Mental Health Advocacy

Charles supports the right of those suffering mental health problems to receive the very best advocacy if they face having their liberties restricted.

Mr. Charles Walker (Broxbourne) (Con): It is a great privilege and honour to move the first Adjournment debate after the Christmas recess. I welcome the Minister to his place. I had the great pleasure of working with him when I served on the Public Administration Committee and he was the Minister for the third sector. He took a great deal of interest in the work of our Committee and he always listened and was always helpful. I hope he will be equally helpful this evening.

I had the great honour and privilege of serving on the Mental Health Bill in 2007. The Bill has now become an Act and its measures came into force on 3 November 2008. Many parts of the Act were welcomed by all sides of the House. However, some parts of the Act caused many Members on all sides of the House great concern. The Act contained significant powers to detain and treat people against their will. Many of us in this place were concerned about that. The Act also incorporated safeguards in the form of independent mental health advocacy that would ensure that people who were being detained against their will or faced being detained against their will for mental health problems could receive the support of an independent advocate. That is crucial.

When someone has a mental illness and has an episode that requires or may require their detention, their liberty is removed and their freedom of movement is restricted. Some people are committed to secure hospitals. Others are subject to community treatment orders which restrict their liberties and freedom of movement in the community. The role of the advocate is to support those people in their dealings with health care professionals. Someone having a mental episode may be extremely bewildered, upset and frightened. They get a great deal of information, some of which they do not agree with and much of which they may be hostile towards. They can feel very alone and isolated.

The role of advocates is to stand and sit by that person and to ensure that they understand as far as possible their rights under the Mental Health Act 2007—their right to say no and to question the treatments and recommendations proposed by health care professionals and clinicians. That is a hugely important part of the Act.

Let us turn for a moment to our criminal justice system. When defendants before the courts face losing their liberty, we have a robust legal system which ensures that they get proper representation, that their interests and concerns are given a proper hearing, and that their side of the story is put. It is just as important that people who face being incarcerated and having their liberty removed as a result of a mental health episode have the same level of professional representation—people who go in to bat on their behalf.

As I said, the Act came into force on 3 November 2008. However, the part of the Act dealing with mental health advocacy is not due to come into force until 1 April 2009. That creates problems, which I should like to explore with the Minister for a few moments. We are about 10 and a half weeks away from the go-live date, but the commissioning of these services by primary care trusts has only just got under way.

On 16 December, just before the House rose for the Christmas recess, the Minister made a helpful statement about how the tendering process would commence. However, today is 12 January and we have just over 10 weeks to get the services in place. Tendering and commissioning is a complex process that requires thought and time. Organisations such as the NHS Confederation, Mind and Rethink are concerned that the tendering could be rushed and that solutions that do not best fit the needs of mental health patients will be put in place. We need to be alive to those concerns.

One of the fears is that because of the short space of time for putting out a tender and commissioning the services, the process may favour large, national providers. As the Minister will know from his time as Minister with responsibility for the third sector, I had a concern about such providers squeezing out good, locally based advocacy providers. Large, national providers have large infrastructures and experts within their tendering teams who can quickly put together and present a complex tender. They may be good advocacy providers; I do not doubt for a minute their ability to deliver the service. However, we must ensure whenever possible that established local groups get the chance—or perhaps are prioritised—to deliver the services. Such organisations are rooted in communities and have a track record of success. I hope that the Minister will give PCTs further guidance on how to ensure the outcome within 10 and a half weeks from the go-live date.


Tim Loughton (East Worthing and Shoreham) (Con)
: I have listened carefully to my hon. Friend and I can endorse his knowledge of and input into this subject, as I was leading for the Conservatives on the Mental Health Bill.

My hon. Friend is absolutely right. My concern is that the Mental Health Act 2007, which represents a reform of mental health legislation for the first time in about 25 years, contains a lot of innovative, controversial and technical legislation. To have advocates in place by April, late though that is, is demanding. To have well trained and well qualified advocates in place capable of offering the service to many vulnerable people in complicated conditions is a great challenge. My fear is that those people might not be available.


Mr. Walker
: My hon. Friend has pre-empted the next part of my speech; if he will bear with me for a few moments, I shall answer his intervention.

I am very concerned that small local providers of advocacy services may be squeezed out as a result of the tendering process. The 2007 Act also set aside £8 million in the regulatory impact assessment to fund the provision of additional advocacy services for people suffering from mental illness who face having their liberty removed and restrictions being placed on their freedom of movement. I believe that the £8 million is still in place and will go to primary care trusts and it is very important that it should. That is additional expenditure.

One of Mind’s concerns is that the money may not materialise and that we will have to rob Peter to pay Paul—that the PCT funding for advocacy services working for other groups of patients will be reduced, so that PCTs meet their statutory obligation under the 2007 Act. I am sure that the Minister will answer those very real concerns as he winds up this evening. We do not
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want to see again the viability of small local groups being put into question because they have suddenly lost significant parts of their funding because PCTs are meeting their obligations by bringing in larger, national providers of advocacy services. I hope that the £8 million will come.

