§ 3.12 p.m.
§ Order of the Day for the House to be put into Committee read.
§ Moved, That the House do now resolve itself into Committee.—(Lord Craigton.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The LORD MERTHYR in the Chair.]
§ Clause 1 agreed to.
§ Clause 2 [Establishment and constitution of Mental Welfare Commission]:
§ THE MINISTER OF STATE, SCOTTISH OFFICE (LORD CRAIGTON)This Amendment gives effect to an undertaking made by my right honourable friend on Report stage in another place. Its effect is to write into the Bill what, in any case, my right honourable friend would have ensured: that the position of Commissioner in the Mental Welfare Commission cannot be held by anyone while he is a civil servant, which includes medical commissioners; so that medical officers employed by the Department of Health for Scotland are barred. There can thus be no doubt about the impartiality of the Mental Welfare Commission in the exercise of its new duties to protect the interests of the patient. I beg to move.
§ Amendment moved—
§
Page 2, line 15, at end insert—
("( ) No person who for the time being is employed in the civil service of the Crown whether in an established capacity or not, and whether for the whole or Part of his time, shall be appointed to the Mental Welfare Commission; and for the Purposes of this subsection civil service of the Crown includes the civil service of Northern Ireland, Her Majesty's Foreign Service and Her Majesty's Overseas Civil Service.").—(Lord Craigton.)
§ On Question, Amendment agreed to.
134§ Clause 2, as amended, agreed to.
§ Clauses 3 to 7 agreed to.
§ LORD TAYLOR moved, after Clause 7 to insert the following new clause:
§ Proposals for provision of services by local health authority
§ ".—(1) Every local health authority shall, within such period as the Secretary of State may specify, submit to the Secretary of State proposals for carrying out their duties under this Act.
§ The Secretary of State may specify different periods under this section for proposals relating to different duties.
§ (2) Not later than the day on which any proposals are submitted to the Secretary of State the local health authority shall serve a copy thereof—
- (a) on every voluntary organisation with which the local health authority proposes to make arrangements for the purposes of section twelve of this Act;
- (b) on the Executive Council constituted under Part IV of the National Health Service (Scotland) Act, 1947 and the Regional Hospital Board for the area in which any part of the area of the local health authority is situated;
§ (3) The Secretary of State may approve the proposals with or without modifications, which may include additions or exceptions, or may remit to the local health authority to submit new proposals, and it shall be the duty of the local health authority to carry out their aforesaid duties in accordance with the proposals submitted and approved for their area under this section.
§ (4) A local health authority may at any time, and if directed by the Secretary of State shall within such period as he may specify, submit new proposals, and the last two foregoing subsections shall apply to any such new proposals.
§ (5) If any local health authority fail to submit any proposals which they are required to submit within a period specified by the Secretary of State, the Secretary of State may himself make proposals, and they shall have effect as if they had been submitted and approved under the foregoing provisions of this section:
§ Provided that, before making any such proposals, the Secretary of State shall serve a copy of the draft proposals on the local health authority and on every voluntary organisation which to the knowledge of the Secretary of State provides in the area of the authority services of the kind dealt with in the proposals and on the bodies mentioned in paragraph (b) of subsection (2) of this section, and give an opportunity to that authority and 135 those organisations and bodies to make recommendations to him for modifying the proposals."
§ The noble Lord said: I beg to move the Amendment standing in my name upon the Order Paper. I may explain that my noble friend Lord Greenhill should be moving this Amendment, but unfortunately he is delayed in Scotland; so he has asked me to look after it for him and to do my best. If I display a lamentable ignorance of Scottish local government and Scottish Mental Health Service provisions, I hope that the Committee will excuse me, but I have had very short notice to cope with this subject.
