Chamber
Plenary, 14 Nov 2001
14 Nov 2001 · S1 · Plenary
Item of business
Mental Health Law
Like others, particularly Margaret Ewing, I very much welcome today's debate on what is an important subject. The Parliament's second bill on mental health will result from a process that contrasts markedly with the way in which we dealt with the first bill. At that time, our process did not include consideration and development of the arguments in debate. As Margaret Ewing pointed out, the Parliament now facilitates a process of constructive debate, which involves all the different agencies putting forward their ideas and clarifying the concepts that they want to apply. At the end of the process and as a result of our work, I expect Scotland to have a leading framework for the handling of mental health.
If I may introduce a cautionary note, however, I do not think that today's debate can entirely be seen as a box ticked. We have not dealt with all mental health issues. For example, we have not talked about the promotion of sound mental health, which is an important subject that needs to be addressed. Perhaps that can be developed in another debate; today's debate has addressed other important issues.
I will concentrate my attention on compulsory orders, which have raised concerns among some who work in mental health. I share some of SAMH's reservations about the lack of a firm evidence base to justify some of the claims that are made about the benefits of community-based compulsion.
The present arrangements for dealing with people who have long-term mental illnesses are wholly inadequate. Some of the more tragic constituency cases that I have had to deal with have arisen out of the distress that mentally ill people—and their families—have suffered because of the lack of care that they receive under the current scheme. I believe that the least restrictive alternative test will provide appropriate safeguards. However, I urge the minister to develop some worked examples of how we might expect that test to be applied in practice. We need further details so that we can develop the principle and let people understand how the test will work in particular cases.
I welcome the principle of reciprocity, which others have mentioned. However, the minister needs to look again at the definition that she gave at the start of her speech. She stated:
"mental illness is different from other forms of ill health. A person who is mentally ill … may not appreciate the nature of their illness or the need for treatment. Sometimes treatment must be imposed, rather than agreed. That is why we need effective legislation—legislation that balances the needs of patients with their rights as citizens."
I agree with that. However, to take that forward we also need to take into account the rights and needs of families and communities. The emphasis needs to be rebalanced so that we shift from focusing exclusively on the treatment of mental illness to considering how the care of mentally ill people can be developed in a community context.
I have attended a number of case conferences at which I have been astonished and appalled at how the arrangements for dealing with the needs of a mentally ill person have been fragmented among different professionals. Often, the mental framework that doctors use in dealing with their work is more suited to a hospital than to a community context. Doctors' specialisms often dominate their obligations to the patient to such an extent that their specialist concerns take precedence over all other considerations, with the result that the mental health of the person is not brought into proper configuration with their physical health needs. Arrangements for providing appropriate forms of social care and a regular pattern of interaction for the individual are seen as entirely secondary to the method of treatment of the mental illness.
To deal with mental illness in the community, we must provide a constructive and integrated pattern of social support. That is what mentally ill people require. Changing the legal framework is one aspect of taking that forward, but it must be accompanied by a systematic and co-ordinated attempt—involving the minister and her ministerial colleagues with relevant responsibilities—to identify how a whole new framework can be constructed. Medicine must be brought into a proper configuration with social work, housing and other forms of support that mentally ill people and their families require.
We are making a major contribution to renewing the framework for dealing with mental illness in Scotland. However, this must not be the only step. We must make progress in a balanced and structured way. The minister is establishing an appropriate framework, but we must add to it.
If I may introduce a cautionary note, however, I do not think that today's debate can entirely be seen as a box ticked. We have not dealt with all mental health issues. For example, we have not talked about the promotion of sound mental health, which is an important subject that needs to be addressed. Perhaps that can be developed in another debate; today's debate has addressed other important issues.
I will concentrate my attention on compulsory orders, which have raised concerns among some who work in mental health. I share some of SAMH's reservations about the lack of a firm evidence base to justify some of the claims that are made about the benefits of community-based compulsion.
The present arrangements for dealing with people who have long-term mental illnesses are wholly inadequate. Some of the more tragic constituency cases that I have had to deal with have arisen out of the distress that mentally ill people—and their families—have suffered because of the lack of care that they receive under the current scheme. I believe that the least restrictive alternative test will provide appropriate safeguards. However, I urge the minister to develop some worked examples of how we might expect that test to be applied in practice. We need further details so that we can develop the principle and let people understand how the test will work in particular cases.
I welcome the principle of reciprocity, which others have mentioned. However, the minister needs to look again at the definition that she gave at the start of her speech. She stated:
"mental illness is different from other forms of ill health. A person who is mentally ill … may not appreciate the nature of their illness or the need for treatment. Sometimes treatment must be imposed, rather than agreed. That is why we need effective legislation—legislation that balances the needs of patients with their rights as citizens."
I agree with that. However, to take that forward we also need to take into account the rights and needs of families and communities. The emphasis needs to be rebalanced so that we shift from focusing exclusively on the treatment of mental illness to considering how the care of mentally ill people can be developed in a community context.
I have attended a number of case conferences at which I have been astonished and appalled at how the arrangements for dealing with the needs of a mentally ill person have been fragmented among different professionals. Often, the mental framework that doctors use in dealing with their work is more suited to a hospital than to a community context. Doctors' specialisms often dominate their obligations to the patient to such an extent that their specialist concerns take precedence over all other considerations, with the result that the mental health of the person is not brought into proper configuration with their physical health needs. Arrangements for providing appropriate forms of social care and a regular pattern of interaction for the individual are seen as entirely secondary to the method of treatment of the mental illness.
