§ Mr. Deedes
I beg to move Amendment No. 5, in page 8, line 44, at end add(j) on the recommendation of two doctors approved under section 28 of the Mental Health Act 1959 to prohibit, for a stated period, administration or supply of controlled drugs for out-patient treatment to a named person and to authorise—In a sense, I should apologise for reviving an issue which was debated at length in Committee. But this is a very important issue and, even at this late hour, I do not apologise for putting one or two new suggestions to my hon. Friend and offering other hon. Members who may be interested the chance to contribute.
- (a) compulsory detention either for observation or assessment for not more than 28 days
- (b) compulsory detention for treatment in secure conditions for not more than one year.
The Clause raises in a new form the difficult issue of compulsory treatment for those who are addicted. Instead of the word "compulsion", I prefer the expression… the degree of control which we shall exerciseover these people.
In Committee, my hon. Friend very reasonably accepted the recommendation of the Sub-Committee on Rehabilitation that, for the time being, there should be no major change in the law in respect of compulsory treatment. The Sub-Committee went on to say that this was a subject which should be kept under review, and it made it clear that the last word had not been said.
I call attention to the fact that, as a result of the Sub-Committee's Report, there has also been produced a very persuasive document by the Magistrates Association. The relevant part of it was compiled by three doctors on behalf of that Association, and it makes the case not for compulsion but for a much stronger degree of control than we exercise at present. That is the point which I want to rehearse once again. The 581 magistrates' case is very persuasive. First, they assert, what no-one can deny, that the mode of spreading drug dependence includes a certain amount of proselytisation. They regard the dangers to those who are not yet afflicted as no less than they have been in the past, and I am sure that that is right.
What we have heard is a clear conflict of interest between those at risk and those already addicted. Many doctors will argue persuasively that for those already addicted a greater degree of compulsion would be a mistake—even a stronger degree of control. But what also a number of doctors will argue, no less reasonably, is that, on behalf of those at risk, that is, those who have not yet indulged in any form of drug abuse, we should exercise more control than we do now for those who may spread that risk.
The magistrates go on to admit, what also we know to be true, that admission of the sort of patient that we have in mind is difficult because there is a lack of suitable accommodation. We have no closed wards for those who need a firm cure for drug dependence. They go on to say—most people would support this—that they are entirely with those who are anxious to avoid any necessity for a court appearance before action is taken.
At present, of course, there is no clear alternative to a court appearance in getting the detention of someone whom a doctor considers should be detained in his own interest and the interests of the community. Yet they argue, along with a number of doctors, that there are cases in which compulsion is necessary because the motivation for cure vacillates. Where in a sense the patient is kept at will, then frequently at a crucial stage in what might otherwise be a cure, the patient opts out.
Finally, the magistrates would like to see—this is a very reasonable proposition—the establishment of at least one centre for the therapeutic treatment of these cases. They envisage a centre with a secure perimeter and a liberal hospital regime. As yet, we have nothing on those lines. I have mentioned before the sort of experiment running on those lines in Hong Kong. One must be careful before comparing circumstances in one country with those in another, but those familiar with the regime at Tai-Pan will know 582 that this is the sort of regime which is proving successful there and might prove successful elsewhere.
But what I would bring to my right hon. Friend's attention in recommending that these considerations of the magistrates be carefully weighed is that the virtue of a centre with a secure perimeter, with a little more discipline than we have in any institution at the moment, would be that it would prevent absconding and also the smuggling in of drugs, which would of course wreck the cure of anyone engaged in a difficult course of treatment.
The centre would have more than one use. It could, if built on the right scale, help in certain cases of alcoholism, and could be used for young people suffering severe psychiatric difficulty, for whom again no suitable accommodation is provided.
The crucial point is spelled out in this passage in the memorandum of the Magistrates' Association:Further consideration should be given to the desirability of perpetuation of the concept that a drug dependent patient has a right to demand the continuing supply of maintenance doses of his drug of addiction.As I said in Committee, this raises the main issue on the Bill. We have accepted this mode of State maintenance. I have always been in some doubt about the respectability of it. Added to that, we have rejected any course which increases the number of people likely to seek a permanent cure.
