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The Deputy Chairman of Committees (Lord McColl of Dulwich): Before I call Amendment No. 32, I must point out that if the amendment is agreed to I cannot call Amendment No. 33.

The Earl of Balfour moved Amendment No. 32:

Page 4, line 33, leave out ("except where the patient otherwise requests").

The noble Earl said: All my amendments are grouped together because they all cover the same subject. One of the tragedies of persons suffering from mental disorder is that because they cease to think logically they cease to trust those nearest and dearest to them. That results in those nearest and dearest being unable to help because they are not trusted. The "nearest and dearest" need not necessarily be a relative. Two or three people may live together and be very close, but not necessarily be related. That is something that should be borne in mind.

Many persons who are seriously mentally impaired may appear to be perfectly normal, and sometimes quite witty. It is only after a period of up to two hours that strangers will become aware of how mentally impaired he or she is, because by that time mentally impaired persons will start to repeat themselves.

Of the four psychiatrists I have met, dealing mainly with my wife, only one of them quickly and clearly diagnosed how seriously mentally ill was my wife. He was the oldest, and the only one who asked the right questions. For the rest of what I shall say, I shall refer to the mentally impaired person as the "patient". The RMO referred to in the Bill should be not less than 45 years old, because persons under that age have not seen enough of life to know the right questions to ask the patient.

My wife was convinced that I needed a psychiatrist much more than she did. That illustrates how difficult it is for the nearest and dearest to be able to seek and

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obtain help. Regrettably she did not trust her daughter, either. The words I propose to leave out of the Bill are designed to remove from the patient the choice of whether the next of kin, or, as I have said, the nearest and dearest, are informed, because in almost every case that I have known such mentally impaired patients, because they do not think logically, always refuse to have their next of kin informed.

I have shown a different side to that described by my noble friend Lord Mottistone in speaking to Amendment No. 18 and others in that group. I ask that, where the next of kin is involved, he or she must be informed. After all, if the patient is cured the next of kin must help that patient to rehabilitate. I beg to move.

6 p.m.

Earl Russell: I congratulate the noble Earl, Lord Balfour, on the courage and clarity with which he spoke about what must be a most painful experience, even remembered at a long distance of time. I understand the situation that he described. He illustrated that the noble Baroness, Lady Jay, perhaps exaggerated the position in describing as romantic the review of the relationship with the family as given by the noble Lord, Lord Mottistone.

There are many people who are homeless, rootless and without contacts, as the noble Baroness described. However, there are also others whose families are deeply anxious. It does not necessarily follow that what the noble Earl has recommended is the solution. Such distrust of the people who care for the person most is a characteristic symptom, and therefore it is part of the problem. Indeed, it is almost at the heart of the problem.

However, I am not convinced that because it is at the heart of the problem one can deal with it by pretending that it is not there. One must recognise its existence and one must bring the treatment to the patient in a form that the patient can accept. It is a case of, "You can take a horse to the water but you can't make it drink". I express my greatest sympathy with the noble Earl, but I am not certain that the amendment solves his problem.

Baroness Cumberlege: I too greatly respect the experience and knowledge that my noble friend has of the subject. However, as he will be aware, our proposals allow that a patient's nearest relative, as defined under the Mental Health Acts, should be informed of every significant development connected with his or her aftercare under supervision—unless the patient requests otherwise. If the nearest relative is, or is to be, the patient's informal carer in the community, he or she will be consulted and kept informed throughout the process in any case.

My noble friend's amendment will allow the patient's nearest relative to be informed of what is happening to the patient, and possibly of the classification of his mental disorder, regardless of the patient's own wishes and the nature of the relationship between the two. They may have become distanced in any number of ways and, in rare cases, may well be on terms under which it would be entirely reasonable for the patient not to wish further contact or knowledge.

