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Mental Disorder: Autism and Learning Disabilities

Volume 800: debated on Tuesday 5 November 2019

Private Notice Question

Asked by

To ask Her Majesty’s Government, in the light of reports that people are being wrongly detained in secure hospitals units, whether they will review the Mental Health Act 1983 to amend the definition of mental disorder to exclude autism and learning disabilities.

My Lords, I beg leave to ask a Question of which I have given private notice and declare an interest as president of the National Autistic Society.

My Lords, we recognise the significance of this issue and its importance to stakeholders. The recent independent review of the Mental Health Act considered the definition of autism in the Act and recommended that the Government should keep it under review. We will respond to the review’s recommendations via the forthcoming White Paper.

My Lords, since 2015, there has been a 24% increase in the number of autistic people sectioned, even if they have no mental illness, because the Mental Health Act defines autism as a mental disorder. Autism is not a mental disorder. Last weekend, the Health Secretary promised to detach autism and learning difficulties from mental health legislation. That is most welcome, as is the appointment of the noble Baroness, Lady Hollins, to chair an independent panel to oversee case reviews.

However, those reviews will be conducted over a 12-month period. I press the Minister for one more step. Will the Government set up an advice hotline for families who are in despair because they have no idea where to go for help or advice as their children—and they are children—face Christmas locked up and detained by a medieval practice that deprives them of the human rights?

I thank the noble Lord for raising this very important Question today. I should like to be clear that the Government are committed to ensuring that people with learning disabilities and autistic people have the best quality of life and live a full life in the community. A lot of the work that has been done recently, including reviewing and replacing the autism strategy and doing case reviews of every individual who has a learning disability or autism and is in in-patient care, is designed to ensure that we deliver that. I shall take back to the department the noble Lord’s specific point about a hotline for families and ask what can be done.

My Lords, as my noble friend has rightly highlighted, neither autism nor learning difficulties are mental health conditions. These children should not be in wards which are likely to be noisy, bright and unpredictable. Noble Lords may have seen the report on Sky News about Jeremy, whose autistic daughter Bethany is being held in a mental health unit. He has been campaigning about her inhuman treatment for a long time—too long. He says of the proposed review: “There are 600 people whose care plan says that they should not be in hospital, and for half of them, their local authorities do not even know that”. Those are the Government’s own figures. We have had one review after another since Winterbourne View, nine years ago. I agree with Jeremy— we need action not reviews.

Worse, Matt Hancock, the Secretary of State, is apparently sitting on a report about Jeremy’s daughter and said that it will be released before Parliament rises. Can the noble Baroness ensure that Bethany’s report is released to her parents this afternoon and tell the House when we will see action, rather than reviews, for this vulnerable group of young people?

We absolutely agree with the noble Baroness’s point. We need to ensure that everybody who can be cared for in the community is able to be cared for. That is why we have reduced the number of people in in-patient care by 22%; we have set a target to reduce that number by 50%. We are driving that forward as quickly as possible.

On the matter of the serious incident review of Bethany’s case, we have received the report and are working to release it as soon as possible. NHS England is taking action to improve Bethany’s situation and secure an alternative, more suitable, provider in the community as quickly as possible.

Regarding the case reviews of every individual, the Government have committed to providing each patient with a date for discharge or, where that is not appropriate, with a clear explanation of why and a plan to move them closer to being ready for discharge in the community. This significant commitment from the Government should be welcomed.

My Lords, I declare two interests. First, I had an editorial published in the British Journal of Psychiatry last week, proposing that learning disability and autism should be removed from the Mental Health Act. Secondly, I have just agreed to chair a panel to review the cases of people with learning disability and/or autism who are in segregated care. Does the Minister agree with the treatability criterion in the Act, particularly with respect to the question of removing learning disability and autism from it? In other words, does she agree that, in detaining somebody in hospital under the Act, the excuse of doing so to improve—or with the intention to improve—their behaviour, even though their behaviour may be a reaction to inadequate social care, is an inadequate reason for detention under legislation?

I thank the noble Baroness for taking on the chairing of the independent panel. I cannot think of anybody better placed to do so. When it comes to her question about the detention of an individual to improve their behaviour, again, I do not think that anybody in this place or elsewhere could disagree with her. On changing the Mental Health Act, we commissioned the independent review led by Sir Simon Wessely, who is also a leader in the field. He reported in December. In its findings, the review made it clear that we need to modernise the Mental Health Act, ensure that views are respected and ensure that patients are not detained for any longer than is absolutely necessary. Sir Simon stated that there is “no clear consensus” on removing autism from the Act, and that,

“we have heard also about the many negative consequences that could arise from being outside this framework … this should be kept under review”.

Obviously, we will not respond to that immediately. There will be a White Paper by the end of the year. We will consider this carefully and we recognise the strength of feeling on this matter.

In support of what the noble Lord, Lord Touhig, and the noble Baroness said—we greatly welcome her chairmanship of the review—there is a very good reason for removing autism as a mental disorder: it is not a mental disorder. It is as simple as that, although it is true that people with autism, including children, will have comorbidities and will develop a mental health condition on top of their autism. I do not know whether the Minister understands my frustration, but I have been raising this issue in Parliament for nearly 28 years. The real problem is that we do not have sufficient psychiatrists who understand and can differentiate between autistic behaviour and what they believe to be psychotic behaviour. Once patients start the spiral of medication for psychosis, the autism disappears and the person disappears altogether.

My noble friend puts this very clearly. The Government accept completely that autism and learning disability are not mental disorders. The question is whether being excluded from the legislation would cause challenges or difficulties for those who may have autism and mental disorders. We will have to consider that carefully as we go into the process of considering a review of the Mental Health Act. As my noble friend just said, we recognise that we will have to go through a careful process. We also recognise the strong feelings—and the correct view—that autism and learning disability are not mental disorders. There is no disagreement on that point.

My Lords, does the noble Lord—I am sorry, does the Minister agree that we are confusing disability with illness, something which has gone on for far too long? Are we going to have a programme to train people in recognising the different facets of the two and how they interact? The treatment that many people with autism have undergone is probably the best way to induce poor mental health in many of them. Can we please do something to stop that?

I thank the noble Lord and I recognise the challenge to my gender today. He and my noble friend are absolutely right that we must ensure that all health and social care staff have appropriate training on autism and learning disability. A number of Members of this House have campaigned long and hard to ensure that this happens. Some £1.4 million of government funding has been put in place to develop and test some new training packages and today we published the government response to the consultation on mandatory learning disability and autism training which confirms the intention to introduce mandatory training for all health and social care staff. I think that that is an excellent step forward and I am absolutely sure that this House will scrutinise it for its effectiveness. That is right, but it marks a steps forward and should be welcomed.