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Lord Campbell of Croy: My Lords, I have much sympathy for the amendments in so far as they apply to mental illnesses and I declare an interest, having been associated with the National Schizophrenia Fellowship (NSF) for many years. It and three other organisations concerned with mental illness have made clear their comments on this part of the Bill. They recommend that people with mental illnesses should not be subject to compulsory interviews but that the interviews should be voluntary. That seems very sensible. Voluntary interviews might well be extremely helpful in their cases.

It is not possible to generalise about people with mental illnesses. Cases can be very different, as can the symptoms, some of them not visible, and the circumstances can also be very different. I agree with the remarks of my noble friend Lady Buscombe about the incidence of stress in the circumstances of being summoned to an interview. Therefore, I would ask the Government to consider very carefully whether, in the categories of cases which I and the noble Lord have indicated, the interviews should be voluntary and not compulsory.

Lord Thurlow: My Lords, I should like very strongly to support this amendment. I think that the case of the severely mentally ill, especially schizophrenics, puts them into a totally different category. There is no way by which they can be fitted into the existing system as it stands. The noble Baroness has explained that there are very many safeguards and provisions for discretion and so on, but I do not see how the severely schizophrenic patient could possibly be fitted into this system.

I speak, as I think the noble Baroness is aware, from considerable personal experience of care for a severely schizophrenic case. I cannot imagine how my son would have been able to go through this system without creating very great embarrassment for everybody

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concerned in the interviewing process. If in the Bill there were a separate category, a separate compartment, into which the severely mentally ill--in particular those diagnosed as suffering from schizophrenia--were put to be dealt with by advisers who had received considerable training for dealing with the mentally ill, that would be rather a different matter. But I cannot see that it is even fair to the interviewers to expect them to be able to handle such people.

The noble Baroness is aware that the kind of patients to whom I refer are really very difficult to deal with. One simply does not know how they will react. They are also, as one of the symptoms of their disease, highly irresponsible, and they usually find it impossible to deal with correspondence of any kind. I do not wish to suggest that there is a real danger of violence, because this has been so much overdone in the press, but there is a residual possibility of violence, so I should like to appeal to the noble Baroness to treat this amendment as a special case.

The Earl of Listowel: My Lords, I too should strongly like to support this amendment. I sit in on assessments for young homeless people and my concern, which goes rather beyond this amendment, is that some of these, while not exactly classifiable as having a mental illness, are obviously very distressed. We are talking now about older people, but I imagine those too may well be distressed. When I attend these interviews sometimes the interviewer is very sensitive. He will say something like, "I appreciate this must be a difficult experience for you." He may say, "I know sometimes it is difficult for you to leave home", and the person being interviewed will say, "Yes. Sometimes I just do not want to leave the house".

Sometimes there are sensitive interviewers who try to make the experience, which can be distressing, easy on the applicant. Sometimes the interviewers are not sensitive. They may be falsely jokey about the procedure and the applicant, who is stressed by the experience, is made to feel worse. I agree with the amendment and ask the Minister to explain how she will ensure that people who are mentally ill or in a good deal of distress are sensitively treated when they attend the interviews.

5.30 p.m.

Lord Rowallan: I support the noble Lord, Lord Addington. I believe that from the point of view of mental patients, Clause 52 is frightening. The Bill prevents thousands of people with severe mental illness accessing the financial support that they require to regain and sustain their mental health.

Even worse, in some cases changes create additional barriers and stress. I am concerned that the effects of the interview will cause great problems for the mentally ill. The lack of understanding of severe mental illness and its effects was eloquently described by the noble Lord, Lord Addington. It is a serious problem which needs to be considered most carefully. There is an extreme likelihood that some people will be so unwell

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that they will be unaware of the impending interview and too ill to attend on the day. They will have a fear of losing their benefits as a result.

Amendment No. 93 does not prevent them attending on a voluntary basis and therefore I believe that the Government should be able to support it. Amendment No. 94 is also important. It, too, has a voluntary basis, but it is essential that on leaving hospital a mental patient is given time to settle down at home. The time when such patients first arrive home is the most stressful of all. They do not have immediate access to nursing staff and perhaps their medicines are beginning to wear off or have side-effects. It is an extremely stressful time and the time when the highest number of suicides occur. That must be considered. I believe that the interviewing of mentally ill people must be seriously considered, as should the whole of Clause 52.

Lord Haskel: I share the concerns of Members of the Committee about the dangers of the interview for mentally ill people. However, there is another danger; that of stereotyping people. Tonight, we are stereotyping and assuming what their reactions will be. With too many exceptions, that is exactly what happens and I hope that my noble friend the Minister will bear that in mind.

Baroness Anelay of St. Johns: I, too, have great sympathy with Amendments Nos. 93 and 94. Unlike the noble Lord, Lord Thurlow, I have never been a carer; nor do I have experience or working with organisations which represent the mentally ill, as do my noble friends Lord Rowallan and Lord Campbell or Croy. I have only been a lay member of appeal tribunals considering incapacity benefit. In that capacity, I was always keenly aware of the importance of not stereotyping anyone who came before the tribunal and of the dangers of so doing. As a layman, I was also aware of the difficulty of making assessments on behalf of people who have mental illnesses, some of which express themselves in different ways at different times and in different ways to different people. I am sure that we shall return to that issue when dealing with Amendment No. 106 relating to the training of advisers.

My noble friend Lord Rowallan spoke effectively of the difficulty facing people who are recently discharged in-patients who have received some form of treatment. As he said, the risk of suicide and self-harm is particularly high at the point of discharge. Almost one-quarter of the suicides covered by this year's national confidential inquiry into suicide and homicide by people with mental illness occurred within three months of discharge from hospital, with the highest number in the first week. The suicide risk after discharge is 213 times greater than that of the general population for men and 134 times greater for women.

That evidence was provided to me by MIND and MACA. As those organisations point out, the evidence provides the strongest possible case for people not to be approached for a compulsory interview which may be

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perceived as threatening within at least three months of discharge. I hope that the Government will look favourably on Amendment No. 94.

Lord Davies of Coity: I am extremely sympathetic to the arguments advanced in protection of people with mental illness who may be subjected to greater stress. However, I must return to my earlier remarks, recognising that we are concerned with people in receipt of benefit. They will have made an application and undergone an interview for benefit. The range of mental illness is enormous. Perhaps at one end there will be the schizophrenic and at the other the educationally subnormal. Anyone conducting an interview--

Baroness Anelay of St. Johns: Perhaps the noble Lord, Lord Addington, was about to make a better point than I, but I believe that the noble Lord, Lord Davies of Coity, may not have meant to refer to those who are educationally subnormal in the same range as those who are mentally ill. Perhaps the noble Lord was grouping two things together at the same time.

Baroness Hollis of Heigham: In terms of classification by category for invalidity benefit, they are indeed grouped together.

Lord Davies of Coity: I apologise if what I said was offensive. I wanted to point out that the range of mental illness can be such that some people can fulfil occupations and go to work. Indeed, they want the opportunity to have work presented to them. However, at the other end of the spectrum, someone else would not be in that position. We must give credit to those who will be conducting the interviews; those involved in providing benefit for people with mental illness. At the risk of stereotyping certain classes of people, it is not necessary to express that intention in the Bill.

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