Hansard

The bill is modest but, as Mark McDonald and Jenny Marra said, it is important. It is based on the McManus report but, as Malcolm Chisholm reminded us, there was a massive number of amendments to the 2003 bill—the number of amendments today was fairly modest, thank goodness—but even then not all the McManus proposals were included.

I welcome the fact that the Government carefully considered the evidence, the stage 1 report and the stage 2 debates. As a result, I can commend the Government for acknowledging concerns, which has led it to withdraw some of the original proposals, such as the proposed 10-day extension to tribunal hearings, the length of time to appeal against transfer, and the proposed possible extension by 100 days of the community treatment order suspension period.

I also particularly welcome the victim notification scheme and some of other measures in the bill that will undoubtedly help the mental healthcare and treatment of people in Scotland. I regret that the nurse’s power to detain was not left as it was. I still do not understand where all that came from or what consultation was done on it. It is fine to tighten up the rules, but existing cases were not being reported to the Mental Welfare Commission in the first place, so that is what needs to be tightened up rather than the rules and whether detention should be for two or three hours.

I also regret that many of my, Jackie Baillie’s and Nanette Milne’s amendments were rejected. They were lodged after careful consideration of the evidence that had been presented and after discussions with and support from a number of organisations. Notwithstanding their rejection, I hope that many of them will be part of the wider review that the Government has already instructed civil servants to start thinking about. I welcome the sense of urgency that the minister is lending to the issue. I hope that he will be able to continue to apply that pressure.

Learning disability, or intellectual impairment, and autism spectrum disorder will need to be addressed. Mark McDonald called for a wider stakeholder conference to look at the remit for the review. I hope that the minister will consider that and I hope that it will not be some sort of internal review that leads to a bill, but that there will be a full-blown commission of the same sort as the Millan commission. Millan and McManus recommended that all the acts—the Criminal Procedure (Scotland) Act 1995, the Adults with Incapacity (Scotland) Act 2000, the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Protection of Vulnerable Groups (Scotland) Act 2007—be considered. As the minister has said, that will be complex and will require a commission that is of good standing and which can command broad support. If we begin with the sort of conference that Mark McDonald suggested, we might be able to set an appropriate remit.

There are serious concerns about a range of issues. The right to refuse treatment is fundamental, but it is not applied to people who have mental health problems except under specific conditions. It does not apply if they give an advance statement; that was rejected today.

The use of psychoactive medicines is still far too widespread. The fact that antidepressants were being used in increasing amounts was appropriate because GPs were learning to prescribe appropriate doses for longer periods. However, the amounts that are being prescribed have gone on rising and it is becoming a matter for concern, although the particular target on that has been dropped.

There is the vexed question of the difference in application between a seriously impaired decision-making ability under the 2003 act and the definition of incapacity under the 2000 act. That needs to be addressed. Use of physical restraint has been addressed in respect of children, but it needs to be looked at again for adults because it might be being used inappropriately in one or two situations. The number of people who have been adversely affected by the issues that I have mentioned might be small, but one is too many. The guardians of good care and treatment should have more powers.

The Mental Welfare Commission in its many helpful reports draws attention to too many occasions on which it has not been able to get the information that it requires. The acceptance of amendments 25, 35 and 36 will undoubtedly help in that regard, but Scotland must have regulators that have teeth. If we continue to have regulators—the Healthcare Environment Inspectorate and, on occasion, the Mental Welfare Commission—covering only small areas, that will not be enough. We need to look again at HIS, the Care Inspectorate, and the Mental Welfare Commission. We decided not to integrate them during the previous reform, which was the correct decision at the time, but there are now issues that may need to be looked at.

I agree and disagree with Mark McDonald’s comments on mental health. I agree that there has been progress in care plans for patients who have severe and enduring mental illness. However, on child and adolescent mental health, although there was progress on the issue of admissions to adult wards, which was welcomed by the Mental Welfare Commission, the situation has gone backwards since 2009, as Malcolm Chisholm reminded us.

Mary Scanlon listed a number of issues, including the number of MHOs, which has reduced, and local authorities’ ability to deal with mental health. She also listed a number of other areas of concern with which I agree, particularly in relation to prisoners, in respect of whom far more must be done.

Rhoda Grant drew attention to personality disorders, which are still not being managed effectively in Scotland, as well as to intellectual impairment that is associated with brain damage.

I thank all those who gave evidence, and the many organisations that helped me to formulate the amendments and gave support on issues that were raised. I also thank the Parliament’s legislation team, whose drafting and responses to the changes that I sought were always patient and often creative.

The debates have been of value if only to inform the review. We have made progress since 1999, but we must keep moving forward and acknowledge the changes that have been made, in particular in neurodevelopmental science, but also in the culture. We must change things, but Labour will fully support the bill tonight.