Friday, April 27, 2007

First two days of the mental health bill

The Government is now proceeding apace with the reversal of the Lords' amendments to the Mental Health Bill.

The amendments were voted by Conservatives and Liberal Democrats in line with a campaigning organisation called Mental Health Alliance. The "Alliance" includes any organisation that matters, speaks for all professionals, all service users, all carers, has a complete harmony amongst its 80 organisations. Apparently. So there is no need for any mental health organisation to put any thought into mental health matters as the MHA speaks authoritatively on behalf of all its members at all times. All the thinking has been for you and all there is left for you is to agree.

Now I don't want to be over harsh. I certainly respect where the MHA (though probably not the Conservatives) are coming from, and on some of the issues they are either raising entirely legitimate concerns or have ideas that deserve to be taken seriously.

However they have tended to exaggerate and over simplify making it very difficult to have a sensible debate at all.

Day one of the committee saw the Government reverse the amendment on exclusions from mental disorder (including sexual orientation, political and cultural views etc). The Government's argument is that as these are not mental disorders it would be strange to exclude them as if they were and would muddy the waters considerably.

I am sure the Government are right in this. In particular I note contributions from Chris Bryant:

I can see several reasons, therefore, why it might seem intrinsically a good idea for the Bill to contain the proposed exclusions. However, on sexual orientation in particular, it seems bizarre that we would want to cover it in the Bill. We should assume that nobody believes that somebody’s homosexuality is a reason for them to be sectioned. We should make that assumption, together with the assumption that nobody should be sectioned for their political, religious or cultural views [.....]

That is why, despite understanding the reasons why people might wish to include them, I find the exclusions patronising and therefore inappropriate. I also believe that they would be a legal nightmare. The person who does not want to be sectioned, and whose lawyer says that his claim to be God is a religious belief, will be able to advance that argument before the courts. That gives a much more complicated set of decisions to the courts than would be appropriate.
And the Minister (Rosie Winterton) put it very well when she stated:

As I said, including something that is not a mental disorder in a list of exclusions of mental disorders is not only unnecessary but, particularly in matters such as sexual orientation, gives the impression that we do think that it is a mental disorder and therefore must be excluded. It is stigmatising in that respect.

Day Two of the committee saw debate over the 'imparied decision making' test that the Conservatives want inserted. The debates were very revealing as there seemed a lot of confusion on the Tory and Lib Dem side as to what exactly they were proposing and what such a test would mean.

As a mental health worker myself I have to admit that it isn't immediatley clear what they are wanting to propose. Some state (and I think that this is the guidance given in Scotland, where they have adopted such a test) that if you are suicidal or posing a risk to others then, by definition, your decision making is impaired. Well - that seems to make the test hopelessly circular and subjective rather than a clear and genuine test.

Others said it was similar to the test for capacity (if not identical to it) and therefore if you met the test and wanted to commit suicide you should be allowed to do so; if you were a risk to others you could not intervene to stop them.

So the Tory/Lib Dem position lacks the benefit of being thoroughly worked out.

Again the sentiments are good but this is no way to make law. Legislation should aim at relative clarity and tests should be just that, not completley open to divers and contradictory interpretation.

The committee went on to debate that vexed question of 'treatbility' or 'therapeutic benefit' test for detention, but that debate continues in the next session.

The link to the committee debates can be seen here, though the exchanges are quite in depth and occasionally technical, as well as quite argumentative on occasion.