I appreciate that we live in straitened financial times and that Members asking for money in the House tend to get pretty short shrift. However, the NHS Confederation is extremely concerned that, given the short time available to get the services in place, the £8 million will not be enough. In a sense, I am the mouthpiece of the NHS Confederation on that point; I am bringing its concerns to the Minister. I hope that he will be able to respond. Whatever he says, I am sure that it will go some way towards putting the minds of those at the NHS Confederation at rest.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) mentioned training and qualifications. As we debate independent mental health advocacy this evening, there is no recognised qualification in place for these advocates to take. There are plans afoot and wheels in motion to produce that qualification, but as of yet it has not materialised. I hope that in the next six months something will appear. As my hon. Friend said, the legislation is extremely technical, and we need people representing the mentally ill who have an implicit and intrinsic understanding of it and of their client’s rights under it. In the criminal justice system, one would expect to be represented by a lawyer or, at the minimum, a paralegal of some training who understands what is going on. We should not in any way sell the mentally ill short on the quality of the representation that we give them.

There is a delayed training requirement. By that, I mean that people providing advocacy from 1 April will not be required to demonstrate proficiency in the Act for a year after they have started providing that advocacy. I do not know—perhaps the Minister can tell me—whether that is only in the first year from 1 April 2009 to 31 March 2010, while the Act beds in. However, I hope that as soon as possible we can ensure that people providing this service in very stressed conditions where the stakes are very high—we are talking about removing people’s liberty for six months or more—have the level of expertise to get it right and to ensure that the clients whom they represent are confident in their abilities. I know that it is dangerous territory to talk about measuring the effectiveness of representation, because we have too much measuring, but in the early stages we need to ensure that the advocacy being provided, even by people with training, is up to the mark. People with mental illness deserve the very best, and we as a society should give them the very best.

I have received representations from organisations and clinicians who represent and deal with ethnic minority groups, and they are very concerned about the delay in the implementation of advocacy services. A black Afro-Caribbean male exhibiting the same symptoms as someone who is white is twice as likely as a white person to be detained under mental health legislation. That is fairly horrifying, and it needs to be addressed. We need to ensure that people providing advocacy services have cultural relevance. I have nothing against people in the home counties providing advocacy services to a broad range of clients, but in inner-city environments it is absolutely vital that people providing those services understand the cultural issues and pressures and the sense of anger and fear that resides in many ethnic minority communities about their chances of being penalised and discriminated against under the Act. We need to ensure, as a priority, that minority groups get representation that meets their needs and in which they have total confidence.


Tim Loughton
: My hon. Friend continues to make a strong case. There are subsections within black and minority ethnic communities, particularly young Afro-Caribbean men, for whom the figures are far worse than just twice the likelihood of being picked up. Not only are there problems with encouraging members of BME communities experiencing mental health problems to access services—they are often less likely to come forward—but once they are in the care of those services it is vital that they have trust in somebody who is going to advocate for them. I have noticed that there is a campaign trying specifically to recruit advocates who reflect the people whom they are going to represent in court.


Mr. Walker
: The last thing we want is communities suffering in silence, or fearing an engagement with the health service that is there to serve them because they fear a result that affects their liberty or freedom of movement. My hon. Friend is absolutely right, and I know that the Government will be concerned about the issue. I know that they were concerned about it during the passage of the 2007 Act. All of us have a duty to get it right, for everyone, but we must not forget the difficult groups that feel excluded. We need to get it right for them as well if our mental health system is to carry the credibility it deserves.

I have spoken for 15 minutes, which is the normal allotted time for such debates, but I understand that I have a little longer tonight. I will detain the House only for about another five minutes. Connected to the issue of mental health advocacy services is the idea of care in the community. While I have the Minister’s attention, I would like to bring to his attention something exciting and innovative that I recently came across. We all accept that the idea behind care in the community was good, but that it lacked something in the execution. A lot of people felt very isolated when they were returned to the community because it remains fearful of people with mental illness—I shall return to that point at the end of my short speech.

Something called adult fostering is being pioneered in America, which a few local authorities are now adopting. Adult fostering involves not taking people out of a mental health hospital and putting them straight into the community, but placing them with families who understand and have compassion for people with mental illness and who can meet their needs and support them back into the community. I think that idea is revolutionary. It is a truly exciting development, which really is care in the community, and reflects that aspiration. I know that the idea is slightly off the terms of tonight’s debate, but I hope that the Minister will consider it. It works both ways: it helps people coming out of hospital back into the community, but it can prevent people from going into hospital by providing them with support to ensure that they can recover their equilibrium and do not need to spend time in hospital. I do not have the details of the scheme, but I would like to learn more about it. If successful, it might be implemented throughout this country, where we could be very proud of it.

I conclude by noting that our tabloid press are having great sport with discriminatory remarks made by a member of the royal family. The reporting of the tabloid press on people with mental illness is atrocious and appalling, and it is discrimination of the worst kind. Many people are fearful of coming forward with mental health problems because they fear that they know how their community will react to them. There is still hostility in our communities to people with mental illness and I firmly believe that a lot of that hostility is whipped up by hysteria in the tabloid press. It is the worst kind of discrimination; it is vile discrimination. I hope that our tabloid press gets their house in order before we have to get it in order for them.

Thank you for hearing me out, Mr. Deputy Speaker. I shall now allow others to take part.


8.48 pm

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