Chamber
Plenary, 11 Dec 2002
11 Dec 2002 · S1 · Plenary
Item of business
Mental Health (Scotland) Bill: Stage 1
I thank the clerks, the committee's adviser and all those who gave evidence. We took evidence from the Carstairs state hospital, from Dundee and from people in the Highland users group, who probably travelled the furthest. I hope that the bill addresses the isolation and stigma of people with mental illness. If it addresses those who say—to quote the chaplain—"I telt ye, I need nae help," that will be a mark of success.
I shall state our concerns. The bill was due to be considered by the Health and Community Care Committee at the beginning of February. We received a draft bill of 89 pages in June. The amended bill, which arrived in September, had almost doubled in size to 168 pages. I understand that there are 1,400 amendments by the Executive alone and that we can expect several hundred more amendments to be lodged by various organisations. The Mental Health (Scotland) Bill is possibly the most extensive and complex bill to be faced by the Parliament. It will affect a huge number of people, and we need time to get it right, not deadlines. When the Law Society of Scotland came to the committee, it stated that it found the bill confusing and ambiguous. If the Law Society found the bill confusing and ambiguous, perhaps the minister should have more consideration for members of the committee. That justifies our concerns over the timetable. However, the Scottish Conservatives will support all provisions to end stigma and to bring respect and dignity to the care and treatment of people with mental illness.
Most of those who gave evidence said that they wanted the principles to be made explicit in the bill. I accept the minister's point—that he has accepted that wish in the committee's report, on the basis of what works—but I think that we will look at what he decides works and see how different that is from the principles that were set out in the Millan committee report. If the principles were stated in the bill, that would help us to decide what the bill is designed to resolve, what wrongs will be righted by the bill and how its success will be judged.
The main concern is about resources. I find it difficult to believe the financial estimates. The financial memorandum states that the additional costs associated with the bill will be £23 million a year, with a further £9 million in start-up costs. I wonder how those figures were reached. The minister has said that the Executive will undertake an assessment or audit of current mental health provision. How can the Executive accurately assess what is needed unless it knows what it has got already? As has been mentioned, the basic infrastructure to treat people with mental health problems is simply not there. In Carstairs state hospital, 29 patients on average are waiting to be discharged. We need more medium-secure units. We also need more understanding from MSPs, who will vote the bill through. They must look more positively to contribute to the consultation and help to get rid of the myths that surround medium-secure units, which Shona Robison mentioned.
We need more supported accommodation and day centres. We also need to reconsider the treatment of children in adult wards. Last week, Bill Butler's members' business debate dealt with the provision that is needed to help mothers to cope with post-natal depression. There is also a grave need for provision for people with eating disorders. Tremendous infrastructure needs to be put in place simply to implement the bill.
Our next concern is over staffing. Currently, there are 29 vacancies for psychiatrists in Scotland. To implement the bill fully, we will need a further 28 psychiatrists. We also need mental health officers, against a background of a serious shortage of social workers. I was pleased to hear the commitment that the Minister for Health and Community Care gave to Shona Robison about financing the bill. I can understand that money is much easier to find than staff. We cannot magic 57 psychiatrists out of thin air to fully implement the bill.
Generally speaking, I can accept compulsory treatment and community-based compulsory treatment orders, based on the principle of the least restrictive alternative. However, Maggie, from the Edinburgh users forum, told us in evidence that she did not want her home and her privacy invaded. She did not want her home to be used as a hospital or for her treatment. We also heard evidence from Marcia from Elgin, who stated:
"If people are ill enough to be sectioned, they are ill enough to be in hospital."—[Official Report, Health and Community Care Committee, 30 October 2002; c 3263.]
Although I agree in general with compulsory treatment orders in the community, we should not assume that they will be appropriate for everyone. It will be difficult to provide the level of support that will be needed for people in remote and rural areas. The bill is intended to reduce stigma and isolation; I hope that the minister understands that, in remote and rural areas, the bill will hardly reduce stigma and isolation if a community psychiatric nurse turns up twice a day. I hope that the minister will take that into account. I also hope that health boards and trusts will not use community-based CTOs to justify the loss of beds for mentally ill patients.
