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The Earl of Lindsay: Of course, I shall be as kind with this amendment as I was with the last. We are once again grateful to the noble Lord, Lord Carmichael, for bringing this matter to our attention. We note that there is a difference between the list of people who receive the reports before the patient is reassessed and those who receive the reports made in hospital during reassessment. We shall consider who should receive copies of the reports made in hospital. With that assurance I hope that the noble Lord will withdraw his amendment.

Lord Carmichael of Kelvingrove: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carmichael of Kelvingrove moved amendment No. 123:


Page 25, line 39, at end insert:
("( ) A patient who has been detained in hospital under this section shall not be further detained under this section or under section 24 of this Act immediately after the expiry of the period of detention.").

The noble Lord said: This is another helpful little amendment. I believe that the effect of it will be that there must be no successive detentions under the reassessment procedure. Nor can a patient who has been brought to hospital for reassessment be immediately thereafter kept under the emergency detention provisions of the Act. That mirrors Section 24(6) of the Mental Health (Scotland) Act 1984 which prohibits successive emergency detentions. In crude layman's terms it is known as a "cat and mouse". I hope that the Minister will give an assurance that precautions will be taken against the possibility of that provision being used. I beg to move.

The Earl of Lindsay: This amendment has been described as "another helpful little amendment" by the

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noble Lord, Lord Carmichael of Kelvingrove, who moved it. It prevents the use of Section 24 following reassessment in hospital, and of the use of repeated periods of detention in hospital for reassessment. We do not accept that Section 24 should not be available immediately following reassessment. It may need to be available in such cases, and we see no need to restrict this. However, we undertake to consider whether it is necessary to include a provision to prevent the re-use of reassessment in hospital. This is something which we would certainly not wish to encourage, but we should like some more time to consider this. With that assurance, I would ask the noble Lord to withdraw this amendment.

Lord Carmichael of Kelvingrove: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Carmichael of Kelvingrove moved Amendment No. 124:


Page 25, leave out lines 43 and 44 and insert:
("(1) Within the period of 7 days ending on the 28th day after the patient became subject to the community care order, the special medical officer shall examine the patient or obtain from another medical practitioner a report on the condition of the patient; and if, after consulting the persons mentioned in subsection (2) below, he").

The noble Lord said: This is another amendment to which I hope that the Minister will give sympathetic consideration. It would require a special medical officer to re-examine a patient within the first month of the community care order and consider whether it is necessary. If not, he must discharge the patient. Under the detention provisions, once a patient is in hospital the medical officer must examine him within the first month and discharge him if necessary. This amendment mirrors the provisions of Section 24(4) of the Mental Health (Scotland) Act and provides for a fixed review once the patient has been living for a while in the community under supervision. It is a helpful little amendment and I hope that the Minister will at least accept the spirit of it. I beg to move.

The Earl of Mar and Kellie: I should like to support the amendment. It would be useful for the community care team to have such focus because by the time that the provisions become appropriate, the patient would have been living in the community for at least five weeks. I commend the amendment to the noble Earl.

The Earl of Lindsay: This amendment seeks to introduce a statutory review of the patient's need for a community care order, to be carried out at the end of the first month of the order.

I have to say in passing that in attempting to do so it also removes the general power of the special medical officer to revoke the order if he considers that the patient no longer requires to be subject to a community care order.

We have not included a mandatory review in the same way that this is required for detention in hospital under Section 22 of the 1984 Act because we do not consider that this is necessary for a patient in the community. The constant review of the patient's need for a community care order should form part of good

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multidisciplinary practice by the care team, and is very much a matter for guidance. I hope that the noble Lord will feel able to withdraw this amendment.

Lord Carmichael of Kelvingrove: It would be very grudging of me if I did not say that the Minister has given a good explanation of his reasons for not accepting this amendment, especially when he has accepted many of the other amendments. All that I can say is that I shall take the amendment away but, in the meantime, I beg leave to withdraw it.