§
The purpose of the Amendment is to strengthen the Secretary of State's hand in seeing that the local authorities actually implement the schemes which are the essential basis of this Bill. As the Committee will be aware, this is Mental Health Week, and The Times newspaper to-day has a very fine leading article on the implementation of an Act on this subject dealing with England and Wales. The one point about which The Times newspaper expresses doubt is the capacity and enthusiasm and ability of the local health authorities to do the actual work of carrying out the creation of these new community services, which is essential if the Act is to mean anything at all. The Times points out the shortage of expert workers, of psychiatric social workers, and of the homes, and so on, and it says:
Nor is there any evidence that local authorities by and large have carefully ascertained what the precise needs are going to be. What sort of care will they need? How many will be capable of doing work? That the authorities have by and large accepted the principle that something must be done is easier to believe than that they know exactly what it is.
If we had been perhaps a little quicker off the mark when dealing with the England and Wales Mental Health Bill, before it became an Act, we might have suggested a similar provision to that which I am now proposing on behalf of my noble friend.
§ The point here is that we have lifted a clause out of the National Health Service Act. We have simply taken the section in the National Health Service Act which provides for the local authorities: to take the necessary steps to make a 136 scheme and submit it to the Secretary of State by a certain day, and then to make sure that they carry it out. In fact, if one takes the new clause, subsection by subsection, as we have put it down, it well be seen that it falls into a series of parts. First, it enables the Secretary of State to specify a date by which schemes have to be submitted. It makes a sort of "appointed day" for the submission of schemes. Secondly, it makes sure that all the parties concerned know about these schemes. The third thing it does is to make it a duty on the local authority to carry out the scheme once it has been approved. Fourthly, it enables the local authority to submit new schemes if things have changed; and, finally, it contains a sanction: that if a local authority fails to submit a scheme, then the Secretary of State may himself draw up a scheme.
§ I am sorry that this is such a formidable-looking new clause, but its purpose is quite simple. It is to make sure that the Secretary of State has the power to make this Bill a reality. Needless to say, we are not in any way wedded to the wording; we are concerned with the reality. We want to make sure that there is a service such as we all want to see, and that the Secretary of State has the power to see that the local authorities do the job. I beg to move.
§
Amendment moved—
After Clause 7, insert the said new clause.—(Lord Taylor.)
§ LORD CRAIGTONI am grateful to the noble Lord for entering the lists on behalf of Scotland. He expressed doubts about the ability and enthusiasm of the local authorities to do this work. That is a task for all of us, and we must be especially glad of the growing interest taken by the public generally in mental health, which so much helps all concerned. The question that faces me is whether the Bill would be strengthened, or whether our efforts would be strengthened, by putting this new clause in this Bill. I must agree with the noble Lord that its provisions are necessary.
Except for two necessary drafting points, the new clause is an exact duplicate of Section 21 of the National Health Service (Scotland) Act, 1947, which deals with the local health authority's duty to 137 submit to the Secretary of State proposals for the provision of services under Sections 22 to 27 of that Act. The noble Lord will remember that Section 21 applies to Sections 22 to 27 of the 1947 Act. So far as training and occupation functions of the local health authority are concerned, if the noble Lord will look at Clause 12, he will see that it specifically applies Section 21 of the 1947 Act to the Bill; in other words, the new clause is specifically applied to the training and occupation functions. So far as the general functions of the local health authorities are concerned, Clause 7 of the Bill adopts Section 27 of the 1947 Act, which automatically applies Section 21 of that Act. What Clause 7 does, as well as adopting Section 21, or applying it, as the noble Lord wishes, is to expand Section 27 of the 1947 Act to cover mentally disordered people as well. I must tell the noble Lord that I am advised that the intentions of his new clause are already fully achieved in the Bill as it stands, and that there would be no advantage at all in giving my right honourable friend the power that the noble Lord wishes by re-enacting Section 21 of the 1947 Act at length in this Bill. For that reason, I hope I have satisfied the noble Lord, and I must ask your Lordships not to accept the new clause.
§ LORD TAYLORCould the noble Lord explain two points? Will there in fact be an appointed day, as it were, by which time schemes must be submitted; and, having been approved, will these schemes then be mandatory on the local authorities for them to carry out?
