§ Order for Second Reading read.
§ 1.25 p.m.
§ Mr. William Whitlock (Nottingham, North)
I beg to move, That the Bill be now read a Second time.
I am pleased to be able to introduce this small but sensible measure that will close a gap in the Mental Health Act 1959 and remove such doubts as have arisen about the operation of that Act. I hope that it will be non-controversial as the rectification of the small omission to which I have referred is clearly in line with the spirit of the Act.
The gap in the Act was first brought to light by a judgment of the High Court in July 1972 making it clear that the interpretation of the law on which hospital authorities had hitherto been working could no longer be supported. The position, I am afraid, is rather complex.
Patients compulsorily admitted to hospital under the National Health Act must suffer from one of the four classes of disorder specified in the Act, namely, mental illness, severe subnormality, subnormality or psychopathic disorder. A person of the age of 21 suffering from one or both of the two latter disorders may not be compulsorily admitted unless that is ordered by a court or unless he is transferred from prison.
2169 However, a patient admitted from the community before the age of 21 and suffering from subnormality and/or psychopathic disorder and no other disorder may continue to be detained up to the age of 25 and beyond that age if the doctor responsible for him reports that if released he would be likely to act in a manner dangerous to himself or to others.
The diagnosis of mental disorder from which a person suffers may, of course, change, and a person admitted under one category may be reclassified as suffering from one of the other classes of disorder specified in the Act. Thus a person admitted to hospital as suffering from mental illness or severe subnormality may at any age be reclassified as suffering only from subnormality or psychopathic disorder.
Until 1972 it was thought that if a patient were reclassified in this way after the age of 25 the original authority to detain him still held good. But it is clear from the High Court judgment that that is not so and that if a detained patient, other than one subject to a court order, is reclassified as a psychopathic and/or subnormal patient and nothing else, after he is over 25 he may no longer be detained, no matter how dangerous he may be thought to be. This is so even though he may have been detained if he had been admitted under the age of 21 and at that time had been diagnosed as psychopathic and/or subnormal. He would then have been subject to the assessment procedure that is provided under the Act when patients attain the age of 25.
The purpose of the Bill is to provide for the examination of such patients and for their continued detention if it is decided that they would be likely to act in a dangerous manner if discharged. The Bill also resolves doubts that have arisen as a result of the High Court judgment in relation to certain classes of patient detained under a court order and patients admitted between the ages of 21 and 25. The Bill will secure that these patients too may continue to be detained, notwithstanding reclassification, as suffering from any other psychopathic disorder and/or subnormality if it is decided that they would be likely to act in a dangerous manner if discharged.
2170 It is obvious that any measure of this kind must include adequate safeguards for the patient. The safeguards in the Bill are, first, that he would be given the right to apply to the Mental Health Review Tribunal and would be discharged if the tribunal were satisfied that he would not be likely to act in a dangerous manner. Second, any psychopathic or subnormal patient over the age of 21 who is detained would have to be reassessed as to his continuing dangerousness by the responsible doctor when making each of the statutory two-yearly reports. If the doctor does not report that he is still thought to be dangerous, the power to detain will therefore lapse.
The number of patients who will be involved in such a reclassification is very small. The number of those who would be considered to be dangerous is even smaller. It is impossible at present to tell how many cases fall into this category, but it seems reasonable to assume that we are talking of a measure which will apply to fewer than 10 patients per year.
I hope the House will agree that this is a useful measure since it aims at the protection of the public and at the same time provides adequate safeguards in every way to protect patients and to prevent abuse.
§ 1.32 p.m.
§ Mr. Carol Mather (Esher)
I congratulate the hon. Member for Nottingham, North (Mr. Whitlock) on the way he has brought this matter to the attention of the House after discovering this loophole in the law. Questions of mental health cause a great deal of concern to those who are asked to judge upon them, whether doctors, family or anyone else. They are extremely delicate matters. We all have experience of constituents who have been detained for such reasons who believe that they should not be detained.
As I understand it, the Bill will allow for reclassification after the age of 25—a right which does not exist at the moment—for patients detained at the age of 21. Although the patient may be reclassified, the Bill allows him still to be detained if he is likely to act in a dangerous manner.
However, I have one query. The body which reclassifies the patient and is responsible for deciding whether he is still likely to act in a dangerous way must 2171 know more about the patient than the Mental Health Review Tribunal which answers any appeal. How is it that that tribunal can make better judgments than those who are actually responsible for looking into the case in detail?
§ 1.34 p.m.
