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Division No. 1


Addington, L.
Airedale, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Barnett, L.
Birk, B.
Blackstone, B.
Bottomley, L.
Bridges, L.
Brooks of Tremorfa, L.
Bruce of Donington, L.
Callaghan of Cardiff, L.
Carmichael of Kelvingrove, L.
Carter, L.
Chapple, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
David, B.
Dean of Beswick, L. [Teller.]
Dean of Thornton-le-Fylde, B.
Desai, L.
Donaldson of Kingsbridge, L.
Ezra, L.
Falkland, V.
Farrington of Ribbleton, B.
Fisher of Rednal, B.
Gallacher, L.
Geraint, L.
Gladwin of Clee, L.
Gladwyn, L.
Glenamara, L.
Graham of Edmonton, L.
Granville of Eye, L.
Gregson, L.
Grey, E.
Halsbury, E.
Harris of Greenwich, L.
Haskel, L.
Headfort, M.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Holme of Cheltenham, L.
Hooson, L.
Howie of Troon, L.
Hutchinson of Lullington, L.
Jay of Paddington, B.
Jenkins of Hillhead, L.
Jenkins of Putney, L.
Kilbracken, L.
Kinloss, Ly.
Lockwood, B.
Longford, E.
McCarthy, L.
McGregor of Durris, L.
McNair, L.
Mar and Kellie, E.
Masham of Ilton, B.
Mason of Barnsley, L.
Merlyn-Rees, L.
Monkswell, L.
Morris of Castle Morris, L.
Nicol, B.
Palmer, L.
Raglan, L.
Redesdale, L.
Richard, L.
Rochester, L.
Russell, E. [Teller.]
Sainsbury, L.
Seear, B.
Sefton of Garston, L.
Serota, B.
Shannon, E.
Shaughnessy, L.
Simon, V.
Stallard, L.
Stoddart of Swindon, L.
Taylor of Gryfe, L.
Thomson of Monifieth, L.
Tordoff, L.
Turner of Camden, B.
Warnock, B.
Whaddon, L.
White, B.
Wigoder, L.
Williams of Crosby, B.
Williams of Elvel, L.
Wilson of Tillyorn, L.
Winchilsea and Nottingham, E.


Aberdare, L.
Acton, L.
Addison, V.
Ailesbury, M.
Aldington, L.
Alexander of Weedon, L.
Allenby of Megiddo, V.
Alport, L.
Ampthill, L.
Annaly, L.
Archer of Weston-Super-Mare, L.
Astor, V.
Balfour, E.
Belhaven and Stenton, L.
Bethell, L.
Blaker, L.
Blatch, B.
Boardman, L.
Borthwick, L.
Boyd-Carpenter, L.
Brabazon of Tara, L.
Braine of Wheatley, L.
Brookes, L.
Brougham and Vaux, L.
Bruntisfield, L.
Butterworth, L.
Cadman, L.
Campbell of Alloway, L.
Campbell of Croy, L.
Carnegy of Lour, B.
Cayzer, L.
Charteris of Amisfield, L.
Chesham, L.
Clanwilliam, E.
Clark of Kempston, L.
Cochrane of Cults, L.
Cockfield, L.
Constantine of Stanmore, L.
Cornwallis, L.
Courtown, E.
Crawshaw, L.
Cross, V.
Cullen of Ashbourne, L.
Cumberlege, B.
Dacre of Glanton, L.
Davidson, V.
Dean of Harptree, L.
Downshire, M.
Eccles, V.
Ely, M.
Fanshawe of Richmond, L.
Ferrers, E.
Fraser of Kilmorack, L.
Gainford, L.
Gainsborough, E.
Gardner of Parkes, B.
Geddes, L.
Gisborough, L.
Glenarthur, L.
Grantchester, L.
Gray of Contin, L.
Gridley, L.
Haig, E.
Hailsham of Saint Marylebone, L.
Harding of Petherton, L.
Harmar-Nicholls, L.
Harmsworth, L.
Hayter, L.
Henley, L.
Hogg, B.
HolmPatrick, L.
Hood, V.
Howe, E.
Inglewood, L. [Teller.]
Ironside, L.
Jenkin of Roding, L.
Johnston of Rockport, L.
Killearn, L.
Kinnoull, E.
Kitchener, E.
Knollys, V.
Lane of Horsell, L.
Lauderdale, E.
Lindsay, E.
Lloyd-George of Dwyfor, E.
Long, V.
Lucas, L.
Lucas of Chilworth, L.
McColl of Dulwich, L.
Mackay of Ardbrecknish, L.
Mackay of Clashfern, L. [Lord Chancellor.]
Macleod of Borve, B.
Malmesbury, E.
Mancroft, L.
Manton, L.
Marlesford, L.
Merrivale, L.
Mersey, V.
Middleton, L.
Miller of Hendon, B.
Milverton, L.
Montgomery of Alamein, V.
Morris, L.
Mottistone, L.
Mountevans, L.
Mowbray and Stourton, L.
Moyne, L.
Munster, E.
Nelson, E.
Newall, L.
Noel-Buxton, L.
Northbrook, L.
Onslow, E.
Oppenheim-Barnes, B.
Orr-Ewing, L.
Oxfuird, V.
Peel, E.
Pender, L.
Peyton of Yeovil, L.
Pike, B.
Pym, L.
Rankeillour, L.
Rawlings, B.
Reay, L.
Renwick, L.
Rodger of Earlsferry, L.
Saint Albans, D.
St. Davids, V.
Saltoun of Abernethy, Ly.
Sandford, L.
Savile, L.
Seccombe, B.
Selborne, E.
Sharples, B.
Shaw of Northstead, L.
Simon of Glaisdale, L.
Skelmersdale, L.
Skidelsky, L.
Strathclyde, L. [Teller.]
Sudeley, L.
Swansea, L.
Swinton, E.
Tebbit, L.
Terrington, L.
Teviot, L.
Thomas of Gwydir, L.
Trumpington, B.
Ullswater, V.
Vaux of Harrowden, L.
Vivian, L.
Whitelaw, V.
Wise, L.