I do not believe that we can continue in this way indefinitely. Leaving aside the risks to the community, I do not believe that in our own interests we should continue with this policy of accepting that those dependent on dangerous drugs shall rely indefinitely, as long as their systems stand it, on the free supply of drugs at the State's gift.
My only purpose in tabling the Amendment was to obtain an assurance from my hon. Friend before we leave this part of the Bill that the issue will not die with the passing of the Bill into an Act but that it will be kept under active review and that we shall pursue vigorously our efforts to increase—I do not say the sanctions, but the disciplines which will enable us to bring more people, who may well wish it for themselves if they could be brought to that point, into the ambit of cure as opposed to maintenance.
§ Mr. Arthur Blenkinsop (South Shields)
I am glad that this issue has been raised but sorry that we are debating it at this late hour, because its seriousness demands that it should be discussed at greater length than is possible at this time of night.
I am glad that the right hon. Member for Ashford (Mr. Deedes) has made it clear that a very great part of the emphasis is being placed on the question of facilities for treatment and care that clearly are not yet available. This must be understood by those who call for a greater degree of compulsion in forms of treatment of patients, because what they are really after are greater treatment facilities.
Some of us who have been involved in examining the evidence on this question have been interested in how many of those who gave evidence, including the Magistrates' Association, have made clear their concern on this aspect. Those who have given evidence from the Prison Department, for instance, have expressed concern that so far we have not developed the kind of accommodation that offers the best hope for care and treatment.
Perhaps "treatment" is not always the right word. Some people are coming round to the view that an establishment which enables those who are dependent on drugs to be withdrawn from the whole drug field for a reasonable period is the most that we can hope for. Some take the view that withdrawing people for a period of years enables them to readjust and to be no longer at risk to the same extent. Some people take the view that there are certain ages when people are particularly at risk and that it may help if we can get them over that period. But when we consider compulsion, even in the limited form suggested by the right hon. Gentleman, we are considering very serious interferences with individual liberty, and we must look at the question very calmly and carefully to see how it might apply. The right hon. Gentleman himself rather suggested that such a provision might well apply to alcoholics and others. That was the assumption behind what he said, and there is a wide field of social deviant that we would no doubt have to consider if we proposed to extend the existing compulsory powers.
584 People are perhaps not as conscious as they should be that there are already fairly considerable compulsory powers. It is very important to be satisfied that those powers are adequately used and that there is a real need for their extension before we go further. Many of those who gave evidence to the Sub-Committee with which I was connected strongly felt that the existing powers were adequate and that they had found no need to consider wider powers. Some perhaps even doubt the value of some of the existing powers. There is a wide range of evidence to which we must pay attention.
It has been accepted for most purposes that in order to apply compulsory powers for treatment we must normally be thinking of the needs of the community as a whole and not specifically, or perhaps mainly, about the problem of the individual. If we are thinking of what may be good for someone himself we are extending this area of interference with individual liberty further than we would normally wish. Normally we have used this power only where there is a clear danger to the wider community.
§ Mr. Deedes
I know that the hon. Gentleman will not exaggerate the degree of liberty enjoyed by a narcotics addict.
§ Mr. Blenkinsop
Of course. This point has been raised many times. It has been argued by some who have given evidence to us that such people are in no position to determine their best interests. Here there is a very close analogy with the Mental Health Act. The interference may be for relatively short periods, and at other periods those concerned are fully in control, or almost in control, of their own affairs and their own actions. There is a tremendous range.
What struck many of us, when looking at the problem and hearing evidence from those who were most strongly eager to extend the existing powers, was that we found it almost impossible to obtain any definition of those to whom they would apply the powers. I think that we all felt that we must achieve a definition if we were to propose an extension. We must be clear to whom we would propose to apply it. It was not clear to us then, nor is it clear now. We have certainly accepted that there is a great need 585 for much further investigation of the whole issue not necessarily exclusively with regard to the drug addict but other groups. There have been recent studies which have some bearing on this with regard to alcoholics and they may be of value. There is also the fact that we have only recently passed legislation dealing with young offenders. It gives valuable and flexible powers of handling young offenders which may have some bearing on wider categories—young adolescents and others, perhaps. This is worth looking at as an area of investigation which deserves further consideration.