The police did not give evidence to the Health and Community Care Committee—perhaps they gave evidence to the Justice 1 Committee. I understand that, if a patient fails to turn up for treatment or is absent from home for treatment, the community psychiatric nurse will initially go to neighbours and look in likely places. If the patient is not found, the police will be alerted to look for a missing person. The role of the police needs to be addressed and resourced and the police need to be included in all discussions at the outset, particularly as the bill states in section 205(4)(a)(ii) that patients can be taken into custody. I do not want that issue to be overlooked, because for many patients it gives rise to the fear that it will not be a nurse who comes after them, but the police. I hope that the police's role will be handled sensitively.
The bill tends to state that there will be a "care plan". That term was appropriate for elderly people in the Community Care and Health (Scotland) Act 2002, but given that more than 70 per cent of people recover from mental illness, could we not accept the suggestion that there should be a recovery plan rather than a care plan?
Having listened to all the evidence on advance statements, I find that I agree with the patient and with the psychiatrist, yet their views differ. The issue of advance statements is one of the most controversial that the bill covers. I agree that patients should be given the opportunity to state in advance what treatments they do and do not want; I found the arguments on that most compelling. That is a mark of openness, democracy and treating the patient as a partner in their own treatment. However, when Professor David Owens came to the committee and talked about his duty of care, he said that an advance statement would inhibit his ability to treat a patient. He pointed out that drugs and therapies could advance between the time of writing of the advance statement and the time of care, and that it would be difficult for the patient to change her wishes.
I found both arguments compelling. I agree with them both, but I know that that is not possible. The convener of the Health and Community Care Committee gave a good example when she talked about her wish for natural childbirth—until the labour pains started, when her advance statement changed rapidly. I do not mean to make light of the matter. That is an example of the difference between making a statement in advance and facing the reality.
I find it confusing that, as Shona Robison mentioned, there are advance statements and there are advance statements. For example, if someone says, "I would prefer not to have treatment," that is a different advance statement from, for example, "I do not want that treatment if my life depends on it." We need more clarity about advance statements. I accept the principle that patients should be advised and respected, but we must all respect the psychiatrists' duty of care.
There has been considerable concern about the fact that, although the bill would place a duty on councils to provide advocacy, an individual would have no right to receive the service. Many groups who gave evidence to the committee highlighted that anomaly. The minister said that all those who need advocacy services should be able to obtain them, but we must be a bit firmer on that issue. How can assessing a need assess a demand? For example, someone could be told that they could not see an advocate for six months. Unless we know the need for advocacy services, and people have the right to those services, we cannot assume that supply will match demand. It is not enough for the minister to say that those who need advocacy services should be able to obtain them. We would hope that everyone who has a need for advocacy would have a right to receive that service.
Much of the Health and Community Care Committee's time on the Community Care and Health (Scotland) Bill was spent in looking at the lack of partnership working and joint planning. Of course, the minister was a member of the Health and Community Care Committee when it dealt with the Community Care and Health (Scotland) Bill and I am sure that he remembers the points that were made by representatives from social work and the NHS. Members of the committee spent hours considering the lack of joined-up thinking and planning between the NHS and social work. Given that the Mental Health (Scotland) Bill gives us a wonderful opportunity to consider joint planning, resourcing, managing and budgets, it is rather strange that the bill has separate sections for social work and the NHS, with clear and distinct lines of demarcation.
The minister has many grand words on issues such as joint futures and partnership, but we still have 2,900 blocked beds. The minister was a member of the Health and Community Care Committee when it discovered that £63 million that had been earmarked for the elderly was spent on other services. The bill provides an opportunity to ensure that all the resources that are earmarked for the mentally ill will, indeed, go to help them.
I will conclude on time, Presiding Officer, by giving my party's commitment to the general principles of the bill.