§ LORD CRAIGTONAs I explained on Second Reading, we must go very gently here. We must not make any scheme mandatory on a local authority that the local authority cannot properly carry out. What we are therefore going to do is to ask the local authorities to submit schemes, then get all concerned to examine them, and then, in the end, we shall have to make mandatory a scheme which the local authorities feel that they are able to carry out in a proper manner.
§ LORD TAYLORI thank the noble Lord for his explanation, and on the undertaking that he has given I beg leave to withdraw my Amendment.
§ Amendment, by leave, withdrawn.
138§ 3.22 p.m.
§ LORD TAYLOR moved, after Clause 7 to insert the following new clause:
§ Provision for training of psychiatric social workers and occupational therapists
§ "The Secretary of State shall make provision for the training of psychiatric social workers and occupational therapists and shall co-operate with local authorities and other employing bodies in providing field work training of the necessary standard."
§ The noble Lord said: This second new clause deals with something which my friends in another place found was out-with the scope of the Bill. In other words, they were trying to implement the Younghusband Report by adapting this Bill, in so far as it affected psychiatric social workers and occupational therapists. Having found that it was impossible to introduce a training council for social workers, we thought the best way to tackle it would be to make sure that the Secretary of State had powers to assist in and to encourage the training of psychiatric social workers and occupational therapists, and power to co-operate with the local authorities in this matter.
§ I understand that the situation with regard to trained occupational therapists in Scotland is a very serious one. Apparently, there are only about 47 trained occupational therapists in Scotland, and at one hospital, the Hartwood and Hartwood Hill Hospital, there is not a single trained occupational therapist. Clearly something needs to be, done. How it should be done I do not profess to know for certain, and I am not at all sure that the wording of my new clause is the right wording. One might have preferred to say that the Secretary of State shall have power to assist in the making of provision rather than that he should himself make provision, because it might be that it should be done through some voluntary agency with his assistance; but we should like to feel sure that he has the power to provide the raw material for the working of this Bill, because unless he has these trained social workers and occupational therapists, then these local authorities cannot really do their job. I beg to move.
§
Amendment moved—
After Clause 7, insert the said new clause.—(Lord Taylor.)
§ LORD CRAIGTONWe have no quarrel at all with the intention behind this 139 new clause. We have carefully considered it and have decided that it would not be right to put into the Bill this obligation on the part of the Secretary of State, and I hope to be able to convince the noble Lord that we are right. First, let us take the training of occupational therapists. These skilled people are only one group of a number of medical auxiliaries employed in all types of hospitals, not merely in mental or mental deficiency hospitals. There are also, for instance, radiographers or physiotherapists. It would not be appropriate, therefore, to single out one type of medical auxiliary for specific statutory provision of this kind, especially in a Statute dealing only with mental health. However, I agree with the noble Lord that the training of occupational therapists is a serious matter, and it is being treated very seriously. There is a long-established training school at the Astley Ainslie Hospital in Edinburgh, and the Western Regional Hospital Board are, at the request of my right honourable friend, investigating where in Glasgow a second Scottish school should be established.
Then there is the training of psychiatric social workers: the actual provision of training for psychiatric social workers is a matter for the university authorities, with grant aid from the Department for individual students where it is appropriate. So it really would not be right to transfer this function from the university authorities to my right honourable friend. But this training, too, is not being neglected. At present, there is a year's university course, and my right honourable friend has already arranged for his Department to discuss with the psychiatric social workers how best their numbers can be increased. I hope, therefore, that the noble Lord will appreciate that, in rejecting this Amendment—on the grounds, as I have said, that it would not be appropriate to put into a Mental Health Bill one of a number of medical auxiliaries, or to transfer from the university the functions they are already carrying out—we are already doing what this Amendment seeks to do, and that it would not be appropriate to write into the Bill the new clause which he desires
§ LORD TAYLORI have never been really satisfied that if one could not go, the whole way one should not do any- 140 thing at all. I must say that I should have liked the noble Lord to take back this clause and look at it again, to see whether there was not some way by which he could at least permit himself to assist in these processes without specifying the nature of the professions supplementary to medicine which would require assistance—and I do see the difficulty there. For example, I should like to feel that he had the power to make grants to assist in the maintenance of such persons during their training period. One knows that it is the most difficult thing at the present time to get girls (these are primarily women) to come forward for this type of work, and one would have hoped that he could say something a little more positive on the subject of training, although I admit at once, of course, the validity of his claim that the mechanism by which the machinery of training should operate should continue to be through the universities and the regional hospital boards.
