Hansard

The Mental Health (Scotland) Bill’s overarching objective is to help people with a mental disorder to access effective treatment quickly and easily. It does so by improving the operation of the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Criminal Procedure (Scotland) Act 1995, which provide fundamental protections and safeguards to people with a mental disorder. The bill also introduces a victim notification scheme for victims of mentally disordered offenders in a way that respects the rights of both victims and vulnerable offenders.

I am grateful for the detailed and thorough scrutiny that the Health and Sport Committee gave the bill at stages 1 and 2, which has helped to ensure that we get it right and continue to maximise the protections and safeguards. The bill has been significantly improved during its parliamentary passage as a result, and I thank the committee members, as well as members who are not on the committee but have engaged with the process, for the work that they have done.

I will take a few moments to set out key aspects of the bill. The 2003 act brought in important protections including advance statements, which help to involve patients in decision making about their treatment by allowing service users to state how they would like to be treated if they become unwell. The bill strengthens the position of advance statements, gives service users greater confidence that their wishes will be taken into account in their treatment and ensures that the Mental Welfare Commission for Scotland has a better picture of the use of advance statements.

I am pleased that the Parliament supported Bob Doris’s amendment 28, which will help service users to access support in taking up the opportunity to make a statement. We want advance statements to be used far more widely, and that was a common theme in the committee’s scrutiny of the bill. Taking those provisions together, the bill should increase the use of advance statements and, through that, help more service users to have greater involvement in decisions about their treatment when they are unwell.

Many service users have found the role of the named person, which the 2003 act introduced, to be an important protection, as it gives someone they know a role to act independently to protect their interests. However, I listened to the significant concerns about the fact that service users do not always want a named person, particularly as that person will see confidential information about the patient’s medical treatment.

The bill means that a service user will have a named person only if they want one. That is an important step in promoting service users’ rights. Through stage 2 amendments, we ensured that protections are in place for vulnerable service users who do not have the capacity to decide whether to appeal an order or certificate, while ensuring that that does not impact on their privacy or autonomy.

The bill fulfils the intention behind introducing the excessive security appeal provisions in the 2003 act and the Millan recommendations by extending the right of appeal against being detained in conditions of excessive security to those who are detained in medium-secure units. The intention was to give patients in high-secure units and medium-secure units a right to appeal against detention in conditions of excessive security. We now need to ensure that the scheme that was provided for in 2003 can operate effectively in the present secure estate. Amendments that we debated today will ensure that we do that by extending the right to patients in medium-secure units as quickly as possible. I look forward to discussing that further when the committee and the Parliament consider draft regulations after the recess.

Those are just some of the key changes through the bill that will make the 2003 act work more effectively and enhance the experience of, and protections for, service users.

There has been widespread support for the introduction of the victim notification scheme for victims of mentally disordered offenders. The intention is that the scheme will respect the rights of both victims and vulnerable offenders and will closely resemble the scheme that is already available to victims under the Criminal Justice (Scotland) Act 2003. The scheme will be of huge benefit to victims who were not previously covered by the criminal justice scheme and it will provide them with greater reassurance when offenders begin the process of discharge from treatment.

We have also recognised that mentally disordered offenders may be vulnerable—that perspective was expressed by the committee during its consideration of the bill at its earlier stages—and we have taken that into account. I am grateful to the victims’ rights working group, which included representatives of Victim Support and Hundred Families, for its assistance in getting the balance right.

The bill amends the Mental Health (Care and Treatment) (Scotland) Act 2003, and I am aware that some members would have liked wider issues to be included. The bill is not a full stop at the end of a process, and I am happy to put on record my commitment to certain further steps. I have heard the concerns that a number of people and organisations have raised about the inclusion of learning disability and autism spectrum disorders under the definition in the 2003 act. I thank Jackie Baillie and Richard Simpson for the discussions that we have had on that. We have also debated the issue extensively at stage 3.

The 2003 act provides people with learning disabilities and autism spectrum disorders with protections, safeguards and—importantly—access to care and treatment, and it is essential that, in anything that we seek to do, we ensure that those protections continue. I have committed to reviewing the inclusion of learning disability and autism under the definition of mental disorder in the 2003 act. It is important that that review is genuinely participative and is commenced with an open mind about the outcome and process. As I set out earlier, we have started to discuss with stakeholders how we can undertake that engagement. I hope that the review further demonstrates our serious intent.

A number of committee members also raised issues about the role that psychologists play under the 2003 act, following consideration of the issue by the British Psychological Society, which I thank for its positive engagement. I also thank Dr Milne for raising the issue again today. It is important that we debate such issues. I have made the point before—I make it again—that I am sympathetic to the proposal in Dr Milne’s amendment 33 but that I was not convinced by the provisions in the amendment. It is important that we have widespread consultation on the matter and, as I said, I am committed to looking at the issue alongside the wider review of learning disabilities and autism spectrum disorders. That is a serious commitment.

Amendments were lodged at stages 2 and 3 on the investigation of the deaths of patients who were in hospital for the treatment of mental illness and on the reporting of homicides by those who are being treated for a mental health condition. Although I did not believe that a legislative approach was appropriate, I was happy to accept amendment 36 at stage 3. Further work is necessary, and my officials have already started to explore with the Mental Welfare Commission how we can bring together a working group to develop a streamlined and effective approach to reviewing deaths in detention.

In relation to the reporting of homicides by those who are being treated for a mental health condition, the Mental Welfare Commission will work with Healthcare Improvement Scotland and the Government to produce proposals that build on current practice, to ensure that all cases are reviewed appropriately. In doing that, they will consult key stakeholders such as the forensic division of the Royal College of Psychiatrists and organisations such as Hundred Families.

I will ensure that the Health and Sport Committee is informed of developments on both those issues, and I will always be happy to consider the committee’s perspective in any work that we undertake.

The bill is part of the wider work that the Government is undertaking to improve mental health services, including funding. I announced in May this year an additional £85 million for mental health over five years, beyond the £15 million over three years that was announced in November 2014 for the mental health innovation fund. That is £100 million in total.

We will work with NHS Scotland and its partners to get the maximum benefit from the investment. We will focus on further improvement to child and adolescent mental health services to bring down waiting times; improved access to services and in particular psychological therapies; and better responses to mental health issues in community and primary care settings, including promoting wellbeing through physical activity and, crucially, improved patient rights. I will be happy to keep Parliament up to date with progress on those matters.

The bill further enhances the ability of people with a mental disorder to access effective treatment quickly and easily, while maintaining and enhancing protections and safeguards.

I move,

That the Parliament agrees that the Mental Health (Scotland) Bill be passed.