HL Deb 15 April 1975 vol 359 cc313-21

3.45 p.m.

Baroness BACON

My Lords, I beg to move that this Bill be now read a second time. This Bill was introduced into another place by Mr. William Whitlock who was successful in the ballot for Private Members' Bills. There it was an agreed non-controversial Bill, and it passed all its stages, not only without amendment but without any Amendments being moved. The Government support this Bill—perhaps that is an understatement, because I feel quite sure that had Mr. Whitlock not introduced this Bill as a Private Member's Bill, the Government themselves would have had to introduce it at some other time.

The Bill amends the 1959 Mental Health Act in order to restore the position that the Government thought was the case until a High Court judgment in July 1972. Often Parliament passes Acts of Parliament believing that those Acts mean one thing, and subsequently a court rules differently. In this case it is desirable to make this amendment, otherwise a few patients might be discharged before they are fit to be discharged, with danger to themselves and others.

Perhaps I should explain that under the Mental Health Act 1959 patients compulsorily admitted to hospitals must suffer from one of four classes of disorder. These are: mental illness; severe subnormality; psychopathic disorder; and subnormality. A person aged over 21 and suffering from either, or both, subnormality and psychopathy, may be compulsorily admitted for treatment only if ordered by a court or transferred from prison. A psychopathic or subnormal patient, admitted under 21, can continue to be detained after the age of 25 only if the responsible medical officer considers that he is likely to act in a manner dangerous to himself and others, if discharged.

As time goes on, the diagnosis of a patient may change. A patient admitted suffering from mental illness or severe subnormality may be reclassified as suffering from psychopathic disorder and/or subnormality and no other disorder. Before the High Court's decision, it was thought that a patient reclassified in this way after the age of 25 could continue to be detained; but the High Court ruled otherwise. It ruled that if a patient— other than one subject to a court order— is reclassified as psychopathic and/or subnormal after the age of 25, that patient cannot be detained, no matter how dangerous he or she may be. This judgment in the High Court also cast doubt upon whether there is authority to detain a person so reclassified between the ages of 21 and 25. It also cast doubt in relation to some patients detained under a court order.

The purpose of this Bill is to provide for the examination of all such reclassified patients to see whether they would be likely to act in a dangerous manner if discharged. If so, the medical officer would make a report recommending continued detention. Both the patient and the nearest relative would be informed of the contents of such a report, and the patient would of course have the right to apply to the Mental Health Review Tribunal. If the medical officer does not make a report saying that the patient will be likely to act in a manner dangerous to himself or others if released, the authority for detention will lapse and the patient will be released. If the patient is detained, there will also be the two-yearly reports by the doctor, and if not considered dangerous the patient will be freed.

The number of patients affected in this way is very small, and of these the number thought to be dangerous is of course even smaller. Even so, there could be a tragic incident. I hope, therefore, that this House will give a Second Reading to this useful Bill amending the Mental Health Act. It does not disturb the existing philosophy of striking a just balance between freedom of the individual, on the one hand, and protection of the public, on the other. My Lords, I beg to move.

Moved, That the Bill be now read 2a. —(Baroness Bacon.)

3.51 p.m.


My Lords, we are all grateful to the noble Baroness, Lady Bacon, for having explained very lucidly what is, on the face of it, an extremely complicated little Bill. But, as she says, it is a non-controversial Bill. Its objects seem to me to be wholly desirable and indeed, as she said, it only puts into effect something we always thought was meant to be the effect of the relevant Act. It seems to me to be quite right, and indeed to the advantage of both the patient and the general public, that this amendment should be made. After all, it would be highly undesirable if somebody who was thought to be dangerous to himself and to others were allowed to be released from a mental hospital on what is something of a technicality. The safeguard of appeal to the Mental Health Review Tribunal remains. Therefore, so far as we on these Benches are concerned, we are pleased to support this Bill.

3.53 p.m.


My Lords, from these Benches I am equally pleased to support the amendment Bill, particularly as the case that gave rise to it arose in my predecessor's time in the South-West Metropolitan Hospital Board area. There are one or two points which we should consider. Obviously, it is right that the person who is a potential danger to himself or herself, or to the public at large, should be detainable within a mental institution. I am a little concerned about the safe-guards for the person suffering from a psychopathic complaint. Apart from the medical officer's report, I believe it could be necessary to introduce the same safe-guard that exists for a person before he is detained in a mental institution at all; in other words, to have two medical opinions recommending detention under the changed diagnosis.