§ LORD CRAIGTONIf the noble Lord will forgive my interrupting, may I point out that I did say that in the case of psychiatric social workers my right honourable friend has power to make grants in appropriate cases.
§ LORD TAYLORI am grateful to the noble Lord. What about occupational therapists? Has he the power there?
§ LORD CRAIGTONI should like notice of that question.
§ LORD TAYLORI hope that the noble will look at it; and, if he has not the power, perhaps we can persuade him to put down an appropriate clause on Report. With that, I beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Clauses 8 to 39 agreed to.
§ Clause 40 [Detention or guardianship of certain patients after the age of twenty-five]:
§ LORD CRAIGTONWith your Lordships' approval, I will mention with this Amendment Nos. 5 and 6. These are all drafting Amendments. After Amendments in another place, subsection (1) of Clause 40 has become too long. I beg to move.
§ Amendment moved—
§
Page 29, line 18, leave out ("and") and insert—
("(2) Subject to the provisions of the next following subsection,").—(Lord Craigton.)
§ On Question. Amendment agreed to.
§ LORD CRAIGTONI beg to move.
§
Amendment moved—
Page 29, line 19, leave out ("subsection") and insert ("section").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ LORD CRAIGTONI beg to move.
§
Amendment moved—
Page 29, line 21, leave out ("said age") and insert ("age of twenty-five").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ LORD CRAIGTONThis is a drafting Amendment. I beg to move.
§
Amendment moved—
Page 29, line 26, after ("patient") insert ("and").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ LORD CRAIGTONUnder the Bill, the Board of Management or local health authority concerned receive reports from the responsible medical officers which renew authority for detention or guardianship after the special review when the patient reaches the age of twenty-five. By this Amendment, the Board of Management or local health authority, on receiving such a report, must forthwith inform the patient, and his nearest relative. This is important, as the patient or relative has only twenty-eight days from the patient's twenty-fifth birthday in which to decide whether to exercise his right of appeal to the sheriff. I beg to move.
§
Amendment moved—
Page 29, line 27, after ("informed") insert ("forthwith").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ Clause 40, as amended, agreed to.
§ Clauses 41 to 56 agreed to.
§ Clause 57 [Requirements as to medical evidence]:
§ LORD CRAIGTONBy leave of the Committee I should like to discuss Amendments Nos. 9 and 10 together. They are required as they apply to children or young persons compulsorily detained after being brought before a juvenile court the right which is given 142 to others in subsections (3) and (4) of Clause 57, for the child or his guardian to arrange for a medical examination, in private if so desired, for the purpose of producing evidence to rebut the medical reports on which he was committed. I beg to move.
§
Amendment moved—
Page 42, line 24, after first ("person") insert ("that subsection (4) shall have effect as if for the reference to an accused person there was substituted a reference to a child or young person").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ LORD CRAIGTONI beg to move the next Amendment.
§
Amendment moved—
Page 42, line 26, leave out ("that subsection") and insert ("the said subsection (3)".—(Lord Craigton)
§ On Question, Amendment agreed to.
§ Clause 57, as amended, agreed to.
§ Clauses 58 to 81 agreed to.
§ Clause 82 [Removal of alien patients]:
§ 3.32 p.m.
§
LORD TAYLOR moved, after "there" to insert:
and that it is in the interests of the patient to remove him,".
§ The noble Lord said: The purpose of this Amendment is rather unusual. When a person who is mentally ill is to be moved from Scotland to England or Wales, or from England or Wales to Scotland, under the terms of the Bill, there is a provision stating that it must be in the interests of the person to remove him. When, however, an alien becomes mentally in Scotland, these words are omitted. It seemed to my honourable friends in another place that this was a little hard and that aliens should not be treated differently from citizens of the United Kingdom, particularly in so much as we all feel, that the National Health Service is something of which we are very proud and should be available to everybody who lives in this country. Therefore, they proposed twice, once on Committee and once on Report stage, that the same words should apply to aliens as apply to natives of Scotland, England and Wales.