To deal with mental illness in the community, we must provide a constructive and integrated pattern of social support. That is what mentally ill people require. Changing the legal framework is one aspect of taking that forward, but it must be accompanied by a systematic and co-ordinated attempt—involving the minister and her ministerial colleagues with relevant responsibilities—to identify how a whole new framework can be constructed. Medicine must be brought into a proper configuration with social work, housing and other forms of support that mentally ill people and their families require.
We are making a major contribution to renewing the framework for dealing with mental illness in Scotland. However, this must not be the only step. We must make progress in a balanced and structured way. The minister is establishing an appropriate framework, but we must add to it.
In the same item of business
The Presiding Officer (Sir David Steel):
NPA
The next item of business is a debate on motion S1M-2438, in the name of Susan Deacon, on renewing mental health law, together with an amendment to that moti...
The Minister for Health and Community Care (Susan Deacon):
Lab
I am pleased to speak to the motion and proud to lead a debate on such an important issue.This afternoon we are debating the Executive's proposals for renewi...
The Presiding Officer:
NPA
Before I call Nicola Sturgeon to move her amendment, once again I ask those who wish to take part to press their request-to-speak buttons, because I have to ...
Nicola Sturgeon (Glasgow) (SNP):
SNP
I welcome today's debate. I have no doubt that there will be considerable consensus across the chamber about the Scottish Executive's proposals. I agree with...
The Presiding Officer:
NPA
Before I call the representatives of the other two parties, I advise members that the time limit on back-bench speeches will be five minutes.
Mary Scanlon (Highlands and Islands) (Con):
Con
As our business today started with a mention of the patron saint of mothers, on behalf of the Scottish Conservatives, I congratulate the Minister for Health ...
The Presiding Officer:
NPA
I do not think that it is an arrival as yet. Is it an arrival?
Mary Scanlon:
Con
Did you not know, Presiding Officer? I am not implying anything saintly about the minister, but I am delighted about the news of her new arrival.We are delig...
Mrs Margaret Smith (Edinburgh West) (LD):
LD
I congratulate the minister on her impending happy event and pay tribute to the lengths to which she is prepared to go to scrutinise Scotland's maternity ser...
Margaret Jamieson (Kilmarnock and Loudoun) (Lab):
Lab
Many members will be aware that, over many years in my previous employment, I gained much experience of mental health services in Scotland, particularly in t...
Mr Kenneth Gibson (Glasgow) (SNP):
SNP
I am pleased that the minister has now decided to join my campaign to reverse Scotland's declining birth rate. I wish her all the very best over the coming m...
Janis Hughes (Glasgow Rutherglen) (Lab):
Lab
I want first to echo the sentiments that the minister expressed in her speech and to add my support to the motion that is before us.One in four people in Sco...
Lord James Douglas-Hamilton (Lothians) (Con):
Con
I wish the Minister for Health and Community Care continuing good health.We can welcome the Executive's policy statement with commitment and enthusiasm, beca...
Mrs Margaret Ewing (Moray) (SNP):
SNP
I feel as though I am participating in a discussion rather than in a debate; I am pleased about the consensual approach that the Parliament is adopting on th...
Des McNulty (Clydebank and Milngavie) (Lab):
Lab
Like others, particularly Margaret Ewing, I very much welcome today's debate on what is an important subject. The Parliament's second bill on mental health w...
Robin Harper (Lothians) (Green):
Green
I add my congratulations to the minister on her impending good news. My business manager gave birth to a fine bouncing baby last month; I am sure that she wo...
Dr Richard Simpson (Ochil) (Lab):
Lab
I declare that I am still a fellow of the Royal College of Psychiatry and I am a member of SAMH.The Millan report is a patient, thorough and comprehensive re...
The Deputy Presiding Officer (Mr George Reid):
SNP
From now, speeches are down to four minutes.
Stewart Stevenson (Banff and Buchan) (SNP):
SNP
Presiding Officer, thank you for chopping off the last page of my speech.I join the prevailing consensus in the chamber and welcome the Millan report and the...
Mr David Davidson (North-East Scotland) (Con):
Con
Members will be well aware of this week's coverage of my daughter Suzy's current problems with an eating disorder. I therefore intend to talk principally abo...
Brian Adam (North-East Scotland) (SNP):
SNP
I will address two matters, one of which is advocacy, to which others have referred. Individual advocacy has been discussed, and I do not doubt that the mini...
Mr John McAllion (Dundee East) (Lab):
Lab
In the spirit of consensus that is prevailing today, I will begin by welcoming all the speeches that have been made during the debate. In particular, I want ...
George Lyon (Argyll and Bute) (LD):
LD
I, too, congratulate the minister on the announcement of her pregnancy—there has certainly been consensus on that today. There has been consensus throughout ...
Ben Wallace (North-East Scotland) (Con):
Con
The Scottish Conservatives welcome the opportunity to debate the proposals for new legislation on mental health. Mary Scanlon underlined our commitment to th...
Shona Robison (North-East Scotland) (SNP):
SNP
The debate has been productive and worth while. There has been much agreement and we are extremely pleased that the SNP's amendment has been accepted. Long m...
The Deputy Minister for Health and Community Care (Malcolm Chisholm):
Lab
The debate has been excellent and, as Margaret Ewing put it, a shining example of what the Parliament is about.There have been continual references to the wi...