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The Earl of Mar and Kellie: My Lords, the noble Baroness, Lady Jay, is right. We are definitely not looking for compulsory treatment at a physical level. But it is important that the community care team is able to take action sooner rather than waiting for the mental breakdown of the patient and subsequent hospitalisation. It is important that this is seen as a main condition of the order.

Lord Thurlow: My Lords, in general terms I support the amendment. I realise that it takes us into a wide field. It was not discussed in Committee, but, as the noble Baroness said, her intention is primarily a probing one.

I have long been in favour of this kind of provision but it requires a great deal of public discussion in order to get more public support than is at present apparent. There does not seem to be any logical reason why, if one has compulsory medication in hospital, under suitable safeguards one should not have it out of hospital, especially as, if treatment is to be effective, it is imperative that it should be regular. While saying that, I would not wish to press for any far-reaching commitment at this stage.

Lord Rea: My Lords, I wish to speak to Amendment No. 33, so it will seem as though my noble friend and I are doing a strange double act in that she is advocating one course and I am advocating precisely the other course. However, there is a valid point of view which objects very strongly to the power to convey, which is quite an essential part of the Bill.

My remarks on this matter should be taken in conjunction with my noble friend's points in her amendment, which suggests that the power to order medication should logically be part of the power to convey and is the only way in which it would work effectively. Good community care for those with severe mental health problems entails intensive support from key workers, who will work at making good relationships with service users and will visit service users and keep in touch with them regularly and not just when they have an appointment for medication. Sadly, the latter is what one sees so often now. It is feared that the power to take and convey will enable supervisors to keep a minimum of contact and not to maintain a supportive relationship.

In Committee the noble Baroness said that this power would give a useful backing to the care team when there is a temporary reluctance on the part of the patient to

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co-operate. That highlights a concern that the power will be exercised to force a patient to comply with the conditions imposed on him or her, such as the requirement to attend for medical treatment, but, curiously, not to have to accept medication or other forms of treatment once they have attended. There is in the Bill little control over the exercise of the power to take and convey.

The Government maintain that they envisage a comparatively rare use of this power. The noble Baroness said:


    "Clearly this power to convey would be used only in times of emergency".—[Official Report, 4/4/95; col. 156.]

But there is nothing in the Bill to regulate the use of the power and, as drafted, it could be exercised arbitrarily, at any time, in any circumstances and for any reason. Such an extensive power could be open to widespread abuse.

A number of organisations, including the Commission for Racial Equality, are extremely worried about the power and suggest that it might well be discriminatory in its effect. Despite the belief of Sir Louis Blom-Cooper that there would not be problems with the European Convention on Human Rights, his is not the only opinion and others feel that there might well be problems with the European Court of Human Rights.

I have set out a very small list of the points which people have made against the power to convey. I feel that either the power to convey should be dropped altogether or that it should be given some teeth, as my noble friend suggested.

Lord Mottistone: My Lords, perhaps I may comment on all three amendments. It may be helpful if I give the House the view conveyed to me by the National Schizophrenia Fellowship on this very tricky area. I refer first to Amendments Nos. 31 and 35. The National Schizophrenia Fellowship members are not in favour of a patient being required to take medication when living outside hospital. They do not think it is workable on practical grounds. If a patient is not prepared to comply with taking prescribed drugs, either orally or by injection, he or she should be admitted to hospital. It is as simple as that. If there is a deterioration in mental health or a danger in terms of suicide risk or violence to others, which often happens as a result of not taking medication, hospital must be the place for them.

Turning to Amendment No. 33, as the noble Lord, Lord Rea, said, many civil liberties organisations object strongly to the power to convey. The National Schizophrenia Fellowship thinking on that point is that the power to convey could not and would not be used to convey someone to a clinic, a residential home, a work experience project, evening classes or whatever by force, as is sometimes necessary on admission to hospital. If there were any attempt to do that the National Schizophrenia Fellowship would object as much as any of the civil liberties organisations might do, as it sees that as destroying the whole basis of the Bill, which is to get as far as possible by consultation.