I shall state our concerns. The bill was due to be considered by the Health and Community Care Committee at the beginning of February. We received a draft bill of 89 pages in June. The amended bill, which arrived in September, had almost doubled in size to 168 pages. I understand that there are 1,400 amendments by the Executive alone and that we can expect several hundred more amendments to be lodged by various organisations. The Mental Health (Scotland) Bill is possibly the most extensive and complex bill to be faced by the Parliament. It will affect a huge number of people, and we need time to get it right, not deadlines. When the Law Society of Scotland came to the committee, it stated that it found the bill confusing and ambiguous. If the Law Society found the bill confusing and ambiguous, perhaps the minister should have more consideration for members of the committee. That justifies our concerns over the timetable. However, the Scottish Conservatives will support all provisions to end stigma and to bring respect and dignity to the care and treatment of people with mental illness.
Most of those who gave evidence said that they wanted the principles to be made explicit in the bill. I accept the minister's point—that he has accepted that wish in the committee's report, on the basis of what works—but I think that we will look at what he decides works and see how different that is from the principles that were set out in the Millan committee report. If the principles were stated in the bill, that would help us to decide what the bill is designed to resolve, what wrongs will be righted by the bill and how its success will be judged.
The main concern is about resources. I find it difficult to believe the financial estimates. The financial memorandum states that the additional costs associated with the bill will be £23 million a year, with a further £9 million in start-up costs. I wonder how those figures were reached. The minister has said that the Executive will undertake an assessment or audit of current mental health provision. How can the Executive accurately assess what is needed unless it knows what it has got already? As has been mentioned, the basic infrastructure to treat people with mental health problems is simply not there. In Carstairs state hospital, 29 patients on average are waiting to be discharged. We need more medium-secure units. We also need more understanding from MSPs, who will vote the bill through. They must look more positively to contribute to the consultation and help to get rid of the myths that surround medium-secure units, which Shona Robison mentioned.
We need more supported accommodation and day centres. We also need to reconsider the treatment of children in adult wards. Last week, Bill Butler's members' business debate dealt with the provision that is needed to help mothers to cope with post-natal depression. There is also a grave need for provision for people with eating disorders. Tremendous infrastructure needs to be put in place simply to implement the bill.
Our next concern is over staffing. Currently, there are 29 vacancies for psychiatrists in Scotland. To implement the bill fully, we will need a further 28 psychiatrists. We also need mental health officers, against a background of a serious shortage of social workers. I was pleased to hear the commitment that the Minister for Health and Community Care gave to Shona Robison about financing the bill. I can understand that money is much easier to find than staff. We cannot magic 57 psychiatrists out of thin air to fully implement the bill.
Generally speaking, I can accept compulsory treatment and community-based compulsory treatment orders, based on the principle of the least restrictive alternative. However, Maggie, from the Edinburgh users forum, told us in evidence that she did not want her home and her privacy invaded. She did not want her home to be used as a hospital or for her treatment. We also heard evidence from Marcia from Elgin, who stated:
"If people are ill enough to be sectioned, they are ill enough to be in hospital."—[Official Report, Health and Community Care Committee, 30 October 2002; c 3263.]
Although I agree in general with compulsory treatment orders in the community, we should not assume that they will be appropriate for everyone. It will be difficult to provide the level of support that will be needed for people in remote and rural areas. The bill is intended to reduce stigma and isolation; I hope that the minister understands that, in remote and rural areas, the bill will hardly reduce stigma and isolation if a community psychiatric nurse turns up twice a day. I hope that the minister will take that into account. I also hope that health boards and trusts will not use community-based CTOs to justify the loss of beds for mentally ill patients.
The police did not give evidence to the Health and Community Care Committee—perhaps they gave evidence to the Justice 1 Committee. I understand that, if a patient fails to turn up for treatment or is absent from home for treatment, the community psychiatric nurse will initially go to neighbours and look in likely places. If the patient is not found, the police will be alerted to look for a missing person. The role of the police needs to be addressed and resourced and the police need to be included in all discussions at the outset, particularly as the bill states in section 205(4)(a)(ii) that patients can be taken into custody. I do not want that issue to be overlooked, because for many patients it gives rise to the fear that it will not be a nurse who comes after them, but the police. I hope that the police's role will be handled sensitively.
The bill tends to state that there will be a "care plan". That term was appropriate for elderly people in the Community Care and Health (Scotland) Act 2002, but given that more than 70 per cent of people recover from mental illness, could we not accept the suggestion that there should be a recovery plan rather than a care plan?
