Contribution
My Lords, Amendment 43 in my name is to a list of grounds under which community treatment orders will be allowed. I have to say that, judging by the Second Reading of the Bill, including my own contribution, community treatment orders have not been a great success. I think that is a general view but here they are, listed in the Bill, and it is incumbent upon us to make them as strong and comprehensive as possible so that they are fit for purpose, if they are to remain.
I felt that there was an omission from the list of grounds in the Bill. I say to the Minister that I put my hand up immediately: I have had this this discussion with her outside the Chamber. This is something that I want to put into the Bill, but I am still not entirely sure that this is the right place for it. I hope she will not bat it out of—I do not know what to say in cricketing terms because I do not have my noble friend’s expertise in cricket. Anyway, I shall quickly move on.
We know the problem: there is a shortage of psychiatrists. In some areas, people are well served but in others they are not. Today’s debate has focused on psychiatrists who have expertise in autism and learning disability.
I am looking at a scenario where a person has autism or a learning disability, as well as a recognised mental health condition, and is discharged into the community on a community treatment order. Despite what I have said about my reservations about them in principle, because there is such a paucity of psychiatrists, particularly those who have expertise in autism and learning disability, once that person is being cared for on a community treatment order—or, for that matter, someone in the community who is not on a community treatment order but is medicated—where are the psychiatrists that they can turn to?
To my certain knowledge, there are around the country some integrated care boards that feel they are serving the autism community well enough if they can identify psychologists with expertise. There is nothing wrong with that, as there are excellent psychologists around the country, but of course, psychologists cannot prescribe. So there is a real challenge for people in that situation who need ongoing medication—the dosage of which may need to be changed, for example—having local access to an appropriate psychiatrist.
I am a bit nervous about the wording of the amendment—it is my wording, but I am still nervous about it—as it includes the word “local”. I assure the Minister that I am realistic enough to know that there is not going to be an appropriate psychiatrist just round the corner, but in many cases, as I am personally aware, there is not even anyone in the county. If someone has been subject to an in-patient stay in a mental health hospital, admitted in an emergency, that does not necessarily mean they are going to be in a local hospital; because of the shortage of beds, they may be quite far from home. So the community treatment order may not be exercised close to where someone has previously been an in-patient.
We also have problems at the borders between Wales, England and Scotland. For mental health services, there are mutually agreed agreements about where patients can be seen, and particularly where hospitalisation can take place. However, if community treatment orders are to be maintained, on discharge they may well be a long way away from where they live. That is why I have added my wording at the end of the list of grounds for community treatment orders.
We in Parliament make a great virtue of saying that decisions are made at local level. That is all well and good, but if the decision made at local level is, “We don’t need a psychiatrist within our geographic area who has that expertise”, that is not much help to the patient. I have shared with the Minister cases involving people who are not necessarily under a community treatment order but who have an ongoing need for medication and cannot access a psychiatrist with that expertise, and who end up having to travel to centres of population and paying very nice fees, thank you, privately because it is not available in any other way. That cannot be right, which is why I have added my wording to the list of grounds for CTOs. If the Minister does not think that that clause is the appropriate place for it, I will understand; but if so, I hope she will tell me where in Bill it should go, because I really believe it should be there.
As a postscript that has nothing to do with community treatment orders, for people with mental health conditions who need medication, people with autism without mental health conditions—I am looking away from the noble Baroness, Lady Murphy, at this point—and people with autism who need ongoing medication for, for example, autism-related anxiety, personalised medicine is going to be a real advantage, enabling them to know exactly the right drug and the right dosage. It is out of reach on the NHS at the moment, but personalised medicine, using DNA testing to get the right dosage, is very good. I hope we are going to see it pretty soon, particularly in mental health. Let us start with mental health. I beg to move.