SECOND
MARSHALLED
LIST OF AMENDMENTS
TO BE MOVED
IN COMMITTEE

      The amendments have been marshalled in accordance with the Instruction of 29th November 2006, as follows—

[Amendments marked * are new or have been altered]

Amendment
No.

"(aa)

because of his mental disorder, his ability to make decisions about the provision of medical treatment is significantly impaired";

"(aa)

because of his mental disorder, his ability to make decisions about the provision of medical treatment is significantly impaired;"."

"1A     Rights to support and treatment      (1)   This section applies to persons who have or have had a mental disorder and who are not in hospital. (2)   Such persons have the right to a comprehensive assessment of their needs for support and treatment arising from their mental health, emotional and social support needs and accordingly it shall be the duty of each local authority and each NHS body ("the responsible authorities") to carry out such an assessment on receipt of a request by such a person or his authorised representative. (3)   In carrying out an assessment under subsection (2), the responsible authorities shall ensure that the person concerned is empowered to define his own needs. (4)   Persons falling within this section have the right to assistance by— (a)   a nominated supporter or an independent advocate, or (b)   a communication support worker (or both),    in order to express and define their needs and accordingly it shall be the duty of the responsible authorities to make arrangements for such assistance. (5)   The responsible authorities, having due regard to the results of an assessment carried out under this section, shall then decide whether the requirements of the person concerned call for them to— (a)   provide him with services which provide support and treatment, or (b)   secure the provision of such services for him. (6)   Where the responsible authorities are satisfied in the case of any such person that it is necessary, in order to meet the needs of that person, for them to provide, or secure the provision of, services to him then it shall be their specific duty to make the necessary arrangements. (7)   All arrangements made under this section shall be agreed with the persons concerned and written down in a support plan. (8)   Any treatment or support provided by virtue of this section shall be provided in accordance with the choices, lifestyle preferences and aspirations of such persons. (9)   Services provided by virtue of this section shall be designed to— (a)   minimise the effect of the mental disorder on such persons; (b)   promote the dignity, well-being and social development of such persons; (c)   accord them respect for their individual qualities, abilities and diverse cultural and religious backgrounds; and (d)   increase the extent to which such persons are able to enjoy the same choice, freedom, dignity, control and substantive opportunities to participate fully in work, family life, education, public, community and cultural life as persons who do not have or have not had a mental disorder. (10)   For the purposes of this section, "treatment and support" includes, without prejudice to the generality of that expression— (a)   talking therapies; (b)   assistance with personal care routines and daily living; (c)   practical and emotional support in a crisis; (d)   residential accommodation with appropriate levels of support; (e)   social, cultural and recreational activities; (f)   support, including advocacy, which enables participation in mainstream services and activities; (g)   training and assistance in obtaining and in undertaking employment; (h)   assistance in welfare rights and managing finances; (i)   such facilities for, or assistance in, travelling as the relevant authorities may consider necessary to enable those persons to attend or participate in any services provided or arranged under this section. (11)   For the purposes of this section, in relation to England "local authority" means— (a)   the council of a county; (b)   the council of a district for which there is no county council; (c)   the council of a London borough; (d)   the Common Council of the City of London; (e)   the Council of the Isles of Scilly. (12)   For the purposes of this section in relation to Wales "local authority" means the council of a county or county borough. (13)   "NHS body" means— (a)   in relation to England, a Strategic Health Authority, a Special Health Authority, an NHS trust, an NHS foundation trust, a Primary Care Trust (including a Care Trust established under section 16A of the National Health Service Act 1977); (b)   in relation to Wales, a local Health Board or an NHS trust. (14)   The appropriate national authority may by regulations make provision for and in connection with requiring or authorising the relevant authorities mentioned in the case of a person of a prescribed description who falls within this section to make, with that person's consent, such payments to him as they may determine in accordance with the regulations in respect of his securing the provision of the services mentioned in this section. (15)   In this section the "appropriate national authority" means— (a)   in relation to England, the Secretary of State; (b)   in relation to Wales, the Welsh Ministers.""   Clause 4   LORD CARLILE OF BERRIEW EARL HOWE BARONESS MURPHY BARONESS MEACHER   The above-named Lords give notice of their intention to oppose the Question that Clause 4 stand part of the Bill.   