Mental Health Bill [HL]

My Lords, I am grateful to the noble Lord for allowing us to debate what is undoubtedly an important matter. However, the Government disagree with him. I shall explain. When a patient on supervised community treatment is recalled, it will be because he needs treatment in hospital to avert a risk to himself or others. He may have failed to comply with the medication authorised in the certificate, and it is simply the lack of compliance that engenders a risk. In that case, the treatment he needs would be the same as he has been receiving in the community. Alternatively, the patient’s condition may have deteriorated to the point where some additional different treatment is needed to restore his stability. I am advised that it is possible to foresee the possibility that such deterioration might occur, and to determine what medication would be needed to deal with it. SOADs make that kind of assessment quite regularly when they authorise treatment to be given as required. That is simply the kind of judgment we are proposing clinicians might make when completing a Part 4A certificate. It is interesting to note that, under the Mental Health Care and Treatment (Scotland) Act, which we have discussed on a number of occasions, it is possible to authorise treatment given on recall, just as we propose. I understand that this has caused no particular problems. I should emphasise that a SOAD certificate provides an authority to administer medication. It is not a direction to do so. It remains for the treating clinician to decide whether it is right and proper to administer the treatment at any given time. The amendment which seeks to replace the Part 4A certificate is potentially detrimental to getting patients the treatment they need quickly on recall to hospital. If a patient is recalled to hospital and they do not consent to that treatment or do not have the capacity to object in some way, they cannot be treated with medication unless it is an emergency. Under this amendment, a responsible clinician would have to wait until a SOAD could be organised before he could treat the patient. This might cause an unnecessary delay of days. It could be a common scenario and could result in a worse deal for patients. Delays in treatment are not in the best interests of patients and may mean that a patient has to spend longer in hospital because they cannot be treated quickly and return home. We think the Bill achieves a pragmatic approach; it allows a patient to be treated quickly while benefiting from the safeguard of a second doctor review of that treatment. Recall to hospital is an event that everyone concerned will clearly hope to avoid, but it is available if needed, and it makes sense to plan for it. Planning in advance of the eventuality and setting out transparently what treatment could be given on recall is surely helpful to the patient and their family, with an opportunity for them to contribute to the decision. We have had a discussion about the length of time before which a SOAD must certify the medication of a patient under the Mental Health Act. As we have had that debate, I will not return to it in this context.