§ We now hope that the Government may have had second thoughts, or that perhaps they may be prepared to accept the slightly altered wording of my Amendment, and make it so that at least it 143 should not be against the patient's interests if he were removed to another country. In the old days, patients in mental hospitals for treatment were usually there for prolonged periods but nowadays, thank goodness! most new admissions are there for short periods and, therefore, in future it will be very rare that an alien, having been admitted to a mental hospital, will remain there for a period of more than six weeks or so—at least we hope so. However, there will be rare cases, of the senile patient or the patient who dements, and the mental hospital in question will apply to send that patient off to his distant domicile, wherever it may be. All we ask is that, before any such removal is contemplated, not only should the Secretary of State make sure that arrangements at the receiving end are adequate, as he already does under this clause, but he should also assure himself that it is not against the patient's interests to make this removal. I hope that, having given way on the two previous Amendments, the Government may feel that they can accept this Amendment, or at least look at it to see whether, in a slightly altered form, it may be acceptable. I beg to move.
§
Amendment moved—
Page 62, line 28, after ("there") insert ("and that it is in the interests of the patient to remove him,")—(Lord Taylor.)
§ LORD CRAIGTONThis is a borderline case. I hope that the noble Lord, Lord Taylor, is not asked more often to bat for Scotland. The Government are convinced by what the noble Lord has said, and I would ask your Lordships to accept this Amendment.
§ LORD TAYLORI thank the noble Lord very much.
§ On Question, Amendment agreed to.
§ Clause 82, as amended, agreed to.
§ Clauses 83 to 118 agreed to.
§ First and Second Schedules agreed to.
§ Third Schedule [Transitional Provisions]:
§ LORD CRAIGTONAmendments Nos. 12 and 13 are both drafting Amendments. I beg to move the first one.
§
Amendment moved—
Page 90, line 14, after ("thirty-nine") insert ("and section fifty-one").—(Lord Craigton.)
§ On Question, Amendment agreed to.
144§ LORD CRAIGTONI beg to move the next Amendment.
§
Amendment moved—
Page 90, line 18, leave out ("that section") and insert ("the said section thirty-nine").(Lord Craigton.)
§ On Question, Amendment agreed to.
§ LORD CRAIGTONThis is a drafting Amendment, consequential on Amendments having been made in another place. I beg to move.
§
Amendment moved—
Page 94, line 51, after second ("of") insert ("section eighty-nine of the Lunacy (Scotland) Act, 1857,").—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ Third Schedule, as amended, agreed to.
§ Fourth Schedule [Minor and Consequential Amendments]:
§ LORD CRAIGTONWith your Lordships' approval, I should like to discuss Amendments Nos. 15 to 18 together. This Bill introduces the one concept of mental disorder as covering all forms of mental illness and mental deficiency. So it is essential to replace the obsolete and less acceptable forms of description contained in existing Statutes. Your Lordships will be as glad as I am to see the last of "lunatics", "idiots" and "fatuous or furious" persons. Many of these have already been disposed of in the Fourth Schedule. The task of tracing references in so many Acts could not be completed by the time the Bill left another place. This series of Amendments, and a few to follow in a few minutes, add, in their correct chronological order, what I hope are the remainder of the Acts to be amended. I beg to move.
§
Amendment moved—
Page 95, line 9, at end insert—
§ ("The Land Tax Redemption Act, 1802 (42 Geo. 3. c. 116)
§ In section fourteen, as it applies to Scotland, for the words lunatics or of idiots' and `lunatics, idiots', wherever they occur, there shall be substituted the words persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.
§ The Admiralty (Signal Stations) Act, 1815 (55 Geo. 3. c. 128)
§ In section three, as it applies to Scotland, for the words lunatics, idiots' there shall be substituted the words persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act. 1960'.
