---

Mental Health Bill [HL]

moved Amendment No. 9: 9: After Clause 5 , insert the following new Clause— ““Single gateway for treatment Section 3 of the 1983 Act (admission for treatment) is amended as follows— (a) in subsection (1) after the words ““to a hospital””; and (b) in subsection (2) after ““a patient””, insert ““who has been admitted to hospital for assessment under section 2””.”” The noble Baroness said: There were some good things in the 2004 Bill which have sadly been omitted from the amenment Act. One was to set up a single gateway into compulsory powers under which every patient had a 28-day assessment period before being either discharged or placed on a compulsory treatment order by a tribunal. Under the 1983 Act the assessment period under Section 2 may be bypassed, and some patients placed immediately on a treatment order in Section 3, which enables clinicians to bypass an early application to the tribunal. There is a right of access to the tribunal to challenge each order. The purpose of this amendment is to provide for a single gateway into the system for the exercise of compulsory powers, similar to that in the 2004 Mental Health Bill, to ensure that any individual who is potentially to be detained and treated against his or her will in hospital always undergoes a period of assessment before that occurs. This approach was also recommended by Ginevra Richardson’s expert committee, and adopted for the 2004 Bill. The merit in that is that circumstances change clinically, the nature of the disorder may change, and it is always a mistake to assume that because somebody has had it before, this is another episode of the same. I have seen many such mistakes made when people are re-admitted, harking back to what was said by the noble Baroness, Lady Finlay of Llandaff, in her response to the previous amendment. Something seriously amiss has happened in the patient’s life to justify intervention under the Act. The factors that precipitate the detention and their impact on the patient need to be assessed. The single gateway provides for an early tribunal when admitted, and a second bite at the appeal cherry if they are then subsequently detained. This has been supported for a number of years by Jones’s Mental Health Act Manual, the established authority on the Mental Health Act for practitioners. It was also encouraged in the first code of practice for the 1983 Act, which I made a contribution to writing. Chapter five of the 1999 revised code of practice gives a rather longer discussion of when Section 2 should be used and when Section 3 could be, and suggests that the frequently admitted patient might come in on a Section 3. Since then, the Mental Health Act Commission has noted an increase in the use of Section 3, but it does rather miss the clinical point about the purpose of assessment and the greater opportunity for an early tribunal. We cannot get the full impact of a single gateway into the 1983 Act because the role of the tribunal in authorising compulsory treatment has been omitted, but the amendment could get us near enough to doing so. I stress that clinicians consider that what is proposed here is normal best practice, but not all psychiatrists have followed it, and I think they probably should. It becomes particularly important in the case of any form of supervised community treatment, because in theory someone could be admitted for treatment directly, remain in hospital for one day and then be placed on supervised community treatment. The Government’s response will rightly be that that would be rather bad practice and that we would expect people to behave better. Nevertheless, these very serious decisions, if we are to take them, require considerable in-patient assessment, and if we have a single gateway into care, a patient will be guaranteed a proper and thorough assessment each time. I beg to move.