I think that some people are rather too easily tempted to draw an analogy between various forms of sickness and illness which may be contagious and the drug addict, but the analogy is not entirely satisfactory, as is apparent to most people. In most cases of contagious disease, we usually know what kind of treatment we want to apply. I wish that could be said of the drug addict, but it cannot, and we are deluding ourselves if we think that there is some easy way of escaping from the great wide social problem before us merely by saying that we provide compulsory treatment when we know very well that, except in relatively rare circumstances, treatment is a very uncertain factor.
§ Mr. Blenkinsop
I do not think that is a particularly good analogy either. I think that it is positively harmful for anyone to try to suggest that the drug addict problem is anything other than a whole complex of problems and that it is not very deeply linked with social problems of a very wide character. If we give even the appearance of thinking that there is some kind of shortcut, I think we are deluding ourselves.
All the experience we have been able to draw from other countries and the various forms of compulsory treatment they have initiated is not encouraging. I agree that we should look at other proposals, as the right hon. Gentleman has mentioned, but the experience of the United States, which has the greatest experience, offers perhaps some suggestion that we should not give up hope of the 586 possibility. But I do not think that we can go beyond that hope. It does not suggest any easy solution and certainly does not suggest that there is any short-period solution.
If one is to move into this area—which, indeed, we may have to consider further—of the provision of special security institutions such as have been suggested, then it is certainly a long-term matter and one which will require almost certainly longer than the year provided for in the Amendment. We would be misleading ourselves if we thought that there was any likelihood of anything shorter than that. We have to set against that the very grave dangers inevitably involved in any interference with individual liberty and the relationship of it to all the other types of social problem which might well be thought to qualify.
Certainly this matter should be further considered. I hope that the new bodies to be set up under the Bill will regard this as a matter of very great importance and will initiate studies and take account of the other groups in the social problem area which are very closely allied to this question. But it would be a great mistake—and I do not really believe that the right hon. Gentleman proposes this—to write it into the Bill. Rather should we encourage the further investigations which are so urgently needed.
§ Mr. Philip Goodhart (Beckenham)
It may seem odd to some hon. Members, and it certainly seems odd to me, that after five years, during which drug addiction has been an increasingly important social problem, we should not have had available a full and authoritative study of the question of the compulsory treatment of addicts. I do not mean in any way to criticise the Sub-Committee with which the hon. Member for South Shields (Mr. Blenkinsop) had so close a connection, because after all, his subcommittee was asked to undertake a review of the compulsory treatment of addicts only in March, this year, and it is understandable that it should not have had time to put before us a complete and balanced study of the problem.
However, the Sub-Committee established that powers for ordering compulsory treatment were fairly widely used already. Of some 3,000 admissions of 587 drug addicts to psychiatric hospitals in 1968, some 459 were admitted under compulsory treatment orders, mostly under the Mental Health Act, but some under Section 4 of the Criminal Justice Act, 1948. I understand that the number of probation orders made under that Section has increased sharply in recent months. The principle of the compulsory treatment of drug addicts is therefore already in wide use.
Whether it should be extended was the subject of much evidence to the Sub-Committee by consultant psychiatrists. Some consultant psychiatrists working with drug addicts did not use compulsory powers and did not wish to do so; others used them and considered that the existing powers were adequate; some used the existing powers but considered that the extent to which they should be applied to addicts needed to be clarified and that additional powers were needed. In other words, the House will not be surprised to find, the consultant psychiatrists, who were expert in this matter, had every possible option open to them at one time or another.
§ Mr. Blenkinsop
It is interesting to note that those who had the closest and most regular contact with drug addicts were almost unanimous in not wanting any extension of the powers.
§ Mr. Goodhart
That may be. But I come to the memorandum which I think has been sent to all hon. Members who were on the Sub-Committee and to all hon. Members of the House who have shown an interest in this subject. After all, the Magistrates' Association has some expertise in this field, and the psychiatrists are not the only ones who have expert knowledge. Certainly, when hon. Members now on this side of the House were in opposition, we used to quote the texts of resolutions passed by the Magistrates' Association as though they were almost Holy Writ. It is from three members of the Magistrates' Association who have considerable medical experience of this problem that the memorandum has come, urging that the powers should be increased.
