Mental Health Bill [HL]

Blooming Change has pointed out the significance of childhood trauma as a factor underlying a large number of mental health admissions involving young people and the challenging behaviour that they then exhibit. The problem is that, all too often, the link between childhood trauma and the way that a patient behaves is not recognised or understood. As a result, someone with autism or a severely troubled and traumatised young people person going into meltdown —as was well described, incidentally, by my noble friend Lady Browning during our first day in Committee —is simply viewed as wilfully disruptive or downright disobedient, with punishments doled out in response.

People must be seen as human beings in the round when these treatment decisions are made. That should be reflected in the type of treatment offered, including non-drug-based interventions, such as talking therapies, which are adapted to the individual and have a real prospect of offering therapeutic benefit, either in place of or in addition to medication. I readily acknowledge that treatment can involve either. That judgment is for a clinician to make.

I was very encouraged that the Joint Committee on the Bill recognised in its report the importance of non-drug-based treatment and recommended that the code of practice makes clear that appropriate treatment includes non-drug-based treatment. However, to ensure the Bill aligns with the principle of therapeutic benefit, it is important that this emphasis on non-drug-based interventions is reflected in the Bill.

It is well known that the transition from children’s services to adult services can be particularly difficult when it comes to overmedication and failing to adequately deliver non-drug-based interventions. This has included cases where young autistic people on children’s wards have been provided with some level of speech and language therapy, arts and crafts, and general help with establishing a routine. However, when the transition is made to post-18 adult services, the quality of care can drop off markedly, with no non-drug-based therapeutic treatment delivered, leading to a decline in well-being. In many ways, as has already been said, this is little different from being held in a cell.

Having a wide range of these interventions means that in-patients can have greater choice and control over their care—another key principle of the Bill. The use of non-drug-based therapies in hospital is important, not only to provide a therapeutically beneficial environment during detention but to ensure some essential continuity of support after discharge.

My Amendment 51 differs from Amendment 50 in that it would apply only to autistic people and those with a learning disability detained under Part III. It would ensure that the clinical checklist is followed when treatment decisions are made when making those decisions includes specific consideration of whether non-drug-based interventions are more appropriate in place of, or in addition to, medication.

As we have already discussed, one of the most significant changes in this Bill is the change to the detention criteria in Part II, Section 3. This means that autistic people or people with a learning disability cannot be detained under Section 3 unless they had a co-existing psychiatric disorder. However, this is not being applied to Part III patients—that is, those detained through the criminal justice system. This means that autistic people and people with a learning disability can continue to be detained for “treatment” in mental health hospitals under Part III, even if they do not have co-existing psychiatric disorders. One of the concerns about the Bill, as we have heard, is that a consequence of poor implementation could mean that more autistic people and people with a learning disability are diverted into the criminal justice pathway to get round, frankly, the new detention criteria for Section 3.

It could well be the case that Part II patients who are autistic or have a learning disability will exhibit behaviours that challenge, for which certain psychotropic medications can be prescribed. These medications can include anti-depressants, anti-seizure or anti-psychotic medications, sedatives or stimulants. NHS England’s website states:

“People with a learning disability are thought to be 16 times more likely and autistic people 7 times more likely to be prescribed an antipsychotic than the general population”,

despite existing guidance that people should be given psychotropic medication for only the right reasons, in the lowest dose and for the shortest time.

I simply conclude by saying that the focus on non-drug-based interventions in these amendments is not about saying that medication should not be used. Indeed, it can be highly beneficial in many cases. It is about ensuring that other factors that contribute to therapeutic benefit are always considered and put on an equal footing.