even that cannot be truly effective. Great emphasis has been placed by hon. Members on the shift from formal and restrictive to informal treatment, and in most cases that means exactly what it says. A determined informal patient would be free to leave hospital and post his own mail. The best solution, then, is to rely on sympathetic advice and persuasion by members of the staff to the patients concerned.

It is more consistent with the status of all informal patients that they should be free to correspond as they wish. The Government feel, as does the hon. Gentleman, that on balance the weight of advantage lies with repealing section 134, which imposes these draconian censorship provisions, and with removing a limitation on the rights of informal patients.

It is a regrettable comment on our debate that, with the exception of the hon. Member for Chertsey and Walton, there has been very little consideration by hon. Members of the resource implications of the Bill. This is something that no Government spokesman can refrain from commenting upon. In absolute terms, the sums involved are very small. The increase in the mental health review tribunal hearings unfortunately cannot be reliably estimated. We cannot predict the extent to which patients will choose to take advantage of their new opportunities, although I am sure that many of them will. Our highest estimate assumes an increase in hearings of about 50 per cent. The practical results are likely to be somewhat less than that, but I would not wish to forecast by how much.

It is expected that the existing review tribunal staffs will be able to cope with the extra work load without any need for increased recruitment, but there will be additional fees and expenses for members and expenses for witnesses likely to total between £25,000 and £50,000 in a full year.

I realise that there is a 100 per cent. variation between those figures, but that will indicate that I am talking in fairly broad terms. Nevertheless, even a variation of that size can be contained within the Estimates for the 1979–80 financial year. The Bill would come into force only in the second half of the year, and the transitional provisions would mean that the increase would build up slowly. The public expenditure survey alloca- tions for 1980–81 and beyond already provide plenty of elbow room for implementation of the proposal.

Many patients seek help from solicitors in preparing for a tribunal, making demands upon the legal assistance and advice scheme. No reliable estimates can be made, but it is thought that this will cost, at most, £25,000 in a full year. The Lord Chancellor's Department feels that it can absorb this increase within the allocated planned expenditure.

Resources are not only a question of money; there are manpower implications. I understand that the Home Office is likely to be burdened with an increase in staff of one, who will help with the increased processing of cases referred by the Home Secretary to the tribunals. The Home Secretary, however, feels that this problem can be solved within his Department.

I am happy, therefore, to assure the House, on the basis of somewhat more detailed calculations than the hon. Member for Chertsey and Walton was able to make, that the resource implications that he foresaw for his Bill are substantially confirmed. This legislation will not only be effective and desirable; it will be economical to operate.

Mrs. Chalker

I asked the Minister of State about the wider expenditure implications of the Bill. I realise that he might be unable to deal with that aspect now. These worthwhile and economical amendments may open up a new avenue of expenditure, and before the Committee stage, therefore, it would be helpful if the Department could examine these wider expenditure "threats". We would hate the Bill to fail through our failure to take account of those implications.

Mr. Moyle

I think that the implications, so far as we can foresee them, have all been taken into account. We do not foresee any further problems. If the hon. Lady has any in mind, I shall certainly consider them if she lets me have a note of them. I shall see what we can do to meet those problems.

My hon. Friend the Member for Lewisham, West (Mr. Price) was most anxious that staff interests should be considered. He was anxious that there should be no tendency on the part of my Department to fail to consult COHSE and NUPE during the course of future legislation. Fortunately, the hon. Member for Chertsey and Walton is fully seized of his responsibilities with this Bill. I can reassure my hon. Friend that the Department now makes a practice of consulting fully the staff nurse unions involved in mental hospitals, particularly COHSE and NUPE, on all policy matters. There is, of course, local machinery for joint consultation on local problems.

My hon. Friend the Member for Basildon (Mr. Moonman) was anxious to ensure that general practitioners should be encouraged to monitor cases of mental ill health in the community before such cases are received for treatment at mental hospitals. That is most important.

We are debating the Bill against the background of a general desire to move the treatment of mental patients away from institutions and towards care in the community. Three of the proposals in the Bill have some bearing on this issue.