The hon. Member for South Shields said that his Sub-Committee was unable to think of any particular group to which added powers of compulsory treatment 588 might be applied. In their memorandum, the Magistrates' Association picked out one group. After pointing out that they accepted that difficulties were bound to occur in securing the co-operation of a patient where admission for treatment was compulsory, and after stating that they did not want it to minimise the problems, they went on to say:At the same time, we feel that in many cases compulsion is necessary, particularly to support the patient when his motivation for cure vaccilates.A number of us in this House have had some experience of addiction when the desire for cure has vacillated. It would be fair to say that, between 1948 and 1958, I gave up my addiction to cigarettes at some 40 different times. But it was not until 1958, when I had the external discipline of a doctor telling me that I was particularly sensitive to nicotine and would do better to give it up for the sake of my health, that I finally gave it up.
Most hon. Members have a considerable amount of self-discipline, but the group of drug addicts about whom we are talking tend to have less self-discipline than the normal run of citizens in this country. Those who had any self-discipline to start off with, tend to have their powers eroded by the drugs which they take. So I should have thought that those who showed some willingness to undertake a voluntary cure, but who needed the support of the discipline of compulsion in order to see the cure through, would benefit by the acceptance of a Clause such as this.
The point has been made by my right hon. Friend that the facilities for compulsory treatment are not in existence in this country at the moment. Here we have the chicken and egg situation because, until we have adequate powers of compulsory treatment, it seems highly unlikely that the Department is going to make the necessary money available to provide those facilities.
It is obvious that until those facilities are available doctors will not use the powers they already have under the Mental Health Act or Section 4 of the Criminal Justice Act. I hope that in the next few months we will have a strong lead from the Government over the provision of facilities and that my hon. Friend will accept this Amendment. If 589 he is not prepared to do so now perhaps he will consider taking steps in another place to obtain reserve powers so that at some future time new powers for compulsory treatment can be brought in without the necessity of bringing in another Misuse of Drugs Bill. It is not every year, thank heaven, that we have such a Bill. The tide of informed opinion, medical and lay, is moving towards a wider use of compulsory powers.
§ 12 midnight.
§ Mr. Selwyn Gummer
I want to take issue with the point raised by the hon. Member for South Shields (Mr. Blenkinsop) on the question of compulsion. There is considerable evidence, not only from the work done at St. Mary's Spelthorne, in this country, but by Odessey House in America, that the circumstances envisaged in this Amendment would be very helpful in the treatment of drug addiction. We should be mistaken if we felt that we could leave this provision to some future time when we might know more about this. I take seriously the point made by my hon. Friend the Member for Beckenham (Mr. Goodhart) who said that we will not have such a Bill every year.
We are giving ourselves the opportunity to make a change in the law, enabling us not only to have a further provision of the kind envisaged here but also to take advantage of experience in America. This suggests that if we can only give addicts the first chance to come to terms with the effects of drug-taking and strengthen them at the time at which their will vacillates, we can introduce them to a therapeutic community in which they will be able to overcome their addiction. The experience of the drug addiction centre in my constituency is that any extension which would give them that chance at a point at which their will may not be very strong is something that they would welcome. So far I have not met, certainly in the U.S.A., any opposition to this kind of enactment. The feeling there was that such a measure would help considerably.
§ Mr. Blenkinsop
Is the hon. Gentleman aware of the strong feeling expressed in America that there is a danger that some hospitals have been turned into prisons so far as general attitudes are concerned and that if we institute this 590 sort of compulsion we may endanger the possibility of getting certain people in for treatment at all?
§ Mr. Gummer
The hon. Gentleman is right that there are real dangers. My experience, from spending some time in a drug addiction centre and living there was that there were a number of people who had been referred to it under similar provisions making remarkable recoveries from addiction which would not have been started if the oportunity had not been available for them to be referred, compulsorily, to Odessey House in this case.
It would be a great mistake to allow this opportunity to pass without making some such change in the Bill. I very much hope that my hon. Friend the Minister of State will at least assure the House that opportunities compulsorily to refer people who come to doctors as envisaged in the Clause will not be opposed because, in some sense, we do not have all the information which we should like to have. We shall not have another opportunity to do it. Experience in the United States and at advanced centres in this country suggests that this proposal would be well worth adopting, and I should be sad to see it lost.
