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Lord Campbell of Croy: My Lords, I am grateful to my noble friend for such a full reply, which I shall convey to those who have raised this matter. I hope that there will be adequate arrangements in the final legislation for relapses where sufferers from mental illness, particularly schizophrenics, seem perfectly normal but then have one of their really dark periods. I am grateful to my noble friend and beg leave to withdraw the amendment.

Baroness Farrington of Ribbleton moved Amendment No. 4:


Page 2, line 22, at end insert:
("( ) For the avoidance of doubt, a person to whom a duty is owed under section 117 below shall be deemed vulnerable as a result of mental illness under section 59(1) (c) of the Housing Act 1985 (Priority need for accommodation).").

The noble Baroness said: My Lords, the importance of this amendment cannot be underestimated. In terms of the need to have an acceptable package which will provide an environment in which someone can have the right to care and treatment, housing is an integral part. Because of the nature of the illness involved, the normal housing priority considerations may well not apply. It may well be that the individual concerned is not without a roof over his (or her) head. He or she may well have a room in a home with other members of the family, but it may be singularly inappropriate in the view of those considering the care package for that accommodation to be taken up.

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Given the shortage of housing and the difficulty of finding it, it is critically important for that category of people —I cannot say how many are involved; perhaps at this stage I could press the Minister to be a little more specific about the numbers that the Government envisage might be involved with this legislation—that proper housing is part of the care package. Therefore, it is also critically important that a patient should be deemed to be, absolutely beyond any kind of argument, a priority need in terms of housing availability. I beg to move.

3.30 p.m.

Baroness Jay of Paddington: My Lords, I rise briefly to support my noble friend, who mentioned all the principles that lie behind the amendment. I wish to draw your Lordships' attention to one specific case which came to my notice after we debated this amendment at Committee stage. I hold in my hand the report of an independent panel of inquiry to the City of Westminster, the Kensington, Chelsea and Westminster health authorities and the North West London Mental Health Trust on the case of a mother and son, Ellen and Alan Boland, both of whom died.

I draw your Lordships' attention to this case because it illustrates clearly the points made by my noble friend about how inadequate housing may exacerbate the mental health problems of an individual. Mr. Alan Boland, one of the people who were the subject of the inquiry, was under the care of the local health authorities and attending a day hospital for his mental condition. He lived jointly with his mother, Ellen Boland, in a council flat. His relationship with his mother was particularly difficult and the people looking after him said that it seriously exacerbated his mental condition. Unfortunately, he later murdered his mother and six months ago committed suicide in Wandsworth Prison.

The problem as it relates to this amendment was that although his medical carers and the social services involved in his case applied several times—I imagine they made dramatic pleas given the circumstances and the final outcome —for him to be rehoused, the report states that,


    "There was a considerable lack of urgency about his particular case. There was a lack of understanding by officers in charge of the housing of the exact nature of his problem".

Alan Boland was described in the report as having been a "cipher" on the housing list.

When the report was published various practical recommendations were made and, with your Lordships' permission, I shall quote them in a little detail. They fulfil some of the criteria which, at Committee stage, the Minister suggested would be good practice at local level. For example, one recommendation said:


    "The Westminster Housing Department and its medical adviser, together with the medical practitioners and health authorities in the borough, should establish a formal mechanism through which they develop and keep under review the medical criteria and application procedures for obtaining priority housing on medical grounds".

The policy and procedures group, which arose from another recommendation of the housing department,


    "should improve the scope and quality of the advice it provides to housing officers on how to implement policies and on the procedure that the group lays down. The housing department should examine the

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    nature and location of the guidance given by senior managers to junior housing officers in cases of particular complexity. The housing department should, as part of service development, examine its procedures, publications, standard letters and other communications to ensure that they are clear, comprehensive and comprehensible".

If all those recommendations are accepted by the local authorities concerned, they will become an outstanding example of good practice. I refer your Lordships to the Minister's response to a similar amendment at Committee stage where, at col. 165 of the Official Report on 4th April, she said that it must be for local agencies to determine priorities. My concern is that if every local agency must suffer a tragedy similar to that I described, which happened close to our doors here in central London, it would be much more sensible for the legislation to be drafted in such a way that it establishes the vulnerability of people who are under these orders so that they become, automatically, priorities of local housing agencies and the difficulties of which I spoke are not likely to arise. I am reminded of the arguments that we rehearsed some 10 years ago in relation to the question of children on "at risk" registers when we argued that it was awful if every local authority had to suffer some individual tragedy which then had to be the subject of a public inquiry before national guidelines were set.

When replying to a similar amendment at Committee stage, the Minister said that not all people under the terms of the Housing Act and the terms of my noble friend's amendment, would be described as "vulnerable". I have been advised that that cannot be the case; that anybody who comes under one of the supervision orders must be vulnerable within the meaning of the Act and therefore would be suitable for this treatment. For those reasons I support the amendment.

Lord Desai: My Lords, I rise briefly to support the amendment in the name of my noble friend. Whatever the technicalities, when one talks to people or reads the tabloids and more popular newspapers an impression is given that people are being released from hospitals to roam around the streets and that they are liable to cause great harm.

The Minister may deny that, but that is essentially the impression that most people have; that under care in the community something has slipped. It is felt that these people are either homeless or not being placed in homes where they are looked after. That impression will not go away unless something specific and clear is done about the housing of vulnerable people. That is why I say that it is in the interests of us all to do something that is clear and noticeable.

The Earl of Mar and Kellie: My Lords, this amendment brings this specific client group into a special category. Social services and the health authorities are already working at maximum priority. I hope that the Minister will be able to bring housing up to that level of priority.

Baroness Cumberlege: My Lords, as I understand it, noble Lords opposite are seeking to reintroduce an amendment which was proposed at Committee stage but are now suggesting that it should appear in a different part of the Bill. I am not clear about the significance of this repositioning, but I believe the effect would be the same;

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that is, to introduce a provision whereby all patients entitled to receive services under Section 117 of the Mental Health Act will be deemed vulnerable under the Housing Act 1985, whether or not they are subject to supervised discharge.

The consultation arrangements we have built into this Bill, its emphasis on inter-agency co-operation and communication, and the importance it attaches to care planning must mean that accommodation will rate highly in the considerations of all concerned. As I said when this was last discussed, it is for local agencies to decide where their housing priorities lie and we do not think it necessary or desirable to give all previously detained patients blanket vulnerability status in law.

The new power established by this Bill is rooted in Section 117 of the Mental Health Act 1983 which places a clear obligation on health and local authorities to provide for the aftercare services the patient needs. It would clearly be inconsistent with this not to ensure that the patient had an acceptable place in which to live.

Housing needs will be considered as part of the initial assessment and housing placements will relate to the total care plan. The suitability of this housing placement will, of course, be kept under review as part of the regular review of the aftercare services.

The noble Baroness, Lady Farrington, asked how many people would be covered by the Bill once it is enacted. The numbers will depend very much on how it is used. Our best estimate at present is around 3,000 people a year. We accept that the housing authorities have a key part to play. We believe that that is best covered by co-operation between the health authorities, social services and the housing departments rather than by a statutory requirement. I hope therefore that the noble Baroness will not press the amendment.


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