MENTAL HEALTH BILL

HL Deb 16 July 1959 vol 218 cc150-64

7.10 p.m.

Order of the Day for the Third Reading read.

THE LORD CHANCELLOR

My Lords, before I move the Third Reading of this Bill I would suggest that we take the Third Reading formally. I will then move the Amendments, and we can then have any discussion on the Motion that the Bill do now pass. I beg to move that this Bill be now read a third time.

Moved, That the Bill be now read 3^a.—(The Lord Chancellor.)

On Question, Bill read 3^a, with the Amendments.

THE LORD CHANCELLOR

My Lords, your Lordships will see that there are a number of Amendments. I have gone through them carefully and I have a full note, which I have mastered, on each one. They are all drafting and clarifying Amendments. If your Lordships are prepared to accept that from me, I will move that all the Amendments on the Marshalled List be agreed to. If there are any points noble Lords may wish to raise I shall be glad to deal with them. I beg to move.

Amendments moved— Clause 80, page 60, line 44, at end insert ("or, where he is treated as if he had been so admitted by virtue of a direction under subsection (1) of section sixty-six of this Act, such form of mental disorder as may be specified in the direction under that subsection.") Clause 87, page 68, line 6, leave out ("Part IV of") Clause 87, page 68, line 8, after ("treatment") insert ("under Part IV of this Act") Clause 87, page 68, line 11, leave out ("the said Part IV") and insert ("this Act") Clause 87, page 68, line 13, at end insert ("under the said Part IV") Clause 87, page 68, line 15, leave out subsection (4). Clause 94, page 71, line 31, at end insert ("or under subsection (2) of section sixty-four of the Criminal Justice (Scotland) Act, 1949")

Clause 96, page 71, line 48, at end insert— ("(3) A patient removed to England and Wales under this part of this Act or under subsection (2) of section sixty-four of the Criminal Justice (Scotland) Act. 1949, shall be treated for the purposes of this Act as suffering from such form of mental disorder as may be recorded in his case in pursuance of regulations made by virtue of section ninety-four of this Act, and references in this Act to the form or forms of mental disorder specified in the relevant application, order or direction shall be construed as including references to the form or forms of mental disorder so recorded.") Sixth Schedule, page 122, line 36, at end insert (",and references in this Act to the form or forms of mental disorder specified in the relevant application, order or direction shall be construed as including references to the form or forms of mental disorder so recorded.") Seventh Schedule, page 140, line 24, column 2, leave out from ("hospital") to ("under") in line 27, and insert ("mental nursing home or place of safety") Seventh Schedule, page 146, line 33, column 2, leave out from ("1959") to ("or") in line 35 Eighth Schedule, page 149, line 38, column 3, at end insert ("In the Eighth Schedule, the amendment of section two of the Mental Deficiency Act, 1913") Eighth Schedule, page 150, line 19, column 3, at end insert ("In the First Schedule, in Part I, the amendment of subsection (6) of section fifty-seven of the Education Act, 1944, and, in the amendments of section one hundred and sixteen of that Act, the paragraph beginning with ' For the words'; and in Part II, the amendments of the Mental Deficiency Act, 1913") Eighth Schedule, page 151, column 3, leave out lines 28 to 30.—(The Lord Chancellor)

LORD SILKIN

My Lords, I am sure the House will be delighted to accept the assurance of the noble and learned Viscount the Lord Chancellor. If any further assurance is necessary, I can say that I have been through the Amendments and that I am perfectly satisfied.

On Question, Amendments agreed to.

THE LORD CHANCELLOR

My Lords, perhaps I may follow the procedure that I followed two days ago. I should like to move formally that this Bill do now pass and then have the opportunity later on to deal with any points that your Lordships may care to raise. I hope your Lordships will not take that amiss. I beg to move that this Bill do now pass.

Moved, That the Bill do now pass.—(The Lord Chancellor.)

7.13 p.m.

