Mental Health Bill [HL]

My Lords, I am grateful to the noble Earl, Lord Howe, for his amendment, which seeks to set a time limit on the duration of a community treatment order. He is right to say that the Bill provides that a CTO can last six months initially, can be extended for a further six months, then for a further year and so on. I hope that I can reassure noble Lords about the possibility that patients will never get off supervised community treatment and can remain on community treatment orders indefinitely. I very much hope, as do the Government, that community treatment orders and supervised community treatment will enable many patients to be discharged as quickly as possible. The very basis of supervised community treatment can be seen as a positive move towards helping patients who originally met the criteria but, because of the impact of supervised community treatment, will no longer meet them and can be discharged completely. There is a clear, laid-down process for extending a community treatment order, which requires examination of the patient and a report to the hospital managers. There are safeguards in place for the patient. I understand the lobster pot analogy used by Professor Richardson, concerning patients who would find it very hard to get out of non-resident treatment. I share the view, as I have already implied, that supervised community treatment should not last indefinitely, but I am not convinced that the amendment is the right way to go about it. Any time limit that we might set is inevitably arbitrary. The noble Earl might have chosen two years or four years; it takes no account of any individual circumstances or of the patient’s clinical condition. I suggest to the noble Earl that there is the danger of a ““cliff-edge”” approach, and the cut-off date might create that. It might leave the responsible clinician in a situation of a perverse incentive, where a patient would have to be discharged on a certain date, irrespective of their clinical need or whether they are able to manage in the community without the support that the community treatment order provides. Mental health practitioners might be in a very difficult position if they had to stand by knowing that a patient was likely to relapse and the only action that they could take if they were not prepared to, or it would not be right to, take the risk of discharging the patient would be to apply to detain the patient once more and the patient would have to come back into hospital. I understand what the noble Earl is seeking to do here, but there is a risk that by putting three years into legislation it could work the other way. It might be perceived as the norm, and there might be an expectation that patients remain on supervised community treatment until their three years are up. We believe that the construct of the Bill, with the safeguards, when the question of renewing the community treatment order is being considered, is the best way to deal with the issue rather than having an arbitrary time limit. Noble Lords should remember that a responsible clinician can discharge a patient at any time, and they must do so if the patient no longer meets the criteria for supervised community treatment as laid out in the Bill. That question has to be explicitly reviewed every time an extension of the community treatment order is considered. The patient can also apply to the tribunal for discharge as soon as a supervised community treatment order begins, once during each period for which the CTO is extended, and again if the CTO is revoked. In conclusion, although I fully understand what the noble Earl, Lord Howe, seeks to do, the conditions and safeguards in the Bill serve the purpose better than a time limit, which, of necessity, is bound to be arbitrary.