Amendment, by leave, withdrawn.

The Earl of Lindsay moved Amendment No. 125:


Page 26, line 15, leave out ("responsible") and insert ("special").

The noble Earl said: I spoke to this amendment earlier. I beg to move.

On Question, amendment agreed to.

The Earl of Lindsay moved Amendment No. 126:


Page 26, line 30, at end insert:
("(4) Where a patient subject to a community care order is detained in custody in pursuance of any sentence or order passed or made by a court in the United Kingdom (including an order committing or remanding him in custody) the period for which, under section 35C of this Act, the community care order has effect shall continue to run but the conditions to which he is subject under that order shall not, for so long as he is so detained, apply in relation to him." ").

The noble Earl said: In Clause 1 for England and Wales there is provision for the effect of a custody sentence imposed upon a patient subject to aftercare under supervision. This amendment introduces a similar provision for Scotland. The effect of the amendment will be that where a patient subject to a community care order is detained in custody on sentence or order of a UK court including a remand order, the conditions of the community care order will be suspended. The community care order will remain in effect and the period will continue to run. On release from custody, if the community care order has not expired, the conditions will resume. On the other hand, if the order has expired, the patient will no longer be subject to either the community care order or the conditions.

Clearly, it is not feasible to expect an imprisoned person to continue to comply with the conditions of a community care order and it is also unfair to "stop the clock" on the order when he is in prison. I hope that the Committee will agree to this amendment. I beg to move.

The Earl of Mar and Kellie: I am a little concerned about the effect of the amendment. Someone who is in the community may need to be subject to a community care order because of their vulnerability due to the state of their mental health; but we now see that they might be imprisoned. However, when their order has expired, and when they come out of prison, which itself is a difficult period, that already vulnerable person will be left high and dry. I wonder whether it is possible to continue the community care order for at least another seven days in order to give the community care team the opportunity to meet up with the patient after he has left gaol.

The Earl of Lindsay: I note what the noble Earl, Lord Mar and Kellie, has said. This is an issue which

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the Government have raised previously and which we continue to study in detail. I remind the noble Earl that the prison rehabilitation services will be involved in a prisoner's departure from prison. Therefore, they can undertake to make any arrangements which they feel may be necessary in the circumstances. We shall continue to consider such points. I commend the amendment to the Committee.

On Question, amendment agreed to.

On Question, Whether Clause 4, as amended, shall stand part of the Bill?

Lord Carmichael of Kelvingrove: It may seem drastic to seek to remove a whole clause from the Bill, but this is the only way in which it is possible to raise one or two of the worries that have been brought to our attention by those involved. We are seeking to retain the status quo in Scotland, pending more detailed consideration of the most appropriate course of action for patients in the community who are suffering from mental disorders.

There is a strong consensus in Scotland across the health, social work and voluntary sectors that it is not appropriate to introduce supervised discharge orders in Scotland nor is the proposed introduction of community care orders supported by CoSLA. It is considered that greater use of the existing powers, particularly that of guardianship and, to a lesser extent, that of leave of absence, should be made. The proposed community care order appears to confer less power than a guardianship order. It is therefore difficult to envisage any benefits arising from its introduction.

I should be grateful if the Minister could comment on some figures that I am about to give him. If he cannot do so right away, perhaps he will write to me later. A significant benefit of the leave of absence arrangements in Scotland is that they allow patients to be discharged into the community while still being liable to recall to hospital should their circumstances deteriorate. I am informed that the total number of patients on leave of absence in Scotland at 31st December 1994 was 412, of whom only 15 had been on leave of absence for over three years; 32 for over two years and 101 for over one year. Those figures suggest that the number of patients likely to become the subject of community care orders is small and that heavy-handed legislation is unlikely to remove all possibility of any such patient committing a violent crime. The Minister may well have more up-to-date figures, but the figures that I have given—if they are correct—show that the principle of Clause 4 seems to be, to say the least, a little over the top.


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