145§ The Defence Act, 1842 (5 & 6 Vict. c. 94)
§ In sections ten and eighteen, as they apply to Scotland, for the words 'lunatics, idiots' there shall be substituted the words 'persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act. 1960'.
§ The Companies Clauses Consolidation (Scotland) Act, 1845 (8 & 9 Vict. c. 17)
§ In section eighty-two, for the words 'be a lunatic or idiot, fatuous or furious person, such lunatic or idiot, fatuous or furious person' there shall be substituted the words 'is suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960, and is incapable by reason of his mental disorder of managing and administering his property and affairs, he'.
§ The Lands Clauses Consolidation (Scotland) Act, 1845 (8 & 9 Vict. c. 19)
§ In section seven, for the words 'lunatics or idiots, fatuous or furious persons' and for the words 'lunatics, idiots, fatuous and furious persons', wherever they occur, there shall be substituted the words persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.
§ In section sixty-seven, for the words 'lunatic or idiot, fatuous or furious person' there shall be substituted the words 'person suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.
§ In section sixty-nine, for the word 'lunacy' there shall be substituted the words 'incapacity by reason of mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.
§ In section seventy, for the words 'idiotcy, lunacy' there shall be substituted the words 'incapacity by reason of mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.").—(Lord Craigton.)
§ On Question, Amendment agreed to.
THE EARL OF MANSFIELDHer Majesty's Government are very much to be congratulated upon the introduction of this series of Amendments. Of this matter I can speak with some personal knowledge, having been for over twenty years a director, and for the greater part of that time chairman, of one of the Scottish royal mental hospitals. We are now, thank Heaven! approaching the time when the public at large will realise that a mental illness should be treated mutatis mutandisin exactly the same way as physical illness, and that there is no reason why a person who suffers from some form of mental illness should not be restored to as complete health as, say, someone who has broken a leg. In the past this stigma of "lunacy" has been one of the greatest deterrents to the 146 recovery of patients. We are now trying more and more to get them to enter mental hospitals as voluntary patients, and, as the noble Lord, Lord Taylor, has said, fortunately the duration of their stay there is now one usually of weeks rather than of months, or even of years, as used to be the case. There is no doubt whatever that the abolition of this deplorable word "lunacy" will do a great deal to induce people to take this early treatment, which is often imperative if they are to be restored to complete mental health.
§ LORD CRAIGTONI am grateful to the noble Earl for voicing in such wise words the growing understanding of mental illness in the mind of the public today.
§ On Question, Amendment agreed to.
§
Amendment moved—
Page 95, line 37, at end insert—
§ ("The Defence Act, 1860 (23 & 24 Vict. c. 112)
§ In section eleven, as it applies to Scotland, for the words 'lunatics, idiots' there shall be substituted the words 'persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.")—(Lord Craigton.)
§ On Question, Amendment agreed to.
§ Amendment moved—
§
Page 95, line 43, at end insert—
("In section twenty-four, as it applies to Scotland, for the words lunatics, idiots, and furious and fatuous persons' there shall be substituted the words ` persons suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.").— (Lord Craigton.)
§ On Question, Amendment agreed to.
§ Amendment moved—
§ Page 96, line 6, at end insert—
§ ("The Building Societies Act, 1874 (37 & 38 Vict. c. 42)
§ In section twenty-six, as it applies to Scotland, for the words becomes a lunatic' there shall be substituted the words 'is suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.
§ The Trade Union Act, Amendment Act, 1876 (39 & 40 Vict. c. 22)
§ In section four, as it applies to Scotland, for the words 'becomes a lunatic' there shall be substituted the words 'is suffering from mental disorder within the meaning of the Mental Health (Scotland) Act, 1960'.").—(Lord Craigton.)
§ On Question, Amendment agreed to.
147THE EARL OF HOMEMy Lords, with the permission of the House, I think that for the purposes of the statement I have to make, it will be as well to move that the House do now resume.
§ Moved, That the House do now resume.—(The Earl of Home.)
§ On Question, Motion agreed to, and House resumed accordingly.