LORD SILKIN

My Lords, it is a real pleasure to pass from a measure which aroused a certain amount of Party political controversy to one which has been discussed throughout all its stages, both in another place and here, on a non-Party basis. It would be wrong to suggest that there have been no differences of opinion, but such differences as have arisen have certainly not been on any ideological or Party basis and have arisen through deep-felt feelings on the part of individual noble Lords or Members of another place; and they have been resolved, I think, in a reasonable and generally satisfactory manner. So far as I personally am concerned, I still feel that the Bill is defective, mainly in one sense—namely, as to the qualifications for detention. I still feel that Parliament is making a mistake in not retaining the safeguard of some kind of lay control. However, we have had our discussions on that and as a good democrat I accept the fact that that is probably not the view of the majority of people and it is not the view of the Royal Commission.

On the other hand, I can say with a good deal of satisfaction that the Bill is a much better Bill to-day than it was when it first came to this House. A number of noble Lords have given a great deal of time and attention to it, and as a result we have considerable improvements. For instance, we have an improvement in the definition of a psychopath. That is a difficult question and one which gave rise to a good deal of discussion. Whilst I am not sure that even now it is completely satisfactory, it is certainly a better definition than it was before. There has been some relaxation on the question of censorship of letters, a matter on which some of my noble friends and I felt fairly strongly. Then there have been other Amendments made to the Bill in the course of its progress through this House as the result of representations made from various parts of the House. I can hardly remember a Bill which has been discussed in such an objective and friendly manner, and with such generally satisfactory results, as this Bill has. Whilst it is, of course, a Bill that is far-reaching from the point of view of machinery, and provides the framework for carrying out vast improvements in our treatment of the mentally sick, on the other hand, it can remain a framework and nothing else. I hope and very much believe that it is the intention of all parties and everybody concerned to make a reality of this Bill and to take a big step forward in the consideration and treatment of the mentally sick.

I have referred to the improvements made to the Bill and to the discussions we have had on it, which I believe have been a model of what Parliamentary discussion on a Bill of this kind should be. No particular Party can claim credit for these improvements; they have been the result of discussions and representations from all sides of the House. I hope that the House (or so much of it as is now left) will forgive me if I refer to one or two individuals, and that for a particular reason. As your Lordships know, this House, and particularly my side of it, has needed strengthening for a long time past, and one of the methods of strengthening it has been the creation of a number of Life Peerages. I personally welcomed that step, but I wondered to what extent it was going to facilitate our work. It has been a great joy to me to find that the new Life Peers, certainly on this side of the House (I do not pretend to speak for the other side, or wish to do so) have enormously strengthened our opportunity of putting forward our views and in no case has that been so manifested as in the discussions on this Mental Health Bill.

If I may be invidious and mention names—and I will mention them in alphabetical order—my noble friends Lord Stonham, Lord Taylor and Lady Wootton of Abinger have all played a great part in modelling and shaping this Bill. They have come here with great experience, knowledge and wisdom, and, above all, with the ability to express themselves, which is of vital importance; and they have made (I hope they will not mind my saying this, and will not think I am being fulsome) a deep impression on the House. I should like to say, quite frankly, that I am satisfied that what we regarded as a dual experiment, that of creating a number of Life Peers and of introducing women Peeresses into the House, has proved a success on both grounds. I am sure the House is extremely grateful to them for the great work that they have done. From my own personal point of view, as one who takes some active part in the discussions in this House, it has been a joy to find that we can get a team together to work, to discuss and to bring before the House proposals that have been found worthy of consideration.

I should also like to say to the House, however—and I hope the noble and learned Viscount will not think that I am being fulsome—that we greatly appreciate the way in which he has dealt with this Bill. I am sure he would not pretend to be an expert on mental health, any more than I should, but he has been prepared to listen and to give consideration to every proposal that has been put forward in the Bill. He has given a large number of promises of consideration and he has kept every one of them, and kept them in a most friendly and courteous manner. Whether, at the end of the day, the proposals which have been put forward have been accepted or not, I should like him to know that we are entirely satisfied that he has carried out his assurances and given the consideration to the proposals as he promised. Naturally, in this life one cannot expect to get 100 per cent. of what one asks for: if one gets 25 per cent. one is very fortunate; and I think that probably that is about the measure of the success that has been achieved on this Bill. But I am perfectly satisfied, as I am sure are my noble friends who have taken such an active part.

