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Mental Health (Patients in the Community) Bill [H.L.]

3.42 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I beg to move that the Commons amendments be now considered.

Moved, That the Commons amendments be now considered.—(Baroness Cumberlege.)

On Question, Motion agreed to.

7 Nov 1995 : Column 1642

COMMONS AMENDMENTS
[The page and line refer to Bill (122) as first printed by the Commons.]

1

Clause 1, page 3, line 37, leave out 'unless the patient has otherwise requested,'.


2

Page 3, line 44, at end insert—


'(2A) Where the patient has requested that paragraph (b) of subsection (2) above should not apply, that paragraph shall not apply unless—
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
3

Page 8, line 19, at end insert 'who is (or is to be)'.


4

Page 8, line 34, leave out 'unless the patient has otherwise requested,'.


5

Page 8, line 41, at end insert—


'(6A) Where the patient has requested that paragraph (c) of subsection (6) above should not apply, that paragraph shall not apply unless—
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer (or the person who is to be the community responsible medical officer) considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
6

Page 8, line 42, leave out ', after such consultation,'.


7

Page 11, line 31, leave out 'except where the patient has otherwise requested,'.


8

Page 11, line 38, at end insert—


'(5A) Where the patient has requested that paragraph (b) of subsection (5) above should not apply, that paragraph shall not apply unless—
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.
9

Page 12, line 46, leave out 'unless the patient has otherwise requested,'.


10

Page 13, line 3, at end insert—


'(3A) Where the patient has requested that paragraph (b) of subsection (3) above should not apply, that paragraph shall not apply unless—
(a) the patient has a propensity to violent or dangerous behaviour towards others, and
(b) the community responsible medical officer considers that it is appropriate for steps such as are mentioned in that paragraph to be taken.'.

Baroness Cumberlege: My Lords, with the leave of the House, I beg to move that this House do agree with the Commons in their Amendments Nos. 1 to 10 en bloc. Perhaps I may speak also to Amendments Nos. 12 and 13.

Your Lordships will remember that the rights of nearest relatives to be consulted about supervised discharge were an important theme of our debates on the Bill. The amendments introduced in the other place are intended to complete the process which began on the Floor of this House. In particular, they respond to a point which was raised at the Report stage by my noble friend Lord Mottistone. I am glad to put on record again how grateful we are to him and to the National

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Schizophrenia Fellowship, which has been working with him, for the highly constructive contribution that they have made.

The issue of consultation with nearest relatives was first raised by my noble friend in Committee. Although we did not accept the precise words that he proposed then we accepted the general principle and brought forward our own amendments on Report. Broadly speaking, the effect of these is that the responsible medical officer must consult the patient's nearest relative unless the patient objects.

My noble friend's further amendment on Report would have allowed the responsible medical officer to consult the nearest relative in spite of the patient's objection, particularly where the patient had a history of violence. In responding to him then I said that the wording of the Bill as it then stood would not prevent the responsible medical officer from consulting the nearest relative against the patient's wishes if there was an overriding public interest. We have considered this further and have concluded that if the patient has a propensity to violence, to avoid any possible doubt there ought to be a clear statutory provision for the nearest relative to be consulted even if the patient objects. This is the effect of the amendments introduced in the other place.

The amendments define two tests which must be satisfied if a patient's objection is to be overridden. First, the patient must have a propensity to violent or dangerous behaviour towards other people. Secondly, the responsible medical officer must believe that it is appropriate for the nearest relative to be consulted.

A patient objecting to his or her nearest relative being consulted is a serious matter which ought not to be set aside unless there are compelling reasons. I believe that the amendments strike the right balance between the rights and interests of patients and those of other people, and meet the concern which has been expressed by my noble friend and other noble Lords. I commend the amendments to the House.

Moved, That this House do agree with the Commons in their Amendments Nos. 1 to 10 en bloc.—(Baroness Cumberlege.)

Lord Mottistone: My Lords, I thank my noble friend for progressing the matter a step further and I also thank Members of another place. The matter was not completed here and it is now in a much better state. I hope that your Lordships agree with me.

Lord Campbell of Croy: My Lords, I supported my noble friend Lord Mottistone in Committee. I shall not repeat the arguments which were cogent and appear to have been persuasive. My noble friend Lady Cumberlege undertook further examination of the issue. I am sure that the amendments will be welcomed by the National Schizophrenia Fellowship. Indeed, I am patron of the National Schizophrenia Fellowship (Scotland) which, among other things, brings together relatives and friends of sufferers of the disease. It will be pleased to

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hear about these changes and I am glad that the Government have considered the matter and taken action.

Baroness Jay of Paddington: My Lords, I too thank the Minister for explaining the amendments so clearly. They relate to the rights and responsibilities of patients and their relatives in relation to this complex legislation, which has been the subject of many debates in your Lordships' House. At this stage, we on these Benches will not oppose any of the amendments, but I wish to question the definition of patients with a propensity to violent or dangerous behaviour.

The Minister, in her explanation of the amendments, gave some definitions but I am anxious that there appears to be an almost self-defeating aspect to the concern about people with a propensity to dangerous behaviour. Presumably the whole understanding of the legislation is that people who could be identified as having such a behavioural problem would not be subject to release into the community. If people are identified as having a propensity to violent or dangerous behaviour they would appear, prima facie, to be unsuitable for such release.

Although I completely understand the narrow terms of the amendment—that in those circumstances their relatives should be consulted against their specific request—I do not yet understand how they fall into the category of those who would be appropriately released into the community under the terms of the legislation. Perhaps the Minister could help the House.

I am aware of the fact that some voluntary organisations which have been particularly helpful in the passage of the Bill—the National Schizophrenia Fellowship has already been mentioned—support the amendment. That is a significant factor as regards its continuing support. However, that fellowship and many other voluntary organisations working in the field have once again, even at this late stage, drawn my attention to their concerns that the Bill's financial memorandum indicates that it will not give rise to additional costs for health or local authorities. That remains a major concern.

Baroness Cumberlege: My Lords, I thank my noble friends Lord Mottistone and Lord Campbell of Croy for their support.

Perhaps I may address the points raised by the noble Baroness, Lady Jay, on the definition of dangerous behaviour. As regards the interpretation of this provision, I am advised that the word "propensity" would bear its ordinary dictionary meaning of an inclination, bent, tendency or disposition. It is not possible to say in general terms how strong that propensity would need to be because the Bill deliberately leaves that to the judgment of the responsible medical officer. Clearly the RMO would wish to consider, for example, what was known about the patient's history; the seriousness of any past violence; against whom it had been directed; how the patient had responded to treatment; and how much light consultation with the nearest relative was likely to shed on the assessment of the patient's present condition and needs.

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But the amendment does not prescribe how that judgment should be exercised and that is quite consistent with the existing provisions of the Act which require the RMO to decide, for example, whether it is necessary for the health or safety of the patient or for the protection of other persons that he or she should be detained in hospital.

We have discussed very fully the point raised by the noble Baroness, Lady Jay, about resources. I believe that she knows the answers that I am likely to give. In the interests of brevity, I shall let the subject rest.

On Question, Motion agreed to.


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