Secondly, I believe we have here an opportunity to amend the Act even further. I further regret that the Bill deals only with Clause 26(2)(a)(i) and does not attempt to make an alteration to sub-paragraph (ii). Once we admit that it is perfectly reasonable and correct to detain within a mental institution somebody over the age of 25 who is suffering from a psychopathic disorder, which is what we are doing by this amendment, it might be correct to remove the age limit of 21 years in paragraph (ii), adding instead at the end of the paragraph, "who is considered to be a danger to the public". I should like, if possible, some assurance from the Government that the person being reclassified and detained within an institution will have the right of two medical opinions. Furthermore, unless I am assured by the Government that there is some possibility of detaining a person over the age of 21 if he is considered a danger to the public, without a reference from a penal institution, I give notice that I may put down an Amendment at the Committee stage.

3.56 p.m.


My Lords, I also should like to support this Bill. I am certain it is closing a loophole in the Mental Health Act 1959 and is definitely necessary. I personally think (and this is not in any way a Party political point) that that legislation is probably one of the greatest advancements in the treatment and legal position of people suffering from mental illness, or of those in mental institutions, bearing in mind the legislation that has gone through Parliament within the last 30 years. It strikes me as right that these patients over 25 should be able to be reclassifled. I personally have always been much concerned about patients suffering from any form of mental illness classified by this very vague term "psychopathic".

On that, one could quote a remark made by Dr. McGrath, who, as many of your Lordships will know, is medical superintendent of Broadmoor. Not long ago he said that if four psychiatrists around a table were asked for a definition of "a psychopath" one would receive five different answers! This is probably true. It is one of the most difficult diagnoses to make unless the patient is under closed conditions. It is most difficult for the medical profession, taking into account all branches of the psychiatric field, to come to a conclusion as to what a psychopathic disorder really is. However, one thing we do know is that people with these disorders are liable to be very dangerous to the public, and quite often to themselves. So, like others of your Lordships who have spoken on this minor adjustment to the Mental Health Act, I give it my full support.

3.59 p.m.


My Lords, if my noble friend Lady Bacon does not mind my saying so, we are indebted to all noble Lords who have spoken in this debate for their support of this Bill. I would express Government support for this measure. We are grateful to my noble friend Lady Bacon for giving it her sponsorship. She made it perfectly clear that this Bill in no way changes the spirit or intention of the Mental Health Act 1959, but simply seeks to provide protection, not only for the community but for the patient himself, from the unfortunate consequences that can result from a premature discharge. We have all been aware over the years of what has happened in instances of that kind.

It is important in a measure of this kind to ensure that the decision to continue the compulsory detention of a patient in a few small categories described by the noble Baroness is taken only when it is absolutely necessary. If one looks at the statistics over the years, one sees that the number of people who have been detained in our various institutions has fallen very dramatically. The Bill includes safeguards: in particular, that the patient or nearest relative—I want to emphasise this notwithstanding the fact that it has already been mentioned—has the right to apply to the Mental Health Review Tribunal for discharge, and the patient can continue to be detained only if the Mental Health Review Tribunal, having considered all the facts, is opposed to his discharge.

Viscount AMORY

My Lords, I think I heard the noble Lord say just now that the total number of these poor people in institutions has fallen substantially. That is very good news indeed. Can the noble Lord amplify that situation with one or two more sentences which would tell us how it has come about?


My Lords, I have tried to come to your Lordships' House fully informed on these matters. The short answer is that we would be surprised at the considerable advancement that there has been in recent years in the understanding of mental disorder, and that has been followed by a great deal of advance in the treatment of mental disorder.

Viscount AMORY

My Lords, I was certainly not trying to trip up the noble Lord; but it seemed to me a piece of rather encouraging news.


My Lords, I served for some years on certain Mental Health Review Tribunals and saw this, and I am sure the noble Baroness, Lady Robson of Kiddington, has seen the dramatic reduction in the number of people who are in our mental institutions. My honourable friend the Minister of State for Health in another place said that in 1955 70 per cent. of the patients at any one time were detained, while 30 per cent. were voluntary patients. Today, only 10 per cent. are detained and the rest receive treatment and care informally. When I used the word "dramatic" I meant it was rather a dramatic change. The noble Baroness, Lady Robson of Kiddington, mentioned that she felt there should be two medically competent people to be responsible for a reclassification. If I may express a personal opinion— although I am sure I ought not to do so— that seems to me to be very reasonable. I am informed that the 1959 Act already provides that, whenever a patient is re-classified, he shall be told and can apply to the Tribunal if he is dissatisfied. It would appear to be inconsistent with other provisions in the Act to require reclassification in these cases to be certified by two doctors, but this is a matter which, if I could make this point to the noble Baroness, is one I could ask my honourable friend the Minister of State for Health to have in the forefront of his mind when consideration is to be given to the Mental Health Acts in the immediate future.