§ Mrs. Renée Short
I find it a little odd that hon. and right hon. Members opposite should be supporting this draconian proposal for compulsory detention for treatment in secure conditions when, only a short time ago, they made such heavy weather of new Clause No. 1, proposed by my hon. Friend the Member for West Lothian (Mr. Dalyell), which made the rather gentle suggestion that there should be tests carried out at school children's medical examinations. I suppose that the leopard is only now showing its real spots.
The difficulty in the whole subject of treatment of drug addiction in this country is that there is no agreed method of treating the addict. The onus is on the Royal Colleges in that they have not come together and made up their minds on how drug addicts should be treated. In the circumstances, the proposal put forward by the right hon. Gentleman the Member for Ashford (Mr. Deedes) should be strongly resisted, because we do not really know what we should be setting in train.
591 The right hon. Gentleman said that there is a system of treating drug addicts by giving them controlled doses of the drug to which they are addicted. This, again, is not agreed by all doctors treating addicts. As the right hon. Gentleman knows, there are some doctors who treat addicts on hard drugs by oral administration of non-addictive drugs. We just do not know enough about the different methods of treatment at present used by the medical profession.
I have a certain amount of sympathy with the first part of the proposal—compulsory detention either for observation or assessment for not more than 28 days".It does not follow that drug addicts always tell the truth about how much they need of their particular drug, and only by having the patient in hospital and really observing him can one find out the level of his addiction. I agree about that, but I strongly resist the second part of the proposal, that is, forcompulsory detention for treatment in secure conditions for not more than one year".The right hon. Gentleman described rather vaguely the sort of secure conditions which he had in mind. The fact that this idea comes from the Magistrates' Association does not weigh heavily with me. I do not think that magistrates are the repositories of all wisdom on this or any other matter which they discuss. There are a lot of rather fuddy-duddy people in the Magistrates' Association who are not in touch—[HON. MEMBERS: "Shame."] Not at all. I have served on the bench, and I have seen them at close quarters. There are many magistrates who are not in touch with young people and their problems or with medical treatment, or, indeed, with the way in which we treat offenders in our system. The Report of the Estimates Committee which my Sub-Committee produced in 1967 had a few things to say about the way in which magistrates deal with young people. I recommend hon. Members opposite to have a look at this.
The available secure conditions are rather limited. If we are talking about young persons, a borstal institution is not the place to send a young drug addict, if only because there will be very little treatment available. The same can be said about sending an adult drug addict to prison. Prison psychiatric services are 592 grossly under-staffed and grossly over-loaded, and the treatment facilities needed by the addict are not available.
If we are talking about secure conditions in an establishment like Grendon psychiatric prison, facilities are available there but drug addicts are not necessarily criminals, and putting them into a prison environment would militate against successful treatment. The only really suitable hospital is a special hospital where secure conditions can be provided and where there are medically qualified staff capable of dealing with addicts. The idea is fraught with difficulty. There is the difficulty of getting the patient into secure conditions and of providing a physical environment in which success could be achieved. To achieve success there has to be co-operation from the patient; nothing will be achieved by compulsion. We should do much more to motivate drug addicts towards acceptance of treatment on a voluntary basis.
Emphasis should be laid on the environment to which the patient returns after treatment. It is foolish, and a waste of medical resources, to push patients out of hospitals or treatment centres back into the environment where they became addicts. We should be supplementing the voluntary organisations who are working on this problem. A small number of people are working very hard, and with some success, but the resources available to them are grossly inadequate. We should be giving a lead in providing a bridging service between hospital treatment and the return to ordinary life. If we have money to spend we should spend it on this and not on setting up prison-like establishments which would be unsuccessful and difficult to operate.
I hope the Minister will resist the arguments of the right hon. Member for Ashford and hon. Members on the Government side who have supported him, and not be tempted to give concessions to them.
§ 12.15 a.m.