The hon. Member for Walsall, North (Mr. Hodgson) spoke of the importance of educating the public in this direction. I agree that that must be done. In spite of 10 years or more during which care has been shifted towards the community, people are still apprehensive at having more mentally ill or mentally handicapped people among them.

That attitude arises from a lack of awareness of the new medical and psychiatric therapies and techniques that have been developed over the past 20 years. As responsible parliamentarians, we should proceed with educating our constituents in these matters. Debates such as this one help in that process, as does much of our other work.

My hon. Friend the Member for Birmingham, Selly Oak (Mr. Litterick) has previously mentioned the problems of looking after people in the community. He said that the care of the mentally ill and handicapped was worse in Birmingham than in any other big city in the country. At Question Time last Tuesday, I commented unfavourably on the standard of mental handicap and mental illness care in Birmingham, but I think now that my hon. Friend rather over-emphasised the matter. Birmingham is worse than many of our big cities in this respect, but not worse than all. Somewhere there is, possibly, a big city with a worse record.

Mrs. Chalker

The Minister knows that we are aware of this, but we must pay greater attention to the fact that many of these big cities attract those who need the most help from the community psychiatric services. The development of the community psychiatric service must necessarily precede, both in training and in finance, what we can refer to as a much better standard of treatment, which every hon. Member wants but which regrettably, in the present resource situation, will not be an overnight change, whoever may be controlling the purse strings.

Mr. Moyle

I agree with the broad principles behind that intervention. Nevertheless, there is a responsibility on all local authorities, which now control their social service departments and which are primarily responsible for care in the community, to do the maximum within the resources allowed to make due provision. I thought that my hon. Friend the Member for Lewisham, West was a little hard on the Government when he talked about the resources which will be made available for care in the community. He seemed unaware of the substantial effort that the NHS is making through the technique of joint financing to deploy NHS money towards the social service departments of local authorities. We shall deploy about £35 million in this way this year and by 1981–82 the total will have reached £40 million, uprated for inflation.

Most of our guidance to local authorities is directed to helping them to provide resources and care in the community for the mentally ill and handicapped. We are well aware that the elderly always have tremendous electoral sympathy in the competition for social service resources, which the mentally ill and mentally handicapped do not have. Therefore, the efforts of my Department are directed to getting the maximum proportion of that joint financing money directed towards those two latter groups.

Mr. Hodgson

May I ask a slightly unfair question? I fully appreciate the need for local authorities and social service departments to be responsible and to look after their local populace, but has the Minister's Department considered the proposals of the next Bill that the House will consider today—the Chronically Sick and Disabled Persons (Amendment) Bill? That will have a great undermining effect on the independence which both the Minister and I wish local authorities to have in the way in which social service departments do their spending.

Mr. Moyle

There is always tension in these matters. We are all anxious to establish local democracy and to ensure that people take their own decisions locally, and that there is rough uniformity between standards of care for our less fortunate citizens. From time to time, Governments have to insist that certain standards are maintained, or, if they cannot go that far, at least to give a lead to the institution of certain standards. Joint financing is a typical example of this latter approach.

I hope that the Bill has a brief, brisk and effective Committee stage, so that we can welcome it back and send it to the Lords as quickly as possible. The possibility of future accidents has been mentioned. I am sure that we can manage to get the Bill on the statute book before anything like that happens.

1.55 p.m.

Mr. John Lee (Birmingham, Handsworth)

The hon. Member for Chertsey and Walton (Mr. Pattie) will, I think, acquit me of any discourtesy in not having been present when he moved the Second Reading, because I was professionally engaged elsewhere. I was pleased to see the Bill on the Order Paper, and I was fortunate enough to hear the speech of the hon. Member for Wallasey (Mrs. Chalker), who applied to this matter the sensitivity and good sense that she always shows.

My purpose is certainly not to retard the progress of the Bill. I should like, first, to use this opportunity, which I think would be in order, to quote examples of lacunae in the law. I intervened in the Minister's speech in anticipation of something that I wanted to raise later, but I should like first to mention another disturbing case which I encountered some time ago in a professional capacity. It would be wrong, and I she not attempt, to identify it—not least because the matters are still the subject of further legal determination and also because it would be professionally improper so to do.

