Clause 32
Mental Health Bill [Lords]
4:15 pm
David Kidney (PPS (Rt Hon David Miliband, Secretary of State), Department for Environment, Food and Rural Affairs; Stafford, Labour)
We are debating the minority of patients who can, even now, be subject to some restrictions when receiving treatment in the community and would, under the Government’s proposals, again, receive treatment under restrictions in the community. It is worth reminding ourselves that the vast majority of patients who receive services in the community do so voluntarily.
My other point is a legislative one. We are placing this provision in section 17 of the 1983 Act, which already, as my hon. Friend the Member for Hackney, South and Shoreditch has tried twice to tell the hon. Member for East Worthing and Shoreham, allows leave, including extended indefinite leave, subject to any conditions at all that the supervising clinician wants to impose, with no restrictions, as long as the conditions are for the benefit of the patient or the protection of other members of the public. It is worth mentioning that that has been law since 1983.
Section 25, which the Government are seeking to replace with CTOs, deals with supervised discharge, which has been in place since 1995, under a Conservative law. It is true that it was estimated in 1995 that about 3,000 patients a year would be under such compulsory supervision, but in fact there are only hundreds each year. A study conducted in 2000, reported in PsychiatricBulletin, volume 24, entitled “Consultant psychiatrists’ experiences of using supervised discharge: results of a national survey”, obtained a 100 per cent. response from psychiatrists using supervised discharge at that time. In 77 per cent. of the cases in which supervision had been in place for more than two months, the treating psychiatrist described it as “helpful or very helpful”. Individual comments were made that the conditions were too restrictive, but people wanted them to be included in wider powers. It is worth bearing that in mind.
I support CTOs and the Government’s proposals, because the pool of those who are potentially subject to CTOs are those who are already compulsorily in hospital, so there is no question about people in the community being picked on and having conditions imposed on them. Such people are in hospital and the choice is whether they are treated in hospital or out in the community. In respect of the least restrictive approach to compulsory treatment, I agree with Dr. Angus Bell, in MH63, who says:
“Least restrictive means in my view “at home” and not unnecessarily in hospital!”
I want to draw Committee members’ attention to research by Gibbs and Dawson in the Journal of Mental Health in 2005 in a study of community treatment orders in New Zealand, an area of jurisdiction that has had this kind of law for 10 years, so it is mature. That report concluded:
“The usefulness of community treatment orders is accepted by most patients under them in”
New Zealand,
“as well as by most psychiatrists. Critical factors include the quality of therapeutic relationships and the structure provided for community mental health care.”
People say that there is no evidence because the Institute of Psychiatry tells us that, so I looked for Gibbs and Dawson in the bibliography in the institute’s report and found it—but it says, in a footnote:
“This paper published after completion of the searches for this review.”
So there is emerging evidence that CTOs can be beneficial. Of course we must be cautious, because it is not yet clear what the evidence is telling us. The last of the Government’s proposed conditions that can be imposed on community treatment, the one about the person’s behaviour, requires particularly careful handling.