Resolved in the negative, and amendment disagreed to accordingly.

4 Apr 1995 : Column 104

3.37 p.m.

Baroness Jay of Paddington moved Amendment No. 2:

Page 2, line 5, leave out from ("from") to end of line 7 and insert ("severe chronic mental illness; and").

The noble Baroness said: In moving Amendment No. 2, I shall speak also to Amendment No. 3. The purpose of both amendments is to define more precisely and narrowly those patients who should be subject to supervised aftercare. In our view, these should be the so-called revolving door patients whose severity of illness makes it difficult for them to comply with care plans outside hospital. They tend to suffer relapse in the community and need to be readmitted to hospital.

4 Apr 1995 : Column 105

The definition, as it is presently drawn in the Bill, appears to suggest a wider group than that which was included in the internal review by the Department of Health of the legal powers for the care of mentally ill people in the community. That was published by the department in August 1993. The review expressed concern about a small group of so-called revolving door patients who needed constant supervision. Without such supervision they would have had to be admitted to hospital. The report identified two groups of patients as being specially prone to this pattern: those with schizophrenia and those with manic depressive psychosis, both forms of severe chronic mental illness. No mention is made in the report of categories of people suffering from mental impairment or any other form of mental disorder who are included in the Bill as it now stands and who are unlikely to present precisely the same problems as revolving door patients. The amendments attempt to limit the number of people who will be subject to this form of aftercare and thereby address some of the problems raised in the previous amendments in relation to the over-burdening of resources.

The second amendment refers to the need to define such patients in terms of their clinical state and the fact that they have been admitted to hospital more than once. As the Bill stands it appears that someone may be subject to a supervised discharge order simply on the basis of one admission to hospital. We have been advised for example by the Law Society that the use of such coercive powers is unjustified unless it has been demonstrated that compulsion is required to avoid repeated admissions to hospital, which may occur because of severe mental illness. It may be that the department's clinical advisers will suggest a slightly different form of words to encompass this group. However, our assertion is that if the group who can be appropriately dealt with in this way in the community is to be as narrowly defined, it should be precisely and narrowly confined to those who have chronic severe mental illness and not to the broader group which includes mental impairment. I beg to move.

Lord Mottistone: The National Schizophrenia Fellowship is appalled by, and opposes strongly, the amendments to limit the numbers. We should forget for the moment whether the resources are available. That is not the point of the Bill. Narrowing the provision down could have all sorts of adverse effects upon the people who need treatment within the terms of the Bill. Account has to be taken of the patient's history. That implies that he must have one. That may mean repeated admissions to hospital. However, it could mean that he has a history of violence to others and of repeated suicide attempts which do not equate with three hospital admissions in the preceding two years.

It would be madness to prevent the patient being subject to aftercare under supervision if he attacked people repeatedly but not within the two years just before the RMO wanted to make the application for supervision or if he had not built up a record of three hospital admissions within that period. The patient may

4 Apr 1995 : Column 106

have been in prison. The narrowness introduced by the amendments is not helpful. I hope that noble Lords opposite will not press them.

Baroness Cumberlege: In proposing the grounds for making an application for supervision in the community, we have chosen the current definition of mental disorder with great care. To have been detained in hospital for treatment in the first place, the patient must have been diagnosed as suffering from one of the disorders described in the Mental Health Act, and that disorder must be of the nature or degree justifying his detention for treatment. To satisfy the criteria for supervised discharge, we believe that the RMO should be satisfied that the patient still falls within one of those legal categories. So we resist the first amendment.

We also find Amendment No. 3 too restrictive. It is true that Clause 1 is directed primarily at revolving door patients—that is, those with a history of admission, discharge, deterioration and readmission. Trying to define that group exactly risks excluding many patients who might be discharged successfully with the safeguards of the new provisions. The Bill requires that the RMO must consider the patient's history, as my noble friend said, before making an application. We believe that that is sufficient to ensure that the issue is considered. I hope that in the light of that explanation the noble Baroness will agree to withdraw the amendment.

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