§ Mr. Timothy Raison (Aylesbury)
Earlier, I found myself very much disagreeing with the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) about the testing of schoolchildren. Now, very much to my surprise, I am leaning towards her view and against that put forward by my right hon. 593 Friend the Member for Ashford (Mr. Deedes) and my hon. Friend the Member for Beckenham (Mr. Goodhart). I appreciate the seriousness of the problem and the reasoning which they have put forward, but I am not yet fully persuaded that the degree of danger in terms of civil liberty which is exposed by their proposal is justified.
As I understand my right hon. Friend the Member for Ashford, the purpose of his Amendment is twofold. It seems to me that it is partly a penal purpose. Perhaps that is overstating it a little, but part of the essence of what my right hon. Friend is saying is that he believes that these people should be locked up. It is not unfair to say that one can see in that something of a penal purpose about it. In particular, the fact that the Amendment is in terms of a maximum of a year rather than in terms of detaining people until such time as they shall be considered cured to some extent reinforces my view.
Irrespective of whether there is something of a penal element about the Amendment, however, we can question it also on its therapeutic impact. Obviously, I am not arguing that detention is solely intended to be penal—clearly, it is primarily meant to be an aid to therapy—but would detention serve a therapeutic purpose?
I believe that the hon. Member for South Shields (Mr. Blenkinsop) and his Committee found that the volume of evidence from the doctors whom they saw tended to support the view that this proposal was, at least in the light of present knowledge, likely to do more harm than good. They argued, I think with force, that a degree of willingness and co-operation is probably necessary on the part of the patient if treatment is to be effective. I am not sure that the notion of compulsory detention would encourage that degree of willingness. I know that, in some cases, the patient is, in a sense, beyond it, but that is not true in all cases and I believe that the introduction of compulsory detention would, to some degree, produce harmful conditions.
Secondly, it is valid to say that the possibility of detention could discourage addicts from seeking treatment. They might well think that if they came forward and revealed their addiction, they could land themselves in trouble. Thirdly, 594 the hon. Member for South Shields asked whether these powers could be confined to this one group of drug addicts without their being extended to alcoholics, sexual deviants, and so on. That is another valid point. We must think about this much more deeply and carefully than is possible in this relatively short debate.
Fourthly, the question has been recalled of whether we know enough about treatment and the success or otherwise of the sort of methods that are available to justify the introduction of this compulsory detention. In the history of mental health, there has been a great deal of argument about the way in which compulsory referral to hospital should take place. A long civil liberties-cum-medical argument is involved here, and it would be a great mistake to do anything precipitate in this problem.
Admittedly, all these points which I have put forward are tentative points and it is conceivable that, in time, we will come to realise that compulsory detention is justifiable. It is feasible that we may reach that position. There would, however, need to be a very strong case for it and, certainly, a stronger case than has so far been made.
I acknowledge that the Amendment is not, as it were, seeking to introduce compulsory detention; it is seeking only to introduce the power for the Secretary of State to introduce regulations which would introduce compulsory detention. If we were prepared to accept that, then, at the very least, these regulations should require positive affirmation by the House. This is not envisaged in the Bill as it now stands.
There is an important issue of principle at stake. To allow these new regulations through on the nod, as it were, would not to my mind be aceptable. I am not yet persuaded that we need the power to make these regulations in the Bill, and I feel that it would be wrong to accept it at this stage. I am sure that the new advisory council will give a lot of thought to this question. I do not believe that it is beyond the wit of the Leader of the House and of our legislators to introduce a new short Bill, if necessary. However, I do not believe that it is necessary at the moment.
§ Mr. Elystan Morgan
I am sure that we all agree that the right hon. Member 595 for Ashford (Mr. Deedes) and his hon. Friend the Member for Beckenham (Mr. Goodhart) have done a good service by bringing forward the Amendment, because it enables the House to remind itself of the great conflict in this situation between medical considerations and considerations of personal liberty.
Some doctors state their case clearly, as did Dr. Max Glatt, the British delegate to the World Health Organisation, when he put it in this way:Why should we stand by and see people die?On the other hand, there is the libertarian case, which can be stated in these terms: that with very few exceptions, the courts are not entitled to deprive persons of their liberty, unless those persons have committed very serious criminal offences or have been deliberately in contempt of those courts.
Therefore, although the idea is fundamentally sound, that unless there is a known therapy which guarantees a fairly high prospect of success in the treatment of persons addicted to drugs, there would be no justification for detention in the terms envisaged by the Amendment.