I felt it right to say that because this is, I suppose, the first occasion on which my noble friends the new Life Peers have come into action as a team, and I hope that there will be many more such occasions. I have complained of the large number of Amendments that have been introduced into this Bill in the course of its progress. Perhaps I should not complain, because to a large extent it has been due to the willingness of the Government to think again and to go on improving the Bill. In the case of the previous measure which we discussed a short time ago, I was complaining of the very opposite—of the refusal of the Government to consider any Amendments at all; and I suppose I cannot have it both ways. I would rather have a Government who are prepared to look at the Bill, and look at it again and again, and make quite sure that it is satisfactory in all respects, than a Government who dig their toes in and refuse to consider any improvements, however good they may be or however reasonable. So we pass this measure. We hope that another place will accept the improvements we have made. We wish this Bill every success, and hope that it will have the effect we wish it to have in dealing with the mentally sick people who are covered by it.

LORD GRENFELL

My Lords, I will not keep your Lordships for more than one moment. I know that if my noble friend Lord Feversham had been here he would have said a few words at this time. I have been able to deal only with the children's side of this Bill, and I, for my part, am perfectly satisfied that we have put before my noble and learned friend and the right honourable gentleman the Minister the urgency of training and planning in the centres, and also the great urgency of research. That is as far as I go. I believe that with goodwill on all sides these things may be carried out. I should like to join with the noble Lord, Lord Silkin, in paying a tribute to those on the other side of the House, and especially those who have shortly come into the House, and to say that the great work that they have put into this Bill has been an inspiration to us, and we are most grateful. To the noble and learned Viscount I would say, as I said on Second Reading, that he has been a real inspiration to us all.

7.25 p.m.

LORD STONHAM

My Lords, I am sure your Lordships will understand that it is extremely difficult for me to speak at this moment, after listening to the warm, kindly and thoughtful words of my noble friend, Lord Silkin, supported as they were by the noble Lord, Lord Grenfell. I am sorry that my noble friends Lady Wootton of Abinger and Lord Taylor are not here—they had other engagements—but I am sure they would have felt, as I do, that we had not deserved such comments, and certainly felt also that we have been very glad indeed to do such work as we have been able to do on this Bill. I am certain that it would have been quite impossible but for the courtesy and kindness which your Lordships have shown, which, of course, is constant and universal, and which we experienced from the very first day we came here.

My noble friend said that we were a team. Of course, it is quite a usual thing for Members of this House or, indeed, of another place, who are of like mind and have a common interest in a particular measure, to get together and discuss particular points and, whether by accident or design, they do appear to form a team. But the remarkable thing to me about this Bill is that we have had a team of the whole House, and the skipper has been the noble and learned Viscount who sits on the Woolsack. It is a remarkable thing that I have never previously experienced at Westminster, and I am bound to say that, in my humble opinion, it is an arrangement that could not possibly be improved upon, certainly on a measure of this kind.

I am sure the noble and learned Viscount will understand me when I say that I do not feel, so far as he is concerned, that I can add anything to what I said on another evening of this week, except this. I always think that when we speak "off the cuff" it comes straight from the heart and expresses our meaning best. Since then I have read what I said, and I would not wish to alter a word of it. I am particularly grateful to the noble and learned Viscount, in that I felt that one of the major defects of the Bill when it came to us was in the provisions with regard to the mentally handicapped. I am bound to say that I raised quite a number of points, and on every single one of them I have been met either by an Amendment—certainly in one case a far better Amendment than my own—which the Lord Chancellor moved to meet my point, and on other points, where I have not succeeded in securing his agreement (and this particularly applies to the last two, where I did not think this was possible) I have received explanations which were completely satisfactory and which convinced me that the position was quite sound.