Some months ago, the case arose of a very sick woman with a record of violence and a long history of in-patient treatment punctuating her sad life, about whom there was every reason for apprehension. Yet the local authority to whose attention the matter was drawn—there was no relative to raise the matter—declined to take action.

Not long afterwards, the woman committed against a child an act of violence which, happily, was trivial in its outcome but which so easily could have resulted in death, and certainly in serious injury. The woman was arrested, indicted and brought for trial. When the matter came before the Crown court and the medical history, supported by comprehensive medical and social inquiry reports, was put before the judge, it was apparent that the incontrovertibly correct solution was that she should be made the subject of a Mental Health Act order and not of a direct punishment.

Inquiries were made about a place for her but the learned judge found that there was no mental hospital willing to take her and that he had no powers under the Act to compel the hospital to receive her. It was not considered—I think rightly from my recollection of the details—of such acute seriousness, despite the history of violence, as to warrant an order which would have committed the woman to one of the three high-grade mental hospitals, Broadmoor, Rampton or Moss Side.

The judge was left with three choices. One was to let the woman go, with every prospect of a repetition of violence. I say "let go" in the sense of imposing a non-custodial sentence. A second was to make a Mental Health Act order, which he knew would be disregarded because of the absence of power in the law to enable him to compel a particular named hospital to accept her. The third was to pass a sentence of imprisonment.

In the end, the only course the judge was able to take was to pass a long sentence of imprisonment. He was obviously distressed and upset at having to do so and commented, at the time of passing sentence, that it was obviously an inappropriate decision. He did so in a spirit of humanity because he did not wish the sentence to be regarded as an indication of the court's proper view of the situation.

The judge also hoped that in due course the matter would be the subject of investigation, so to speak, behind the scenes and that it would be fully ventilated in the Court of Appeal. I understand that the latter, at any rate, will ultimately happen.

This is not the only instance I have encountered. The hon. Member for Chertsey and Walton knows of this situation. It may be argued that that a judge can make a directive, ordering that someone should be detained. But a hospital may conscientiously feel that it cannot cope. While not wishing to be awkward or over-cautious, it may take the view that there is serious danger to other patients, danger of disruption in the hospital, danger of escape, or some other bona fide reason.

One cannot allow a situation in which the purpose of the Mental Health Act, or an important segment of it, can be defeated by the absence of the powers vested in the Crown courts to be able to make a proper disposal order. I have mentioned that case in anonymous terms. I know that the judge, a sensible and humane person, was troubled about it and would wish that I should do so. When this Act, now 20 years old, is comprehensively reviewed, not only in the context of the hon. Gentleman's useful Bill but in the wider context of a general review, I hope that this lacuna in the law will be put right.

I know of another instance, perhaps not in such acute terms. Difficulties arise in that grey area between punishment and mental treatment of an offender. A case occurred two or three years ago of a man brought before a court on a comparatively trivial assault charge. It was readily apparent to everybody—warders, solicitors, counsel, and, in due course, the court—that he was mentally disoriented. Everyone was aware of that, except the prison medical officer at Brixton, whose attitude might be cynically summed up as that of Army medical officers confronted with walking wounded or walking patients and working on the assumption, which takes a lot of rebutting, that they were malingerers.

The medical officer certified that the man was fit to plead. As it was patently impossible for any kind of coherent or rational instructions to be obtained from the individual concerned, there was resort to the comparatively rare procedure of a trial on fitness to plead. In spite of the absence of medical evidence supporting that contention, the special jury empanelled for the purpose of trying the preliminary issue sensibly concluded that he was unfit to plead and the man was accordingly detained.

In that instance, if my memory serves me right, he was detained in a high security mental hospital. He was detained for a period of 18 months or more. Happily, in the course of that time, he recovered. In fact, he recovered to such an extent that he was certified as being fit to plead, it being implicitly conceded that the original medical certification that he was unfit to plead was wrong and that he had been ill but had recovered. The case was then reopened. By coincidence, it came before the same judge and with the same counsel on either side. This is a rare instance. Usually briefs are returned, shunted around and taken by other people. It is very rare that the same judge and counsel find themselves dealing with the same case some 18 months after the original matter has seemingly been disposed of.