Furthermore, as was pointed out by my hon. Friend the Member for South Shields (Mr. Blenkinsop), whose detailed knowledge and experience of these matters we greatly appreciate, it is highly unlikely that any caution would bring about the desired results in this connection.
I mentioned that it was unusual for the courts to have power to deprive a person of his liberty, save in the circumstances to which I referred. However, I should point out that it is not the courts which are vested with authority here; it is the Home Secretary. Clearly, even if this were limited to the most serious cases—I take the point made by my hon. Friend the Member for South Shields that it would be extremely difficult to draw the borderline between these cases and alcoholics, for example—it would clearly be wrong to vest the Home Secretary of the day with such judicial powers. Indeed, there is no provision here for a hearing, and there is no mention of any appeal procedure. Therefore, I should argue that, as the Amendment stands, it must be regarded as wholly unacceptable.
596 I remind the House that the Brain Committee, both in 1961 and in 1965, came to a definite conclusion about this matter, because it stated:We believe that every addict should be treated energetically as a medical and psychiatric problem. The evidence presented to us indicates that the satisfactory management of these cases is not possible except in suitable institutions. We are not convinced that compulsory committal to such institutions is desirable. Good results are more likely to be obtained with co-operative rather than with coerced patients. At a time when the compulsory treatment of the mentally sick is being steadily diminished we see no ground for seeking new powers of compulsion for the treatment of drug addicts.I concede that the problem is such a serious and complex one that it cannot be left there and, as I suggested in Committee, I should very much like to see the Home Secretary, the Minister of State, and officials in the Home Office directing their minds to the possibility of having for adults something along the lines of the provisions for children in Sections 11 to 19 of the Children and Young Persons Act. There should be a system which enables a supervision order to be made which is stricter in terms than the probation order made under Section 4 of the Criminal Justice Act, 1948, but which, nevertheless, falls short of detention in the terms of the Amendment. I do not suggest that such a judicial power should be vested in the Home Secretary. It should be vested in the courts.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
Perhaps I may start by referring to the helpful comments of my right hon. Friend the Member for Ashford (Mr. Deedes) and his reference to what, for shorthand purposes, I may call the Blenkinsop Sub-Committee of the Advisory Committee on Drug Dependence. The interim conclusion of that Sub-Committee was that it did not wish powers to be taken in this Bill, whilst conceding, as I do, that the whole question of compelling addicts to undergo treatment and rehabilitationdeserved more thorough and wide-ranging study ".The Government accept that general proposition. We shall be considering this question of fuller study in the light of the fuller report which we believe and hope the Blenkinsop Sub-Committee will 597 presently be presenting. I hope that the hon. Member for Cardigan (Mr. Elystan Morgan) will accept that the specific point made by him in his concluding remarks about narrow and legal changes which might come into view will be taken into consideration in this fuller study.
There has been a fascinating debate on this whole evenly balanced subject, with which the Blenkinsop Sub-Committee occupied itself, of detention under compulsion and the liberty of the subject. Perhaps I come down on the side of my hon. Friend the Member for Aylesbury (Mr. Raison) and the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short). I remind the House that really there are two stages that we have to take into consideration when dealing with an addict. There is not only the cure, but also the rehabilitation, and the significant reality which the House has to bear in mind is that although for purposes of analysis we can divide these two treatments into cure and rehabilitation, in terms of the best practice this is indivisible.
The most modern continuum treatment centres follow a policy of gradually reducing the dosage of heroin addiction as part of the cure, subsituting for it methadone, whilst simultaneously sending the addict, still in a sense addicted, into the context of normal life in the community in an attempt, through the agencies of social workers, employment officers, and perhaps probation officers, to find satisfactory work for them so that they can take a normal part in communal life even whilst remaining addicted. The whole process is inevitably bound up with rehabilitation.
I ask the House to reflect on what would happen if one artificially divided this process by compelling the addict to suffer detention as the first part of this artificial division—namely, the cure part—and then, when the cure is alleged to have been completed, to discharge him into the community for rehabilitation. As soon as he was discharged from his compulsory cure, the necessary confidence and links between his enforced detention and rehabilitation would be broken.