I should have wished, of course, that a great many of the clauses which we have passed, or will pass shortly, could have been mandatory and not permissive. But I feel that the spirit which has animated our discussion will continue, and if some parts of the Bill are not strong enough—if the authority to be given to the local authorities has not been imposed with sufficient force—nevertheless, if the drive that I expect to be given to this measure is given, then minor defects will fall into place and we shall get the position, before very long, when we can see all the mistakes we have made and when we can take steps to remedy them with the same good will with which we have discussed our differences on this particular Bill.

I feel that the great thing about this Bill is that we have turned our backs on the existing system of mental hospitals, which was a system based on segregation, segregation which arose through ignorance of the nature of mental illness, segregation which came from the fear that all the people had because of their ignorance of the nature of mental illness. The last ten years have seen such a revolution in public opinion on this subject that this Bill was not merely possible but imperative. We therefore, from to-day, shall be turning our backs on segregation and our faces towards the prospect of bringing mentally afflicted people to live in the community.

I have said before that the initiative will and must come from the mental hospitals, because only there at present resides the knowledge, the skill and the enthusiasm of dedicated people. It is not the fault of the local authorities, but it must come from the mental hospitals. What we have to see is that the enthusiasm that they have, the leaven which is already beginning to work, is not frustrated in little things. I believe that the doctors and nurses who are working in our mental hospitals are at last beginning to believe that mental health is no longer the Cinderella of medicine. There are many things we can do. I hope the members of the Council of the Royal College of Nursing will perhaps read our debates and at long last do full justice to mental nurses and make them full members of the Royal College of Nursing. I hope that in the junior appointments in mental hospitals we shall end this injustice of having junior hospital medical officers and have registrar appointments in the same way as in other hospitals. It is in those ways that we can assure the personnel of our mental hospitals, the front line troops in this Bill as they will, at the beginning, be, that we mean what we say.

My noble friend mentioned—and of course it is absolutely true—that everything will depend on the drive with which this Bill is implemented. I hope that the Minister will say to local authorities, "I want your schemes back and approved within twelve months, and within the second year we must make a start on implementing them." If that programme is carried out, this Bill will be a fact. If it is not, then I think it will be just words, and they will be tragic words for we shall have raised hopes only to dash them again. I do not think we shall do that. I think we shall go forward, that the Minister will be prepared as the scheme builds up to provide the necessary money, that he and his staff will tackle this job with such drive and enthusiasm that they will infect the local authorities with the same enthusiasm, and that they, with the hospitals, will work together in providing a service by which the mental hospitals will show that they not only can, but will, live in the community.

As my noble friend said, this was a good Bill when the Minister introduced it. I hope and believe it is a better Bill now. In a few moments we shall have done our job and it will be up to the doctors, the nurses, the local authorities, the whole community, and, above all, the right honourable gentleman the Minister of Health and his stall, to do theirs. I think they will do it, and I believe that in a few years' time, perhaps even less, mental health will have taken its place with the rest of our Health Service and be, as that is, the finest in the world.

7.35 p.m.

LORD PAKENHAM

My Lords, I certainly do not wish to strike a jarring note, but I present myself at this late stage, in a few words, as one who can be described as only a qualified admirer of the Bill. I am, however, at one with other speakers in being an absolutely unqualified admirer of the way in which the noble and learned Viscount the Lord Chancellor has handled the Bill. It has been a most edifying performance, and, if I may say so, if it were possible to admire any quality more than his industry and dexterity it would be the gentleness and kindness with which he has dealt with us.

I feel myself, as I felt when we discussed the Bill on Second Reading, that running through all our thoughts and discussions, and through the thoughts and discussions outside this House, there are two questions: first, the question of how we can provide adequate services, adequate in quantity and quality, which may mean devoting very large resources for the benefit of mental sufferers in order to prevent mental suffering in the future; secondly, according to what principles and procedure are we going to detain people against their wish in hospitals? There is the practical question and there is, if you like, the philosophical question, though it has a very practical edge; and those two questions are inseparable.