Having listened to all the evidence on advance statements, I find that I agree with the patient and with the psychiatrist, yet their views differ. The issue of advance statements is one of the most controversial that the bill covers. I agree that patients should be given the opportunity to state in advance what treatments they do and do not want; I found the arguments on that most compelling. That is a mark of openness, democracy and treating the patient as a partner in their own treatment. However, when Professor David Owens came to the committee and talked about his duty of care, he said that an advance statement would inhibit his ability to treat a patient. He pointed out that drugs and therapies could advance between the time of writing of the advance statement and the time of care, and that it would be difficult for the patient to change her wishes.
I found both arguments compelling. I agree with them both, but I know that that is not possible. The convener of the Health and Community Care Committee gave a good example when she talked about her wish for natural childbirth—until the labour pains started, when her advance statement changed rapidly. I do not mean to make light of the matter. That is an example of the difference between making a statement in advance and facing the reality.
I find it confusing that, as Shona Robison mentioned, there are advance statements and there are advance statements. For example, if someone says, "I would prefer not to have treatment," that is a different advance statement from, for example, "I do not want that treatment if my life depends on it." We need more clarity about advance statements. I accept the principle that patients should be advised and respected, but we must all respect the psychiatrists' duty of care.
There has been considerable concern about the fact that, although the bill would place a duty on councils to provide advocacy, an individual would have no right to receive the service. Many groups who gave evidence to the committee highlighted that anomaly. The minister said that all those who need advocacy services should be able to obtain them, but we must be a bit firmer on that issue. How can assessing a need assess a demand? For example, someone could be told that they could not see an advocate for six months. Unless we know the need for advocacy services, and people have the right to those services, we cannot assume that supply will match demand. It is not enough for the minister to say that those who need advocacy services should be able to obtain them. We would hope that everyone who has a need for advocacy would have a right to receive that service.
Much of the Health and Community Care Committee's time on the Community Care and Health (Scotland) Bill was spent in looking at the lack of partnership working and joint planning. Of course, the minister was a member of the Health and Community Care Committee when it dealt with the Community Care and Health (Scotland) Bill and I am sure that he remembers the points that were made by representatives from social work and the NHS. Members of the committee spent hours considering the lack of joined-up thinking and planning between the NHS and social work. Given that the Mental Health (Scotland) Bill gives us a wonderful opportunity to consider joint planning, resourcing, managing and budgets, it is rather strange that the bill has separate sections for social work and the NHS, with clear and distinct lines of demarcation.
The minister has many grand words on issues such as joint futures and partnership, but we still have 2,900 blocked beds. The minister was a member of the Health and Community Care Committee when it discovered that £63 million that had been earmarked for the elderly was spent on other services. The bill provides an opportunity to ensure that all the resources that are earmarked for the mentally ill will, indeed, go to help them.
I will conclude on time, Presiding Officer, by giving my party's commitment to the general principles of the bill.
In the same item of business
The Deputy Presiding Officer (Mr Murray Tosh):
Con
There are no Parliamentary Bureau motions at this time, so we move straight to the debate on motion S1M-3398, in the name of Malcolm Chisholm, on the general...
The Minister for Health and Community Care (Malcolm Chisholm):
Lab
The bill represents the most fundamental review of mental health law in Scotland for 40 years. At its core is a new framework for compulsory care and treatme...
Margaret Jamieson (Kilmarnock and Loudoun) (Lab):
Lab
Will the minister clarify reports in The Scotsman earlier this week that the Executive intends to withdraw the bill?
Malcolm Chisholm:
Lab
There is no truth whatsoever in that suggestion. The number of amendments was thought to be newsworthy but, as someone who spent nine years at Westminster, I...
Mr John Swinney (North Tayside) (SNP):
SNP
Will the minister clarify his last remark? Will the proposed assessment examine only the new provisions in bill or the range of provisions that exists in Sco...
Malcolm Chisholm:
Lab
With respect, I think that I made it clear that we would be talking about the assessment of existing mental health services—in other words, all the mental he...