§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
I should like to express my congratulations to my hon. Friend the Member for Nottingham, North (Mr. Whitlock) on his luck in the Ballot and on having chosen this Bill. I should like to express the Government's support for it. It is a small but important Bill which will close a small gap in the Mental Health Act 1959, which was brought to light by the judgment referred to by my hon. Friend.
If the Act were left as it is, there is a chance that an unfortunate incident might occur which could have been foreseen and avoided. If this were to happen it could only reflect badly on the working of the Act as a whole and might result in reactions which damaged the good will of the public to the mentally ill and the mentally handicapped generally. At a time when the community is becoming increasingly tolerant of those with psychiatric problems, this could be most unfortunate and could undo much of the very valuable work which is being done to create this good will by the health and social service authorities, voluntary bodies and the patients and their relatives themselves. The Bill will thus have the function of protecting not only the public and the patients concerned but also the reputation and standing of the Mental Health Act itself.
My hon. Friend has explained the purpose of the Bill very well but it may still sound a rather complex matter. As he said, however, it is likely to affect only a tiny number of patients for whom adequate safeguards would be made and its main function is to close a gap in the existing legislation which could otherwise result in some unfortunate repercussions over a wider area. The Government feel that it is well worth while taking the precaution of closing this loophole and hope that the House will feel able to give it support.
I shall look at the point raised by the hon. Member for Esher (Mr. Mather) and 2172 write to him. If that is not satisfactory, he can, of course, raise it again in Committee.
While we are discussing the Mental Health Act, perhaps it might be as well if I gave the House some information on how the Government regard it. That Act reflected the major shift in public and professional attitudes to the treatment of mental disorder which had taken place over the past decade, and which had been analysed with great clarity and percipience by the Royal Commission. Implementation of the Act reinforced these changes of attitude and itself brought about important improvements in the care of the mentally disordered.
In particular, the introduction of the concept of informal admission and the use of compulsion only when absolutely necessary led to a big reduction in the number of patients compulsorily detained. In 1955, 70 per cent. of hospital inpatients at any one time were detained and 30 per cent. were voluntary, whereas today only 10 per cent. are detained and the rest receive treatment and care informally. As the Royal College of Psychiatrists has pointed out, this and other changes have encouraged the development of new therapeutic techniques within the hospitals, better doctor-patient relationships, and a reduction of medical time spent in operating compulsory procedures.
The balance which the 1959 Act struck between the liberty of the individual and the needs of patients and of the public for protection has proved to have been well judged. There have been criticisms from opposing directions—on the one hand that it had become too easy for patients to leave hospitals and on the other hand that the powers of detention were still too extensive—but such criticisms have been few and in general the Act has been well received. Developments in care and changes in public attitude since 1959 have not been such as to suggest that there is any need for a major reappraisal of the law of the kind that was undertaken by the Royal Commission. We do, however, need to look critically at the detailed working of the Act.
The Committee on Mentally Abnormal Offenders under the chairmanship of 2173 Lord Butler has been reviewing the provisions relating to offenders and its report is expected in the summer. The Department has received reports from the Royal College of Psychiatrists and will receive them from MIND—the National Association for Mental Health—which I know is looking at this matter itself, giving their views on the working of the parts of the Mental Heath Act which are outside the remit of the Butler Committee. These views will be considered with those of other interested bodies and individuals and the Department will then issue, hopefully later this year, a consultative document setting out provisional conclusions of the extent to which amendment of the 1959 Act is called for. This document may well be available for consultation and comment at about the same time as the Butler Committee's report, although the timing may well be different—I cannot predict that. On the basis of those very full consultations, the Government will frame any legislative proposals that they think necessary in regard to the Act.
In the meantime, I am grateful to my hon. Friend and I think that the House is wise to close this loophole. I hope that the Bill has a quick and easy run through its remaining stages. Again, I congratulate my hon. Friend.
§ 1.39 p.m.
§ Mr. Whitlock
I am very grateful for the way in which the Bill has been received by the hon. Member for Esher (Mr. Mather) and by my hon. Friend the Minister of State. As the hon. Member said, matters of mental health are delicate and sensitive and we must approach them with all due sympathy and understanding.
The hon. Member seems to have doubts about the review tribunal. That tribunal will have before it all the evidence of the experts about each case, and therefore will obviously act with all the sympathy and understanding which is necessary. Therefore, I hope that this necessary safeguard for patients will be retained in the Act when it reaches the statute book. I am grateful for the support I have received.
§ Question put and agreed to.2174
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).