Hon. Members will accept that there is a contradiction in terms here. First one begins by making the addict a sort 598 of voluntary in-prisoner. I cannot see, therefore, how such a form of treatment could possibly coexist with this artificial division between cure, under detention, and attempts thereafter to rehabilitate when the patient, the prisoner, wants to do nothing more than shake the dust of the detention centre or prison centre from him. Shades of Russia and Solzhenitsyn readily spring to mind. This is bound to be terrifying unless it is really free.
If there is to be a genuine continuum between cure and rehabilitation, it must happen in a condition of mutual confidence. There must be willing cooperation. We must, therefore, give great thought to this question of actually projecting the addict into communal life while he remains partly addicted and while he is going through the process of reduced dosages. The House and, no doubt, the Blenkinsop Sub-Committee will wish to weigh this point. On the basis of what little we know about this, I do not believe that it would be easy to make this division between creative, willing rehabilitation and enforced detention for cure.
My hon. Friend the Member for Beckenham (Mr. Goodhart) went so far as to express the hope that detention would prove appropriate and that we would accept the Amendment in its present form. I ask him to weigh carefully the points which have been made by a number of hon. Members on both sides on the subject of the freedom of the individual. My hon. Friend the Member for Aylesbury (Mr. Raison) made it eloquently.
The Amendment would give my right hon. Friend power to make regulations which would have a profound impact on the liberty of the individual. I do not think that regulations are a proper instrument for taking far-reaching powers such as enforced detention for up to 12 months for people whose misdemeanour is extremely difficult to define in a Statute. How would one define my right hon. Friend's example of the proselyser? It was difficult enough trying to define a prostitute under the Street Offences Act.
§ Mr. F. P. Crowder (Ruislip-Northwood)
Is my hon. Friend aware that Clause 28(2) is the underlying feature of the Bill? What has he to say about that in relation to the liberty of the individual?
§ Mr. Alison
It is nice to see the experts present.
It is not only the liberty of the individual which may be profoundly at risk if such questions of definition are left to mere regulation. There are obviously other unsatisfactory aspects of the Amendment. The reference to the two doctors, for example, falls short even of the safeguards that we have written into the Mental Health Act, under which not only the two doctors are brought into play, but the consent of the relation, friend, or member of the family. The extent to which we have isolated the unfortunate addict from the parental context of the discussions is striking.
The two doctors, in another Act, have often been the subject of considerable misgivings and disquiet, in that it is alleged that abuses arise when the opinions or wishes of two doctors are held to be relevant to a given state of affairs. There are the same attendant risks here if two doctors are brought in without the safeguards of the member of the family or parent that we find in the Mental Health Act.
I must ask my right hon. Friend the Member for Ashford and my hon. Friend the Member for Beckenham to accept our firm commitment not finally to have made up our minds on the deeply complex balance of views on this problem. We are anxious to pursue the matter in further study. I ask them to allow the Government to reject the proposal that either we accept this form of words for imposing a regime of compulsion, or that we might, in so short a time as the consideration of this Bill in another place, introduce a more perfect form of words. We agree that further study is required, and that will be made.
With those assurances, I hope that my right hon. Friend will consider it reasonable to withdraw his Amendment.
§ Mr. Blenkinsop
Before the hon. Gentleman sits down, will he take into account an earlier report of the Rehabilitation Sub-Committee, which called 600 for special research and study into the relative effectiveness of compulsory treatment in prison and voluntary treatment in hospital? This has been further supported by the recent working party of the Medical Research Council. I hope that this will prosper, and that the hon. Gentleman will do all that he can to encourage that research.
§ Mr. Alison
I happily agree to that general proposition, and I hope that the hon. Gentleman will underline it in his Sub-Committee if he thinks that there is scope for it in its report.
§ Mr. Deedes
With the leave of the House. May I thank my hon. Friend warmly for his very fair and capable reply to this Amendment? He talked more convincingly than most doctors on the subject. If he made that speech often enough, he would be in danger of making up minds.
The House will realise that our idea was to give the subject an airing, not to push the Amendment to a Division. In my view, no decision will be reached by the medical profession, even if the matter is left for five years. In the end, it will be a matter for us to decide.
Having said that, I beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.