Hansard

The debate has been excellent and, as Margaret Ewing put it, a shining example of what the Parliament is about.

There have been continual references to the wider spectrum of mental health policy and initiatives, but the focus has been on renewing mental health law. At the heart of our approach are the needs and rights of individual mental health service users. We are strengthening the rights of patients to assessment, services and protection and are giving patients a stronger voice in legal proceedings and dealing with professionals.

However, balancing the rights of patients is a wider public interest, particularly when people with mental disorders are involved in offending behaviour. Our reforms in that area will lead to more transparency in decision making, stronger rights for patients and better protection for the public, through more effective assessment and management of risk.

I thank all the members who have expressed their best wishes to Susan Deacon and, since the next member I will deal with is Mary Scanlon, I particularly thank her for her rather interesting reference to the new arrival. I know that Susan Deacon has been working miracles in the development of maternity services, but I am not aware that she has reduced the waiting time for birth to quite such an extent.

Mary Scanlon asked a specific question about the provision of safe and appropriate services and how they would be monitored. I assure her that they will be monitored as part of the care programme approach and that the Mental Welfare Commission will also monitor the delivery of service in individual cases.

Mary Scanlon's main point was perhaps about advocacy, which is also the point that Nicola Sturgeon started with and which many others referred to. I assure members that we are committed to the same aim as Millan—that mental health service users should have access to an advocate when they need one. In "Our National Health", we have already set out a requirement that NHS boards demonstrate their plans for making independent advocacy available to all who need it. That must be done by the end of this calendar year. We are currently examining their plans. The bill will go further and, for the first time, create a duty on both the NHS and local authorities to support independent advocacy in mental health.

Various members, including Brian Adam, expressed concern about collective advocacy. There are different forms of collective advocacy. It is only recently that the importance of collective advocacy has been properly recognised. If we imposed a duty in legislation, it would be necessary to define collective advocacy and how it should be supported. We are concerned that that might restrict flexibility and innovation. We want collective advocacy to develop through local negotiation and discussion, not in response to a statutory imposition from above. However, we recognise that many people feel strongly about this issue. We will continue to discuss with advocacy interests how the duties in the mental health bill should be expressed, to ensure that the aims of Millan are fulfilled.

Nicola Sturgeon made many points in her speech. I do not have time to go over all of them. She made an interesting and important reference to advance statements and commented on the suggestion from SAMH that those should have a formal standing and perhaps should be able to be overturned only by a tribunal. We will consider that and the many other helpful suggestions from SAMH. We currently feel that that suggestion might create problems in emergencies or where statements are unclear.

Nicola Sturgeon also referred to the title of the coming bill. Robin Harper suggested that it should be called the regulation of psychiatric care act. I think that that title would be rather narrower than the current scope of the bill.

A lot of what Nicola Sturgeon said, and stated in her amendment, focused on resources. She referred to her fear that compulsory treatment orders might be a sticking plaster. We should remember that a new feature of compulsory treatment in the proposals is that a care plan must go with it. Some members have drawn a false dichotomy between services and compulsion.

As I said, Nicola Sturgeon's main point was about resources. I am pleased to announce that we accept the SNP's amendment. We are in discussions with service providers on the resource implications of the bill. It would be premature to specify a figure for its cost. When the bill is published, the financial memorandum will set out our views on resources, but members should be in no doubt about the Executive's commitment to the proposals that we are putting forward. We will ensure that the necessary resources are in place for effective implementation of the reforms.

Margaret Smith asked why we are using impaired decision making, rather than impaired judgment, as one of the criteria for compulsion. It reflects advice from the mental health legislation reference group. A concern was that the term impaired judgment was too limited and subjective. For example, disagreeing with the psychiatrist might be said to be impaired judgment. The point of the test is that the mental disorder must be adversely affecting the patient's ability to understand and make a real choice about the treatment.

Kenny Gibson raised concerns about psychiatric services in relation to sexual abuse. I am very aware of that issue and was pleased to launch some research recently by Sarah Nelson, which focused on female survivors of sexual abuse. The matter was also raised in the "National Framework for the Prevention of Suicide and Deliberate Self-harm in Scotland", which I was pleased to launch recently. I hope that the addition to the mental health framework, on psychological interventions, which I also announced in October, will help survivors of sexual abuse.

Margaret Jamieson made a passionate speech about stigma. I was pleased to announce, on 8 October, the setting up of a national advisory group to take forward the programme of work funded by the £4 million allocated in "Our National Health: A plan for action, a plan for change" for the promotion of mental health and well-being and the attack on stigma. I intended to say more about that group, but I have one eye on the clock so I will just say that the members of the group will be announced soon. Part of its work will take on board Robin Harper's concerns about doing work in schools and Margaret Ewing's concerns about the use of certain language by the media. I regret the absence of the media at this debate.

Lord James Douglas-Hamilton asked how patients could be compulsorily treated in the community. We will explicitly legislate that forcible treatment can be administered only at designated clinics and hospitals. We accept that such treatment in a patient's home, or other domestic or public setting, would be very traumatic and unhelpful, and it will not be allowed.

Lord James Douglas-Hamilton was concerned about the role of ministers. It is right that ministers should no longer be able to discharge restricted patients. That is a judicial role; however, ministers will still be involved in the oversight of restricted patients and will be able to make representations to the independent tribunal and to appeal to the Court of Session against discharge decisions that they consider to be inappropriate.

Margaret Ewing asked about the implementation and monitoring group. We are continuing to support a mental health legislation reference group throughout the process of implementation. Once the act is in force, we will wish to review how the monitoring will continue and will bear in mind the on-going role of bodies such as the Mental Welfare Commission.

I am sure that we all agree that David Davidson made a most moving speech about eating disorders. I am pleased to remind members that, in October, we announced a further extension to the mental health framework which deals specifically with eating disorders and which states:

"Much more needs to be done to create treatment protocols, clear referral pathways and a pattern of specialist in-patient provision in the NHS."

I will conclude by referring to two points made by Richard Simpson. He said that the mental health framework must be driven forward with a real sense of urgency. I believe that that is happening now. Ben Wallace may well be right to say that no support group existed in the early years of the framework, before the Parliament was created, but one of Susan Deacon's early acts was to set up such a group. As a result of the group's excellent work and the additions to the framework to which I have referred, there is now a momentum behind the framework's implementation.

Richard Simpson also referred to the fact that institutional care accounts for 80 per cent of mental health expenditure. That issue is being addressed by the performance assessment framework, in which we specifically examine the percentage of mental health spend on services in the community.

My time is up. I hope that members will appreciate the vast range of initiatives that are in store. Although I have not mentioned the resource question that John McAllion and Shona Robison raised, I should point out that spending increased by 9 per cent in the NHS last year. That increase is over and above specific initiatives such as the mental illness specific grant.

As for the law reform proposals that we recently announced, although our changes are radical, they are also principled and practical and amount to the most fundamental reform of mental health legislation for a whole generation. I commend them to the chamber.