After Clause 4   LORD CARLILE OF BERRIEW EARL HOWE BARONESS MEACHER 8 Insert the following new Clause—    "Renewal of detention (1)   Section 20 (duration of authority) of the 1983 Act is amended as follows. (2)   In subsection (3), for paragraph (a), substitute— "(a)   if he is a medical practitioner, to examine the patient and to arrange for another registered medical practitioner to examine the patient, or (b)   if he is not a medical practitioner to arrange for two registered medical practitioners to examine the patient"; (b)   in paragraph (b)— (i)   for "him" substitute "them", (ii)   for "if it appears to him that the conditions set out in subsection (4) below are satisfied, to" substitute "if the requirements of subsection (4) are satisfied the responsible clinician shall". (3)   After subsection (3) insert— "(3A)   The report to be furnished under subsection (3) shall be founded on the written recommendations in the prescribed form of the two registered medical practitioners including in each case a statement that in the opinion of the practitioner the conditions set out in subsection (2) are complied with and each such recommendation shall include— (a)   such particulars as may be prescribed of the grounds for that opinion so far as it relates to the conditions set out in paragraphs (a) to (c) of subsection (5), specifying whether other methods of dealing with the patient are available, and (b)   a statement of the reasons for that opinion so far as it relates to the conditions set out in paragraph (c) of that subsection, specifying whether other methods of dealing with the patient are available and if so why they are not appropriate.""   Clause 5   LORD CARLILE OF BERRIEW EARL HOWE BARONESS MURPHY   The above-named Lords give notice of their intention to oppose the Question that Clause 5 stand part of the Bill.   After Clause 5   BARONESS MURPHY EARL HOWE BARONESS NEUBERGER BARONESS MEACHER 9 Insert the following new Clause—    "Single gateway for treatment    Section 3 of the 1983 Act (admission for treatment) is amended as follows— (a)   in subsection (1) after the words "to a hospital"; and (b)   in subsection (2) after "a patient",    insert "who has been admitted to hospital for assessment under section 2"."   Clause 6   LORD CARLILE OF BERRIEW EARL HOWE BARONESS MURPHY   The above-named Lords give notice of their intention to oppose the Question that Clause 6 stand part of the Bill.   After Clause 6   BARONESS KNIGHT OF COLLINTREE 10 Insert the following new Clause—    "Provision of appropriate food and drink (1)   Section 58 of the 1983 Act is amended as follows. (2)   In subsection (1)(b) after "medicine" in the first line insert the words ", but excluding the provision of food and drink,". (3)   After subsection (1)(b) insert— "(c)   the provision of adequate food and drink to a patient." (4)   After subsection (3) insert— "(3A)   Subject to section 62 below, a patient shall be provided with adequate food and drink at all times unless— (a)   he has consented not to receive adequate food and drink and either the responsible medical officer or a registered medical practitioner appointed for the purposes of this Part of this Act by the Secretary of State has certified in writing that the patient is capable of understanding the nature, purpose and likely effects of this decision and has consented to it; or (b)   a registered medical practitioner appointed as aforesaid (not being the responsible medical officer) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of the decision not to receive adequate food and drink or has not consented but that, having regard to the likelihood of its alleviating or preventing a deterioration of his condition adequate food and drink should not be given." (5)   In subsection (4) after "(3)(b)" insert the words "or (3A)(b)"."   Clause 7   BARONESS KNIGHT OF COLLINTREE 11 Page 4, line 18, at end insert "but does not include provision of adequate food and drink" 12 Page 4, line 18, at end insert— "(   )   In section 64(1) of the Mental Capacity Act 2005 in the definition of "treatment", after "procedure" insert "but does not include provision of adequate food and drink"."   After Clause 7   LORD CARLILE OF BERRIEW EARL HOWE BARONESS MURPHY 13* Insert the following new Clause—    "Treatability (1)   The 1983 Act is amended as follows. (2)   In section 3(2)(b) (admission for treatment), omit the words "in the case of psychopathic disorder or mental impairment,". (3)   In section 37(2)(a)(i) (power of courts), omit the words ", in the case of psychopathic disorder of mental impairment,". (4)   In section 47(1)(b) (removal to hospital), omit the words ", in the case of psychopathic disorder or mental impairment,". (5)   In section 72(2)(b) (discharge of patients), omit the words " in the case of a patient suffering from mental illness or severe mental impairment"."   