Mental Health Bill [HL]

Baroness Barker Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Barker (LD)]

Would the Minister reflect on this? CTOs were brought in under the 2007 Act. The then Labour Government went shopping around the world for various different models of CTOs and cherry-picked bits and pieces out of the ones that they liked to come up with the model that they did. CTOs were brought before the House, and we were assured that they would be used sparingly and we would not run into all the problems that people then foresaw about them being used disproportionately against some minoritised communities.

This is the first opportunity we have had to go back to CTOs. In the 20 years since, absolutely nothing has changed in practice. Twenty years on, there is no indication—even though there must be ample evidence, not just in this country but around the world—about how they work in practice and the fact that they have not worked in the way they were meant to when they were introduced. Does the Minister understand why those of us who have been here so often before are reluctant to accept the argument that is trotted out time after time, that Governments need to be flexible and make change, when within 20 years there has been no change in the face of overwhelming evidence that the law is not working in the way that was intended?

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Moved by

[Baroness Barker]

43A: Clause 6, page 12, line 34, at end insert—
“(c) after subsection (6) insert—“(6A) Any person subject to a community treatment order must be informed orally and in writing at the time of the making of the order of their right to an independent mental health advocate under section 130A of this Act.””Member’s explanatory statement
The amendment would ensure that people who are to be subject to a CTO would receive information about their right to advocacy.

[Baroness Barker (LD)]

My Lords, I do not want to bore people who were not present 20 years ago when we were discussing the introduction of this measure, but the main focus of our discussion was that CTOs would be a means of enabling people with serious and enduring conditions, such as schizophrenia, to be compelled to take medication in the community. That was as a matter of public safety and protection for those people. Twenty years on, we are talking about people with eating disorders: it is completely different.

The noble Baroness, Lady Browning, is right: the evidence base behind the discussion is woefully lacking. What we do not know—we do not have the evidence for it—is what change has come about on the part of clinicians. It was sold to us that we were going to stop people being held inappropriately in acute services where they did not need to be and where there was not going to be any therapeutic benefit for them. We have never, to the best of my knowledge, seen that there has been change, nor, indeed, that there has been a flow of resources that has enabled those patients who have been on CTOs to leave acute hospitals and not go back. Unless and until we get that evidence base, frankly, we can all come up with our theories about what are the causal factors, but they are nothing more than our own prejudices and theories.

That said, my amendment on CTOs comes from real-life, front-line experience. As the noble Lord, Lord Kamall, read out from the briefing, there are people whose experience of being on CTOs has been so bad that they want to see an end to them; they do not want to see other people being subjected to them, and I have a degree of sympathy with that. Having said that, I accept that there are some people for whom they work.

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[Baroness Barker (LD)]

My Lords, I thank the Minister very much. I will not delay the Committee for very long, particularly given the time of night and that people are screaming to go home. However, there are two or three important points that we need to make. First, on community treatment orders, let us remember that it is compulsory treatment in the community. It happens in people’s own homes or wherever they live, but it is compulsory treatment. We are in danger of forgetting that. Secondly, the Minister said that the intention was to ensure that all detained patients have access to an advocate. Advocacy services are in the acute hospitals. They are not out in the community, yet the treatment which is happening in the community is compulsory treatment.

Both of those two points flag up something that a lot of us mentioned at Second Reading. We have taken the 1983 Act and patched it up, and bolted things on and taken things off so many times that we are now at the point of squeezing stuff in and shoving it around, and we no longer have a basic legal framework which is fit for purpose. We are not talking about building seamless community and acute services which people pass through, get better and come out; we are now in Heath Robinson territory. That is why we are in danger of missing some tricks.

The organisations that came up with my amendment are made up of the people who work, day in and day out, to try to build a proper service, as opposed to episodes of care. They are saying that people who are subject to compulsory treatment are not getting advocacy because of the way that the services are set up. I hope that the Minister might take that on board, but at this stage and time of night, I beg leave to withdraw my amendment.

Amendment 43A withdrawn.