I am sure that many times my noble friend the Minister has told us that consultation and agreement are the basis of so much of what the Bill is trying to do. The

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National Schizophrenia Fellowship feels that having the power will be a very useful reinforcement, as my noble friend said in Committee, for, for example, a community psychiatric nurse or a social worker saying to someone, "You have to go to the clinic. I have my car here. Now come along". Such an approach might well work in practice by persuasion. In other words, what is wanted is the power to reinforce persuasion for the persuadable and not to get hold of 10 policemen or even one to take the patient anywhere by force. Therefore, I believe that the proposal in Amendment No. 33, which is to remove subsection (4), would lead to so much time being taken to implement the other aspects of the Bill that the situation that it is designed to deal with would have long changed into something else by the time the application had been approved by the health authority. Amendment No. 33 is not practicable.

Earl Russell: My Lords, it seems to be the contention of the Opposition that the Bill is, as Sir Winston Churchill said of Sir Clive Bossom, neither one thing nor the other. The Minister might possibly be tempted to reply that in that case the Bill is just like real life.

I understand the argument for saying that one needs a power to compel the taking of medication in the community. But that is a great deal easier said than done. If any of us had been in the position of having to try to induce a patient to take medication which he is absolutely determined not to take, I think it would be agreed that it really is true that one can take a horse to water but one cannot make it drink.

That is why the power to take and convey in this Bill is necessary. I listened very carefully to what the noble Lord, Lord Rea, said. It is true that one takes such powers only warily and hesitantly. In the end one has to take account of safety. There are many situations when the patient left outside is not safe. I remember an occasion when, late at night and in the dark, the patient was in a black cloak standing in the middle of the road. The traffic could not see her, and she would not move. That is the sort of situation where one needs the power to take and convey. I do not believe that we shall ever get this right but it seems to me that the Bill has come as near to it as we can reasonably hope.

6 p.m.

Baroness Cumberlege: My Lords, we very much share the views of my noble friend Lord Mottistone and those of the noble Earl, Lord Russell. I am grateful for his support on this occasion. We feel that compulsory medication in the community has no place in our proposals. The requirements placed on a patient may include where he should attend for treatment. There will be a power to convey him there if absolutely necessary. But the idea of compulsory medication goes against the basic philosophy of the Bill.

The medication a patient needs will be part of the aftercare services provided for him under Section 117 of the Act, and if he does not co-operate with this part of his care the new Section 25E provides for the case to be reviewed and in particular for consideration to be given to whether he might need to be re-admitted to hospital under the Act. As your Lordships know, the

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balance between the liberties of patients and the protection they and other people may need from the effects of their illness is a delicate one. To introduce a provision for compulsory treatment in the community into the Bill would alter that balance fundamentally and this is not a course we wish to take. The fact that there is no power to medicate will itself help to ensure that the power to convey is used sparingly because there will be no point in using it unless there is reasonable expectation that the patient will co-operate.

I must confess that we are a little surprised to find the noble Baroness and the noble Lord, Lord Rea, proposing in the same breath that the Bill should be made tougher by introducing compulsory medication in the community and that the power which it already contains to convey the patient should be removed. As I have acknowledged previously, we recognise that ultimately aftercare under supervision is not going to work without the co-operation of the patient. I also accept that the power to convey a patient can be seen as somewhat more coercive than Clause 1 as a whole. Indeed, we would expect it to be used in only fairly rare cases.

But in those cases where there is a temporary reluctance to co-operate on the patient's part, this limited measure of compulsion may be very valuable in ensuring that the care arrangements are maintained. That is a significant part of the underpinning of the aftercare arrangements introduced by the Bill. I hope very much that the noble Baroness and the noble Lord will agree not to press the amendment. Perhaps I may just add that all the legal advice we have had is that all the provisions of the Bill are compatible with the European Convention on Human Rights.


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