I think the noble and learned Viscount the Lord Chancellor would agree—he has never made any pretence otherwise—that this Bill is not concerned directly with expanding the mental health service of this country. The Bill itself contains no pledge of expanded service. I feel that that is a grave omission. It is open to the Government to say that they had their hands full with this Bill, and the other steps could be taken alongside and taken later. But I am bound to put on record my disappointment that that side of things has been neglected in this Bill. I agree very much with what was said by my colleagues, that of course it is still open to the Government to remedy that defect at a later time, and I know various steps have been taken in connection with the Bill which all point in the right direction. But it would be humbug, and indeed rather cowardly in this atmosphere of generous and sincere words, to conceal my opinion that a great opportunity of committing the Government to a great expansion of mental health services has been missed.

On the other hand, all those who have suffered most and laboured most in this field and with whom I have had any contact are agreed that one overwhelming task which is tackled directly by the Bill is the removal of the stigma which has separated those suffering from mental ill health from those suffering from physical ill health. Undoubtedly this idea of eliminating the stigma has been the driving force, as it seems to me, behind the philosophy of the Bill, and I entirely share the views of those who have applauded the Bill on that ground.

But, of course, even there very nagging questions have presented themselves. I think it might be said that they have been presented in the most difficult form by the noble Baroness, Lady Wootton of Abinger, not only here but in her recent book. It is certainly very difficult, as the noble and learned Viscount would agree (he is himself interested in metaphysics), to know how far you can press this analogy between mental and physical illness. You certainly find points of obvious difference. In the case of mental ill health we have at a certain point in the case of certain people to say to them, "We are sorry; you are not fit to make up your own mind. We are going to detain you against your will"; and that produces philosophical and moral questions of extreme complexity.

In the case of psychopaths we come to a point where misconduct and illness criss-cross and are very difficult to extricate from one another. As the noble Baroness, Lady Wootton of Abinger, said in her book, and as has been said elsewhere, the line between medical and moral becomes dangerously difficult to draw. These are problems whose difficulty the noble and learned Viscount the Lord Chancellor has never sought to conceal, and he would be the last to say that we are very far advanced as a nation or that the modern world has gone very far in sorting out these issues. But some real progress has been made during these discussions, in particular in connection with the improvement of the definition of the psychopath.

Nevertheless, my last words should not be of that character; because, when all is said, whatever the precise sums spent in the next year or in the year after that, or the year after that, this Bill should prove of the greatest benefit to many thousands of sufferers from mental trouble and also those who suffer with them as their dear friends or relatives. It will be, too, a vast encouragement to all those who have dedicated their lives to serve these people. I have in mind those like the noble Lord, Lord Grenfell, and other noble Lords in this House, such as Lord Stonham, the noble Earl, Lord Feversham, my noble friend Lord Taylor. I say that if only because it seems to me that the philosophy of this Bill is fundamentally right. It is based on the idea, which we can call Christian—I should like to call it Christian, but Heaven knows! there are many who are not Christians who share it—that we are all frail human beings, drawn together by our common human nature and, above all, by our common infirmities.

Because I applaud so sincerely, and indeed passionately, the philosophy behind this Bill I do welcome it, in spite of the political and, as I say, administrative reservations that I mentioned earlier. I join with all those who congratulate noble Lords (and here may I mention the noble Lord, Lord Silkin, who has boon our Leader), both here and on the other side, and, above all, the noble and learned Viscount the Lord Chancellor, who has set an example which he himself and others will find it very hard to follow in future years.

7.42 p.m.

LORD AUCKLAND

My Lords, I apologise for not having given notice of wishing to say a few words on this Bill, but as one who took part in the Second Reading debate, and as one who has had a most wonderfully explicit letter from the noble and learned Viscount on the Woolsack in answer to some extremely difficult questions, I should like to associate myself with noble Lords who have paid a tribute to the noble and learned Viscount. So often these days we have the excuse made by people in all walks of life that one is too busy to be bothered to reply to a letter. I can only say—and I know that I speak on behalf of many noble Lords who have received letters which have been concise and explicit— that we have received them promptly and courteously. Particularly in view of the great volume of other Business in your Lordships' House with which the Lord Chancellor has had to deal, I feel that no tribute could be too high to the work which he has put into this Bill.

