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Plenary, 14 Nov 2001

14 Nov 2001 · S1 · Plenary

Item of business

Mental Health Law

McNulty, Des Lab Clydebank and Milngavie Watch on SPTV

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.

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Plenary, 14 Nov 2001

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