The question then arose that if he was fit to plead, what should be done? Because he was not fit to plead, the court could consider the question of plea and, in the event of conviction, of punishment. Had the man been perfectly sane in the first place, the court would at the very most have imposed a much shorter period of prison and detention than the man spent, as it were, behind bars but in a mental institution. In all probability the case would have been resolved by way of a fine or suspended sentence. Fortunately, the judge concerned dealt with the matter sensibly and humanely. He imposed a nominal sentence after the man had entered a plea of guilty.

That case seems to me to illustrate in a dramatic way the difficulties that can arise over people who are thought to be sane but in fact are not. It certainly made me cynical about the competence of the prison doctor who adjudicated on the matter.

That will lead me later to something more directly referable to the Bill. It also raises a matter to which the Bill refers and to which my hon. Friend the Member for Birmingham, Selly Oak (Mr. Litterick) alluded—the problem of aftercare of people who are discharged. This was one of the difficulties facing the judge in the case to which I referred. This often happens when a person has been detained in a high-grade mental hospital. When he leaves and is free lawfully to go about his business, where does he go? Will hostels take him? It is difficult to find bail hostels for persons of no fixed abode where there are no mental problems but only problems or difficulty in the acceptance of an offender. Where there is an antecedent history of violence and mental disorder, the problems of slotting such a person into the community, of not leaving him literally homeless and on the street, is enormous. The hon. Member for Cheltenham (Mr. Irving) rightly and commendably champions people in this unfortunate situation. He will understand what I mean.

I raise these matters because it is right that they should be mentioned. The House will be interested to know of them and will wish to bear these problems in mind when there is a general review of the mental health legislation.

The hon. Member for Chertsey and Walton rightly seeks to increase the degree of external invigilation of persons, and the circumstances of a person's detention, by reducing the time and by making it the subject of tribunal review to a greater extent than happens now. He is entirely right. I do not think that we shall get very far unless and until the legal aid scheme is enlarged to cover tribunal work in a way that it does not do now. Often the persons concerned and their families are of limited circumstances. They can pay only modest fees, and such representation is not easy.

This is not my area of law. However, I represented a person before a Mental Health Act tribunal, in relation to which I put a question to the Minister about someone who has been arbitrarily moved from an open mental hospital to a high-grade security hospital without reference to anyone. That was one of the matters that came up. It was not the determining factor. In the event, the person involved was discharged. It was thought that the detention ab initio had been wrong and should never have happened. The situation was exacerbated because he had been detained improperly and im- properly removed from a low-grade to a high-grade hospital.

Until there is an enlargement of the legal aid scheme, so rightly and generously available for people accused of criminal offences, to cover tribunal work, including Mental Health Act tribunal work, the provisions in the Bill will not be adequate. Therefore, the estimate of the cost of this procedure may turn out to be much larger. I hope that it will. Unlike many hon. Gentlemen, I believe in high Government expenditure on many matters, and some members of the Opposition believe in high expenditure on this matter. The civilised members of the Conservative Party are here today. The Monday Club yahoos have gone home after yesterday's debate on Rhodesia.

It may not necessarily only be a question of providing legal aid to enable a patient properly to instruct a solicitor and counsel for tribunal representation. There will be instances where, by virtue of comparative feebleness of mind, incoherence and inarticulateness, it will be desirable if a person cannot give poper instructions that representations should be made amicus curiae.

I shall use the analogy of the Official Solicitor in relation to other matters. Someone may be appointed by the tribunal to represent a person who is not able articulately to give instructions, and who is not fully aware of his rights and does not have a family pressing on his or her behalf for representation and redress of grievance.

The debate may or may not continue. We have heard the principal speakers already. I am glad that the hon. Member for Wallasey is present. I am sure that she will be interested in at least some of what I have said. I do not claim that there is any merit in my speech save in so far as I have been able to draw attention to one or two aspects of this complicated and important matter which a humane and civilised society certainly would wish to consider.

Question put and agreed to.

Bill accordingly read a Second time.

Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).