Mental Health Bill [HL]

My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 32. I shall speak also to a number of other amendments. We come to the final part of our discussions: the introduction of supervised community treatment. I do not exaggerate when I say that both here and in the other place supervised community treatment has been a source of considerable debate. Without having a Second Reading debate on the principles, I emphasise that supervised community treatment is intended to provide a way to minimise restrictions on people’s lives, allowing some patients to spend less time in hospital and giving them more freedom rather than less. I understand the controversy that supervised community treatment has attracted and we have listened hard to the concerns and questions raised in debates. The amendments brought forward today were laid in the other place and, together with further amendments tabled by the noble Lord, Lord Patel, which the Government will accept, we have come to a satisfactory conclusion, which will ensure that we have a system that is workable for professionals, is beneficial to patients and strikes the right balance between patients’ rights and prevention of harm. Commons Amendment No. 33 removes from the Bill the examples of conditions that could be attached to a community treatment order. We have been responsive to the many strongly expressed concerns about the conditions. Although we have always been clear that the conditions could not be used to exert undue control over a patient’s freedom, we know that the term ““psychiatric ASBO”” has passed into common parlance. This has caused unnecessary alarm to patients and their families and has to be dealt with. That is why the amendment makes it clear on the face of the Bill that the conditions must be about ensuring that the patient receives treatment or about preventing harm to the patient or others. With one exception, which is a technicality, the Bill makes it clear that conditions cannot be imposed for any other purpose. We have recognised, too, that despite the many safeguards for patients on supervised community treatment—the same rigorous process and timing of review as for detained patients, the right to apply to a tribunal and the hospital managers for discharge, automatic referral and the nearest relative’s right to discharge—some people were concerned that it would be hard for patients to get off supervised community treatment. We decided that, in addition to those safeguards, it was right to accept a further provision, originating in this House, that a AMHP should have to agree to the extension of a CTO each and every time it comes up for review. Our Amendments Nos. 38, 39 and 42 cast that provision in a slightly different way from the original but have exactly the same effect. We must get the provisions and safeguards for supervised community treatment right so that best practice can flow from the right base. I hope that your Lordships will agree that the amendments address some of the key concerns that have been expressed. I emphasise that supervised community treatment will be suitable only for a limited number of patients; it cannot realistically prevent all suicides and homicides by people with a mental disorder. But supervised community treatment allows a system to be put in place that makes prevention more likely than it would be without it. It is a fact that a significant proportion of homicides and suicides follow patients’ non-compliance with their medication. If we can tackle non-compliance with treatment through supervised community treatment to keep patients well, that is an end in itself. There is also a real chance that, as a consequence, supervised community treatment will save lives. I am certain that it will improve patients’ lives while at the same time improving patient and public safety. I turn now to the criteria for eligibility for supervised community treatment, which has been the subject of much debate and concern. Your Lordships removed the Bill’s original criteria due to fears that they were too broad and would allow too many patients to qualify. In their place, your Lordships put criteria that would have restricted eligibility to very few patients indeed. I understand the concern that noble Lords expressed. I also understand that your Lordships considered that aftercare under supervision would be available only for those at risk of harming themselves. Noble Lords will recall our debate and the concern that I expressed that running two schemes in parallel would not work. Those original amendments required two compulsory admissions before supervised community treatment would become available. I always understood the rationale for those amendments, but we could not accept them as they stood because they would immediately risk excluding patients who might benefit. Those patients would either have to remain in hospital or be discharged without any form of supervised treatment in the community. We felt that that would put families, carers and clinicians in an impossible position. It would mean that they would have to wait until the patient relapsed before supervised community treatment could become an option. For some patients that could be too late, because the relapse might be fatal, and for all patients the prognosis is worse the longer they wait to get the treatment that they need. Therefore, we felt that such a criterion was arbitrary and would fetter clinical judgment. Therefore, the Government made amendments in the other place, which were accepted, to reinstate the criteria in the original Bill. Before doing so, we reviewed those criteria very carefully. We considered whether the criticism of those criteria made by your Lordships was justified. We concluded that the criteria did the job that they were intended to do and that they were set at the right level. However, we accept that those criteria have given rise to concerns that supervised community treatment could be used too readily and that it could be used as a failsafe option without true justification. We do not agree with that, but we understand that we have to allay those concerns. That is why we support the amendments tabled by the noble Lord, Lord Patel, as they put beyond doubt what supervised community treatment is all about. In so doing, I pay tribute to the noble Lord. I am most grateful to noble Lords who have taken part in these extensive discussions. I beg to move. Moved, That the House do agree with the Commons in their Amendment No. 32.—(Lord Hunt of Kings Heath.)