Brian Adam (North-East Scotland) (SNP):
SNP
Will the minister give way?
Malcolm Chisholm:
Lab
In a moment.One of the bill's most hotly debated aspects concerns community-based compulsory treatment orders. I welcome the fact that the committee has agre...
Shona Robison (North-East Scotland) (SNP):
SNP
Will the minister give way?
Malcolm Chisholm:
Lab
I have already taken two interventions. However, if I have time towards the end of my speech, I will take the two that have already been indicated.On advocac...
Brian Adam:
SNP
Some aspects of care will be delivered through the health service and some through local authorities. However, some of it will be delivered through the volun...
Malcolm Chisholm:
Lab
I am a strong supporter of the voluntary sector in general and the mental health voluntary sector in particular. Indeed, our joint future policy certainly in...
Shona Robison:
SNP
Returning to the subject of compulsory treatment orders, I was pleased to hear what the minister said about the research project that he is establishing. How...
Malcolm Chisholm:
Lab
I mentioned the research. There is an important role to be played by the Mental Welfare Commission in the monitoring of that research and other aspects of th...
Shona Robison (North-East Scotland) (SNP):
SNP
I thank all the Health and Community Care Committee clerks, who have worked hard on the bill. I pay special thanks to our committee adviser, Dr Jacqueline At...
Mary Scanlon (Highlands and Islands) (Con):
Con
I thank the clerks, the committee's adviser and all those who gave evidence. We took evidence from the Carstairs state hospital, from Dundee and from people ...
Mrs Margaret Smith (Edinburgh West) (LD):
LD
I welcome this important bill, which is the most radical overhaul of the mental health legislation for 40 years. It comes at a time when most people would ag...
The Deputy Presiding Officer:
Con
Time is very tight and I do not think that we will be able to call everybody, although we will do our best. I ask for four-minute speeches, please.
Margaret Jamieson (Kilmarnock and Loudoun) (Lab):
Lab
I declare an interest as a member of Unison, which represents many workers in the various branches of mental health services. I welcome the opportunity to de...
Mr Adam Ingram (South of Scotland) (SNP):
SNP
I congratulate the Health and Community Care Committee on the thorough report that it has produced on a long, complicated bill. Like many others with an inte...
Lord James Douglas-Hamilton (Lothians) (Con):
Con
Adam Ingram's speech was welcome. His call for early intervention and prevention rings a chord with us all.The Conservative party gives a cautious welcome to...
Scott Barrie (Dunfermline West) (Lab):
Lab
I declare an interest as a member of the advisory board for the core club, which is a Scottish Association for Mental Health project in Dunfermline, and as a...
Irene McGugan (North-East Scotland) (SNP):
SNP
In my brief speech, I will focus on the issues that affect children and young people. Many of the concerns that I will describe were raised by children's org...
Iain Smith (North-East Fife) (LD):
LD
As many members have said, the bill is the largest and most complex that the Parliament has dealt with so far. It is no less important for its complexity. I ...
Bill Butler (Glasgow Anniesland) (Lab):
Lab
The bill whose principles are under discussion today is a necessary and overdue revamping of the current legislative framework. Indeed, there has been no ess...
Brian Adam (North-East Scotland) (SNP):
SNP
I make no apologies for returning to the issue of resources. It is all very well to produce legislation; indeed, we might even set aside specific sums of mon...
Dr Richard Simpson (Ochil) (Lab):
Lab
I begin by declaring my membership of the British Medical Association, the Scottish Association for Mental Health and the Royal College of General Practition...
Mr David Davidson (North-East Scotland) (Con):
Con
I draw members' attention to my interest as a pharmacist and as the parent of a service user. At last, the Scottish Executive and the Scottish Parliament are...
Dorothy-Grace Elder (Glasgow) (Ind):
Ind
I have had a console problem. It was not working—although it did not look as if it was not working—so I am further down the list of speakers.I thank the conv...
Tricia Marwick (Mid Scotland and Fife) (SNP):
SNP
I will be brief, Presiding Officer. I have serious concerns about the independence of the advocacy service as detailed in the bill. The bill places a duty on...