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Personality Disorder: Compulsory Treatment Orders
23 January 2001
Volume 621
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asked Her Majesty's Government:

Whether the extension of compulsory powers for treatment to those suffering from personality disorder, which is proposed in the White Paper Reforming the Mental Health Act, will violate the human rights of those concerned.

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My Lords, the Mental Health Act 1983 already applies to people with a psychopathic disorder. When implemented, the proposals set out in our White Paper will strengthen the rights of those who are subject to formal care and treatment. Therefore, through the introduction of independent decision-making in authorising the use of compulsory treatment, we consider that the powers will be fully compliant with the requirements of the Human Rights Act.

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My Lords, I thank the Minister for that reply. I declare an interest as a non-executive director of Addenbrooke's NHS Trust and the chair of its mental health committee. What guidance does the Minister propose to offer to psychiatrists up and down the country, who, as I believe the Minister knows, currently are very worried, in relation to the diagnosis which they will be asked to carry out as to exactly what is personality disorder when the people concerned have not committed a crime and are not mentally ill and when one person's personality disorder is another person's political dissident or freedom fighter?

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My Lords, I am grateful to the noble Baroness for that question. I am aware that concern clearly exists with regard to the assessment procedure. Perhaps I may reassure her that a standardised methodology will be in place for the assessment of personality disorder and the risk of serious harm to the public. That will be used as the basis, for example, of reports to a court. We expect that it will take some time to conduct assessments and, in particular, we shall need to ensure a consistency of approach throughout the system. However, I can assure the noble Baroness that we shall work thoroughly to ensure that the clinicians involved are fully aware of their responsibilities.

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My Lords, will the Minister confirm that there will always be a right of appeal for affected persons and that those who are deprived of liberty will always be reviewed at reasonably frequent intervals?

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Yes, my Lords. The mental health tribunals which we propose to establish will be able to review all such cases. Those affected will have the right to ask the tribunal to review their position. When an order is made after the initial 28-day assessment, it will be reviewed automatically after the first six months, the second six months and then at yearly intervals. Therefore, I believe that clear avenues will be open for cases to be reviewed. In addition, independent advocates will be available to help people who seek a review.

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My Lords, can the Minister tell me whether systems are available in the community to monitor people with severe personality disorders?

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My Lords, first, I welcome back the noble Baroness to your Lordships' House. She will know that I have had to answer rather fewer questions while she has been away.

The noble Baroness has raised an important point. Although fears have been expressed about the number of compulsory treatment orders which may be issued, the reality is that, if our mental health services, particularly in the community, are made sufficiently effective, one hopes that there will be less need for such orders in the future. That is why the National Service Framework for Mental Health emphasises the need for effective community services. I particularly commend the assertive outreach teams. By April 2001, 117 places will be available to deal quickly with the type of problem to which the noble Baroness referred.

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My Lords, has the Minister considered the serious criticisms and concerns raised by the Royal College of Psychiatrists in its brief which has been circulated today? In particular in relation to the detention of those who are said to have a personality disorder but have not committed a crime, how does he envisage that it will be possible to order their detention without infringing their human rights?

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My Lords, I have not seen the document circulated by the Royal College of Psychiatrists but I shall, of course, ensure that we study it most carefully. However, I believe that overall the responses which the Government have received in relation to their proposals are positive. The safeguards are clearly in place. I am absolutely satisfied that the existence of the mental health tribunal by which a person may ask for a case to be reviewed and the automatic review of cases in the intervals which I have already mentioned provide an appropriate way of ensuring that no one's rights will be infringed. I believe that the people concerned will have their cases considered in the most effective way possible. As I mentioned, the provision of an independent advocacy service will also ensure that as much support as possible is given to people who ask for their cases to be reviewed.

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My Lords, will it be a valid ground of appeal that the personality defect is not treatable?

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My Lords, the noble and learned Lord has raised an interesting question about the whole issue of what is described as "treatability". A problem which has arisen with regard to the current legislation is that it has not been possible to deal appropriately with people who are considered clinically not to be treatable. I say to the noble and learned Lord that clinical opinion may not be uniformly agreed as to how one describes treatability. Therefore, over the next two years we shall undertake considered work in order to develop an evidence base of research about the treatment of dangerous people with severe personality disorder. There is evidence that a range of interventions are available and that some of those are effective in treating different groups of people with severe personality disorders. On that basis, I believe that we shall be able to resolve the issue of treatability.

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My Lords, can the Minister give an assurance, when such powers are in use, that due regard will be given to the cultural differences between the citizens of the United Kingdom? Already there is a fear that misdiagnosis takes place among British Caribbean people.

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Yes, my Lords, I am aware of the issue that my noble friend has raised and which will have to be tackled in a number of ways. The National Health Service framework is designed to ensure a consistency of approach towards any person in this country who requires mental health services. I would expect that principle to be taken forward in relation to the assessment procedures that will need to be operated within the new system. The fact that a care treatment plan will need to work alongside compulsory treatment orders will also ensure a greater uniformity of approach. We would expect the tribunals themselves to be aware of the cultural issues that my noble friend has brought forward.

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My Lords, in view of the divergence of opinions on treatability and the fact that treatments evolve, will the new provision permit patients who are classified in a review as being untreatable to have their untreatability reviewed in such a review?

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Yes, my Lords, that is the point.