Hansard

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 review of our mental health law. The process surrounding it, which has involved at every stage all those who have a legitimate interest, has been excellent. In that respect, it builds on the report "The same as you?", which was highly praised for its involvement of users and carers.

One of the most difficult aspects of legislation in this area is the need to promote the most effective treatment while allowing the individual as much freedom of choice in treatment as possible and, as Lord James Douglas-Hamilton said, protecting the public from the rare event of violence.

Down the centuries, we have steadily progressed from the manacles and shackles of the 18th century—which I was presented with as a student, as they were still being used in Australia in the late 1960s—to the acts of the 1950s, 1960s and 1980s, which moderated and regulated the infringement of liberty. Recently, I was involved in a study tour for Dutch health workers and politicians, who were astonished that we never use restraints, unlike in the Netherlands. Already, society in Scotland has moved significantly ahead of other countries in terms of the treatment of the most disturbed individuals. Through the legislation that we are about to introduce, we can embrace proposals that will be fit for the 21st century and will promote what Des McNulty referred to: a genuine partnership between the patient, their family or carer and the health professionals.

The principles in the Adults with Incapacity (Scotland) Act 2000, which stated that the treatment chosen should be the least invasive and should follow the perceived wishes of the patient, presage the new legislation. The notion that the treatment and the setting should be the least restrictive will be a central part of the new bill.

Nicola Sturgeon and others referred to advocacy, so I will not dwell on it. Forth Valley Health Board developed one of the earliest advocacy services, which has been crucial to some people with mental health problems. Advance directives, particularly on special treatments such as ECT, are absolutely vital. The management of those advance directives, combined with the nomination of an individual to act for the patient, provides a sensitive and important way of dealing with a difficult situation.

This has been one of the most consensual debates that we have had in the chamber. It feels almost like a members' business debate, so little difference is there between the parties.

The most exciting proposal is the principle of reciprocity, which will ensure that, if the state has to curtail aspects of liberty, the patient will receive the services and treatment that they need. That guarantee is crucial to every citizen. If it is enshrined in law, we will have moved forward care in Scotland in a big way. I would like the roles of the Clinical Standards Board for Scotland and the Mental Welfare Commission in protecting and guaranteeing that right to be spelled out and I welcome the fact that the Executive will review the Mental Welfare Commission.

The CSBS must define the clinical standards that are acceptable and it must inspect the mental health services, while the Mental Welfare Commission must have powers to require health boards to meet those standards. To ensure that we achieve the standards that we want, the mental health framework needs to be driven forward with real urgency and the health boards and community plans need to be subjected to rigorous local accountability and defined outcomes through the national assessment framework.

I say to Robin Harper that community care began in 1956, following the report of the Dunlop commission. It has been part of my life as a psychiatrist for all my working years, although, for the most part, it has not been a reality. Some 80 per cent of our expenditure on mental health services is still on institutional care. We must work to change that situation.

I cannot finish without commenting on one contentious part of the proposals—the new community orders. A recent review in the Psychiatric Bulletin, to which Des McNulty obliquely referred, could be summarised as indicating that, on the basis of the evidence across the world where such orders, in different forms, have been tried, there is as yet no proven advantage to compulsory community orders over high-quality services on their own. Before we proceed with the bill, we should use this brief period to produce research to assist in determining whether those orders are likely to help in fulfilling the Executive's stated aim of introducing greater flexibility and preventing hospitalisation

As the Minister for Health and Community Care said, there is a danger that compulsion, even with guaranteed high standards of care, may be abused. We should commend the Millan commission for its report. I commend the Executive for the exemplary consultation process that it has gone through and for its ambition for the people of Scotland in this policy area. I await the new bill with eager anticipation. I commend the motion and the SNP's amendment.