I think I am right in saying that my honourable friend promised in another place that a review would be undertaken of the Mental Health Acts, and he hoped something would emerge before the end of this year. I should not like to hold him to that statement but, if it results in a White Paper, there is no reason why it should not be debated in your Lordships' House. The noble Baroness may feel that this is a way of dealing with it, and I will certainly undertake to bring this to the notice of my honourable friend because the point she raised seems reasonable to me. If, on the other hand, the noble Baroness, Lady Robson of Kiddington, feels this is a matter which the House ought to deal with much sooner, then, of course, there is a Committee stage, but perhaps it ought to be considered by a larger group, bearing in mind what is involved and the necessity of it. This could be done in the way I suggested originally.

The noble Baroness, Lady Robson, of Kiddington, mentioned Section 26(2) (a) (ii) of the 1959 Act. This might be a proper undertaking for the review of the Mental Health Acts which the Minister of State has announced, and, again, if it will satisfy the noble Baroness, I will give an undertaking to bring this to his notice. It seems to me they are both matters which ought to be looked at, and if the noble Baroness feels there is no undue haste required in this matter, I will see that his attention is drawn to it.

My Lords, I do not think I need say any more; I hope the House will agree to this Bill because it is necessary to close a small gap in the 1959 Act which was revealed by the High Court judgment in 1972. I am very grateful, as I often am, to the noble Lord, Lord Aberdare, for giving it his approval, because I know of his experience and knowledge in this field.

4.8 p.m.

Baroness BACON

My Lords, I should like to thank all the Members of your Lordships' House who have spoken and supported this Bill. The noble Baroness, Lady Robson of Kiddington, raised two points. The first was she wanted the Bill to go a little wider than it does regarding Section 26(2) (a) (ii) of the Mental Health Act of 1959. I hope we will not widen this small Act too much because, as the noble Lord, Lord Wells-Pestell, has said, there will be opportunities to consider this when we discuss the various reviews which are taking place.

In another place the Minister of State, Dr. Owen, said that the Committee on Mentally Abnormal Offenders, under the Chairmanship of Lord Butler of Saffron Walden, which had been reviewing these provisions relating to offenders, had completed its Report which would probably be published in the summer. In addition to that, as my noble friend Lord Wells-Pestell said, at the present time a review is being undertaken of the working of the Mental Health Act. As he pointed out, the Minister of State, Dr. David Owen, said that there would be a Consultative Document setting out the provisional conclusions of those various bodies which had been considering the matter, to be published, perhaps, by the end of this year. The Government would then consider any Amendments which might be necessary to the Mental Health Act.

The noble Baroness, Lady Robson of Kiddington, also raised the question of the two medical opinions instead of one. I was not clear whether, as my noble friend Lord Wells-Pestell understood it, she thought there ought to be two doctors in reclassification, or whether there ought to be two doctors once reclassification had taken place, in order to decide whether or not the patient was potentially dangerous.

This is something which could be considered. My first reaction to it is that, first of all, we might be putting in opera tion different procedures for a few patients as compared with the procedures for the majority of patients in the hospital. The only time I had experience of this was when I was at the Home Office, and those patients who were there by court order, or had been transferred from prison, came before us to see whether or not they could be released. I have the greatest admiration for a doctor at one of the special institutions—I will not mention names—for the wonderful way he dealt with those problems.

It was almost uncanny to see the way he would recommend whether patient A should be retained or patient B released. He hardly ever made a mistake. Of course, we know one or two mistakes have been made but, in view of the hundreds of cases considered for release—I am speaking here of release not reclassification—I think the doctors deal with them magnificently. This is something which my noble friend has said he will bring to the notice of the Minister of State. I can only thank, once again, those who have contributed to this debate, and hope that the Bill will be passed.

On Question, Bill read 2a, and committed to a Committee of the Whole House.