The noble Lord, Lord Silkin, mentioned the model of democracy which has characterised the discussion on this Bill. In deference, I can only agree with him and say that those who criticise Parliament for apathy and for sluggishness, or for other reasons, would do well to read this Bill, which will prove to them that Parliament can, and does, discuss vital matters of this kind intelligently and assiduously. I think that is an important point. In conclusion, I should like to say that, with the high speed at which we live nowadays, the numbers of those who suffer mentally will not decrease, but, through scientific progress and through the exertions which both Houses of Parliament and all Parties have put into this Bill, those who are mentally handicapped will have a far better chance of recovering. I would say that this Bill will do more to show the world how we handle our health and social problems than perhaps any other measure.

7.45 p.m.

THE LORD CHANCELLOR

My Lords, in rising to thank every speaker for the kind words that he has said about me, I want to place only one memory before your Lordships. Your Lordships may remember that when I introduced this Bill on Second Reading I said that it was the first major measure and comprehensive revision of the law dealing with mental health since the great Bills of 1845. How different has been my experience from that of Lord Ashley, later the seventh Earl of Shaftesbury, who introduced those Bills and recorded in his diary of July 22, 1845,

have toiled through obstruction, insolence, delay, desertion to the Third Reading. I have been spared his anxieties which led him again—I give the words which he recorded: To dream every night and pass in my visions through every clause and confuse the whole in one great mass. I, on the contrary, have had the pleasure of informed and constructive debate from all parts of the House, and I should like to add my tribute to that already paid from both sides of the House to Lord Stonham, Lord Taylor and Baroness Wootton of Abinger.

I want to say only one word on each of two points. The first is that which was raised by Lord Pakenham. I should like to put into his mind that perhaps the most important difference between this measure and any other and earlier mental health legislation is that it is set against the background of the National Health Service, and that, so far as the provision of hospital and local government services to which he referred is concerned, the function of the Bill is really to adjust and strengthen the existing legislation. It clarifies the powers, but they are existing powers of a dynamic organism.

Much of the discussion in the Committee and on the Report stages was centred on matters of that kind—the expansion of local health authority services, the supply and training of staff, co-operation between the hospitals and local authorities and mental health research. I am glad that it was. But I do want at this last stage to reassure noble Lords who spoke on these subjects that, while they cannot, because of the structure of the Health Service, and that being the background, be included in this Bill, the Government, and especially my right honourable friend the Minister, recognise their fundamental importance and will strive with all the energy they have for improvement and advance in the existing machinery. I am most grateful for the help we have had in improving the Bill. I think that, as Lord Silkin said, the new definition, the correspondence, the Mental Health Tribunals and the guidance that has been given to me in making the rules, are very important points where we have together definitely made concrete improvements of which we know. I am not going to say any more on that aspect, but the fact that I do not say any more does not mean that I do not appreciate the help.

One other point which deserves just a word of mention is that raised by the noble Lord, Lord Silkin, with his great restraint, about the non-acceptance of the lay figure in the question of admissions. I think that there we have a genuine and unresolved difference of opinion which has certainly been thoroughly discussed, and we are satisfied that our system of check and cross-check provided in the Bill will provide safeguards which are both effective and appropriate to the present circumstances; and we believe that the doctors and laymen taking part in the procedure will justify the confidence which the Bill places in them. But, again, I want to say that we do not leave the matter with the idea that we have found a solution for all time. If we find in practice that improvements are possible, of course we shall be prepared to have a look at them.

Now we go on to put the Bill into operation. We have to prepare the regulations; to set up the Tribunals—and there I hope, indeed I am sure, that I shall have great help from the Council of Tribunals, under my noble friend Lord Reading; to ensure that the principles are understood, and then press on with vigour for their implementation. It is a great task which still awaits us; we understand that. But I want to say once again that I believe that this legislation was well worthy of our attention and that it has called forth the highest qualities which your Lordships' House can show; and that, in turn, has earned gratitude on my part which I shall not soon forget. I thank you again.

On Question, Bill passed, and returned to the Commons.