Deadlock as bill goes to Lords

The government and opponents of the Mental Health Bill are refusing to budge on remaining areas of contention, including the use of compulsory community treatment, as the legislation enters its final stretch.

Opposition peers, who command a majority in the House of Lords, are vowing to push for amendments on four key areas of the bill (see Remaining points of contention), as passed by the House of Commons last week, when the bill re-enters the upper house next week.

However, health minister Rosie Winterton has said that government concessions made in the Commons – on ensuring patients under 18 receive age-appropriate treatment and that treatment of people under section be for a therapeutic purpose – meant the bill required no further change. Any changes in the Lords would have to be agreed by the Commons, meaning there could be parliamentary “ping-pong” until one side backs down, or the bill may fall.

The main area of discord is the use of compulsory treatment orders (CTOs) in the community. As the bill stands, CTOs could be applied to anyone who had been sectioned just once. The government’s opponents in parliament and the Mental Health Alliance want it reserved only for patients who would otherwise be in and out of hospital.

Referring to a government-commissioned report, which showed that international evidence on community treatment orders was inconclusive, Conservative health spokesperson Earl Howe said: “We feel even more strongly about this than we did before because the international evidence on the efficacy of CTOs is so iffy.”

However, he and alliance chair Andy Bell both urged the government to sit down and discuss the remaining areas of contention to forge a consensus.

Bell said: “We’d very much like to work with the government to get something out of this that we can all support.”

Remaining points of contention (back)
● Community Treatment Orders: opposition peers want these limited to patients who would otherwise be regularly in and out of hospital.
● Impaired decision-making: the opposition wants to bar detention for people who possess capacity and refuse treatment.
● Definition: opponents want more exclusions from the definition of a mental disorder, such as sexual orientation.
● Responsible clinicians: opponents want a renewal of detention to be agreed by a medical practitioner and a responsible clinician, such as a nurse, not just a responsible clinician.

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 Mithran Samuel