EARL HOWE BARONESS BARKER BARONESS MURPHY 14 Insert the following new Clause—   "CHAPTER 1A   Treatment safeguards    Electroconvulsive therapy (1)   Section 58 (treatment requiring consent or a second opinion) of the 1983 Act is amended as follows— (a)   at the beginning of subsection (3)(b) insert "except where the trreatment is electroconvulsive therapy"; (b)   after subsection (3)(b) insert "; or (c)   subject to section 58A, in the case of electroconvulsive therapy a registered medical practitioner appointed as aforesaid (not being the responsible clinician) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment but that, having regard to the likelihood of its alleviating or preventing a deterioration of his condition the treatment should be given."; (c)   in subsection (4) after "(3)(b)" insert "or (c) or section 58A or section 63A". (2)   After section 58 insert— "58A Treatment for patients under 18 requiring consent and a second opinion (1)   Subject to section 62 below, a patient under eighteen years shall not be given electroconvulsive therapy, unless a registered medical practitioner appointed as aforesaid (not being the responsible clinician) has certified in writing that— (a)   the patient is capable of understanding the nature, purpose and likely effects of that treatment, and has consented, and that having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given; or (b)   the patient is incapable of understanding the nature, purpose and likely effects of that treatment, and either— (i)   a person who has parental authority for the patient understands the nature, purpose and likely effects of that treatment and has consented to the treatment and that having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given; or (ii)   the High Court has determined that having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given. (2)   For the purposes of treatment given under this section, either the registered medical practitioner responsible for the patient's treatment or the registered medical practitioner providing the second opinion shall be a clinician with special training in child and adolescent mental health."" 15 Insert the following new Clause—    "Informal patients under 18: ECT safeguards    Subsection (2) of section 56 (patients to whom Part IV applies) is amended as follows— (a)   after "Section 57" insert "and section 58A". (b)   for "that section" substitute "these sections"." 16 Insert the following new Clause—    "ECT emergency criteria (1)   Section 62 (urgent treatment) of the 1983 Act is amended as follows. (2)   In subsection (2) at the beginning insert "Subject to subsection (4) below,". (3)   After subsection (3) insert— "(4)   This section shall not apply to electroconvulsive therapy if the patient is capable of understanding the nature, purpose and likely effect of the treatment and does not consent to it. (5)   Subsection (1)(b), (c) and (d) above shall not apply if the treatment is electroconvulsive therapy."" 17 Insert the following new Clause—    "ECT compliance with standards    After section 63 of the 1983 Act insert— "63A ECT compliance with standards    Electroconvulsive therapy (ECT) shall not be administered except in a service that has been accredited for that purpose by the Royal College of Psychiatrists.""   EARL HOWE BARONESS VERMA BARONESS BARKER 18 Insert the following new Clause—    "Administration of medicine    In section 58(1)(b) of the 1983 Act (treatment requiring consent or a second opinion) for "three months" substitute "28 days"." 19 Insert the following new Clause—    "Other treatment safeguards (1)   The 1983 Act is amended as follows. (2)   After subsection (4) of section 58 (treatment requiring consent or a second opinion) insert— "(4B)   When deciding what treatment to give, the responsible clinician shall have regard to the wishes of the patient, whether expressed directly or in an advance statement, and shall record any treatments requested by the patient in the patient's medical record, and if that treatment is not given shall record the reasons for this. (4C)   In certifying that a treatment should be given under section 58(3)(b), 58(3)(c) or 63A, the registered medical practitioner concerned shall give reasons in writing for his opinion explaining how the treatment represents, for the patient in question, a favourable balance of therapeutic benefit over harm. (4D)   The reasons given under subsection (4C) shall be communicated to the patient, except where this is likely to cause serious harm to the physical or mental health of the patient or of any other person." (3)   In section 63 (treatment not requiring consent), at the end, insert— "(2)   When deciding what treatment to give, the responsible clinician shall have regard to the wishes of the patient, whether expressed directly or in an advance statement, and shall record any treatments requested by the patient in the patient's medical record, and if that treatment is not given shall record the reasons for this.""   EARL HOWE BARONESS BARKER BARONESS MURPHY 20 Insert the following new Clause—    "High doses    After section 63 of the 1983 Act (treatment not requiring consent) insert— "63A High doses    No medicine or medicines shall be administered to a patient at doses that singly or in combination exceed limits set out in the British National Formulary, unless— (a)   he has consented to that treatment up to that dose and either the responsible clinician or a registered medical practitioner appointed for the purposes of this Part of the Act by the Secretary of State has certified in writing that the patient is capable of understanding its nature, purpose and likely effect and has consented to it; or (b)   a registered medical practitioner appointed under paragraph (a) (not being the responsible clinician) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment at that dose but that, having regard to the likelihood of its preventing serious risk to the life of the patient, the treatment should be given up to that dose.""