Hansard

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 delighted to participate in the mental health debate. As Nicola Sturgeon said, there is likely to be a tremendous degree of consensus on the issue. However, some concerns have been voiced and, in that respect, I appreciate what the minister said about the on-going reviews. I hope that the clarifications and assurances that I seek on various issues will be taken in the tenor in which they are sought, as they are meant to be constructive points in the debate.

We welcome the opportunity to work towards ending the stigma and the prejudice that surround mental health. The Scottish Conservatives are broadly supportive of the proposals. Mental health legislation is due for an overhaul and we endorse fully the Millan committee in the excellent job that it carried out in evaluating current practice and proposing reforms.

The British Medical Association said recently that at least 30 per cent of general practitioner consultations have a psychological component. I hope that the new system of providing care and treatment for those with mental illness will involve GPs.

We further welcome the inclusion of a statement of principles in the new mental health bill. Today, I will concentrate on three of those principles, which I do not list in order of priority and which were mentioned earlier. The bill will be hugely complex, but the three principles about which I feel most concern are reciprocity, the respect for diversity and the use of the least restrictive alternative. My colleagues will examine other issues, including the proposed mental health tribunal.

In turning to the principle of reciprocity, I will quote from the Executive statement:

"Where society imposes an obligation on an individual to comply with a programme of treatment and care, it should impose a parallel obligation on the health and social authorities to provide safe and appropriate services, including ongoing care following discharge from compulsion."

As the system is not currently in operation, I have difficulty envisaging how it will work. Will the obligation of health and social authorities to provide safe and appropriate services be monitored by the NHS or the new regulation of care commission? How will they be held to account for the delivery of those services? It is also interesting to note that that obligation will apply to patients who receive compulsory treatment without compulsory hospitalisation. Whether a person is cared for at home or in the community, they are undoubtedly entitled to the best standards of care. Our challenge is to regulate, monitor and gain the feedback to ensure that those service users are achieving and attaining the best standards of care.

I welcome the minister's points in the statement that the role of compulsion is to be more fully considered. How will the obligation on the individual at home to comply with a programme of treatment and care be monitored? Will relatives be asked to give an account? Will the individual being treated have to prove compliance? If so, how? I ask those questions because I feel that the issue is likely to be highly subjective.

I welcome the moves to strengthen the role of the mental health officers. To say that their role will be strengthened is an understatement, given the reduction in the use of emergency detention and the proposal to introduce long-term compulsory interventions in a community setting. Will community psychiatric nurses be turned into community custodians, rather than having a therapeutic relationship with the patient and their family? The grounds for compulsion are where

"the necessary care and treatment cannot be provided by agreement with the patient; the person's decision-making ability is impaired to a nature or degree which would justify compulsory measures; … there is a significant risk of harm to the health or safety or welfare of the patient or a significant risk of harm to other persons if such treatment is not administered."

We begin to get a picture of the enormous responsibility of compulsory care in a community setting.

My next point on reciprocity, which has been more or less covered by Nicola Sturgeon, is about dropping the right to advocacy, as was recommended by the Millan committee, and replacing it with

"a duty on the NHS and local authorities to ensure that a range of advocacy services are provided."

In its submission, SAMH said:

"The right to advocacy is a clear principle and a clear right."

I hope that, under the principle of reciprocity, service users will be entitled by right to advocacy services to ensure that they receive the appropriate choice and care for their needs. I also believe that advocacy is essential to protect against neglect and abuse.

The second principle that I want to discuss is respect for diversity. There seems to be an underlying assumption that a wide range of options for care are available. The aim is that service users should receive care that

"accords respect for their individual qualities, abilities and diverse backgrounds and properly takes into account age, gender, sexual orientation, ethnic group and social, cultural and religious background."

These are undoubtedly worthy principles and aspirations, but there is no doubt that, to achieve them—and in order for people to have choice and appropriate treatment—significant resources will need to be reprioritised into the mental health budgets. Any intervention or treatment is only as good as the best possible assessment of need. I am concerned about many of the answers to written parliamentary questions on waiting times and on vacancy rates for clinical psychologists, psychiatrists and the shortage of forensic psychologists.

The final principle that I want to mention is the least restrictive alternative. Again, the policy statement says that service users should be provided with the

"necessary care, treatment and support … in the least invasive manner and in the least restrictive manner and environment compatible with the delivery of safe effective care, taking account where appropriate of the safety of others."

A full range and choice of diverse services must be available to exercise and achieve that principle.

SAMH raised concerns about community-based compulsion, saying that the evidence to support that approach has not been provided, despite research into the use of similar orders elsewhere in the world. In fact, SAMH goes further, stating:

"Until there is a firmer evidence base, the move towards community compulsion should be resisted".

Although I feel sympathetic to community compulsion, I would like some of those issues to be addressed. I would like to be assured that the system has been applied elsewhere and that it is the best system for people with mental illness in Scotland.

Research from other countries seems to show that compulsion in the community, combined with enhanced service, produces better outcomes. Even the enhanced services by themselves produce good outcomes. However, we return to the need for a range of services to allow choice, diversity and appropriate care designed for individual needs.

The basic principles of reciprocity, respect for diversity and the least restrictive alternative can be meaningful in practice only if there is a full range of services, including crisis services, based in the community. The reconfiguration of that wide range of services would also prevent many people from becoming so ill that it becomes necessary for them to be detained in hospital. That is why the Scottish Conservatives will today acknowledge and endorse the SNP amendment.

It is hoped that the range of services would be provided by the public, private and voluntary sectors to enable choice. I have already spoken about resources. It is important to point out that recent community care statistics have compared the average weekly charge per resident in residential care homes for people with mental health problems. The statistics state that the average weekly charge for a private sector place is £254, the average weekly charge for a voluntary sector place is £357, and the average weekly charge for a local authority place is £616. With local authority weekly charges at more than double the cost of the private sector, the cost of treating two people in a local authority home would cover the treatment of five people in private or voluntary sector places. If we are considering a wider and more diverse range of services with limited resources, it is important that we also consider providers.

Delayed discharge has been mentioned in connection with compulsory community orders. Members should note that, in Inverness alone, 38 patients who have been in New Craigs hospital for some time are awaiting discharge into the community. I very much welcome the increase in services in the community.