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There is an underlying confidentiality issue here. It is perfectly reasonable to consult and inform all those who are to play a part in the aftercare arrangements (which could not be set up without the patient's compliance from the outset) but not to inform automatically someone who fits the technical definition of nearest relative unless he is one of these or unless the patient has no objection. In many cases the nearest relative will be the patient's carer and consulted accordingly. If this is not the case the patient should be allowed to ask for confidentiality.

I have agreed to consider the amendments tabled by my noble friend Lord Mottistone, which go some way towards these amendments, but I do not believe we can override the patient's wishes completely. I therefore suggest to my noble friend Lord Balfour that he does not press these amendments.

The Earl of Balfour: I had no intention of pressing the amendments. I merely wished to bring forward the side of the problem that I and so many of my friends have experienced. I wish to make one further comment and I do not expect my noble friend to reply at this stage.

In the case of my wife and in that of others, the real problem was that she was drinking—only wine but quite a lot. As far as the doctors were concerned, she was under the influence of drugs and therefore they did not want to know. I regret to say that I had to call in the doctors at the end of the day and say, "Enough is enough. Take her away". That is exactly what happened.

It is a matter of the nearest and dearest being able in some way or another to obtain help from social workers, doctors or whoever. What I have described is not uncommon. If there is a way in which people in that unfortunate position can seek and obtain help I should be pleased to help them. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 33 not moved.]

Earl Russell moved Amendment No. 34:

Page 6, line 16, at end insert ("uncle, aunt, or grandparents").

The noble Earl said: I hasten to assure the Committee that the amendment does nothing to increase or to diminish the powers of the next relative. I am aware that that is a controversial area of the Bill but the amendment does not enter into it. It deals merely with who shall be classified as next relatives and makes two additions; that is, uncle and aunt or grandparents.

Often those people are personally involved. In a sad number of cases it happens that where a person suffers from severe mental illness, either his or her parents suffer from such mental illness too—living with such illness is in itself a severe strain—or for one of many possible reasons the parent is absent. In such situations either the grandparents or an aunt or uncle tend almost instinctively to take on the responsibility. Therefore, if we are making a list of closely involved relatives, I do not immediately see any logical reason for leaving them out.

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Perhaps I may add a light footnote. When we were putting the amendment together in the Whips' Office, our assistant, who was writing it, only just managed to do so because his infant niece, who was sitting on his knee, nearly got away with the pen. That illustrates why I believe the amendment is sensible.

Lord Mottistone: I was most intrigued by the amendment because I thought that the noble Earl was merely adding to the list the people who appear in Section 26 of the 1983 Act. Indeed, he has done so, but perhaps we may compare Section 26 with subsection (10), which the noble Earl is amending. Subsection (10) contains a list of in-laws who do not appear in Section 26, and it is strange that there is such a discrepancy between the two provisions. It would be nice to know why there is such a discrepancy and why all those in-laws have crept in.

Baroness Farrington of Ribbleton: Perhaps I may ask about a slightly different category of carer and next-of-kin. I refer to people who, in the case of single parents who are mentally ill, are family members caring for the children. They have a particular knowledge, concern and interest and need to be consulted. There may exist a degree of mistrust of other members of the family, as referred to with such depth of knowledge by many Members of the Committee, and in such circumstances a specific problem can be created with regard to the role, relationship and difficulties facing someone who cares for the children.

Baroness Jay of Paddington: I agree with the noble Lord, Lord Mottistone. When I first looked at the amendment in the name of the noble Earl, Lord Russell, I thought that it referred back directly to the 1983 Act. But, indeed, Section 26 is slightly broader and different.

I should like to ask the noble Earl, Lord Russell, why he did not include a person other than a relative with whom the patient normally resides. Such a person is referred to in Section 26. I believe that the colloquial expression for such a person would be "the partner". If the amendment intends to extend the category of those people with whom the patient has a close relationship, then the partner—I hesitate to use the words "significant other"—is a relevant person to be included.

On an earlier amendment introduced by the noble Lord, Lord Mottistone, I asked whether the patient is to be consulted about who he or she regards as a close relative, and I make that point again in relation to this amendment.

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