BMJ  2007;334:447 (3 March), doi:10.1136/bmj.39140.465764.DB

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UK government is defeated on community treatment orders

BMJ

The government was defeated in the House of Lords this week over a key plank of its mental health bill for England and Wales, compulsory treatment in the community.

A further defeat this week, to ensure that children are not admitted to adult psychiatric wards, brings the total of defeats that the peers have inflicted on the government over the controversial bill to six.

The latest successful amendments came only a week after peers inflicted three defeats on the government, imposing new safeguards on powers to detain mental health patients (BMJ 2007;334:384, 24 Feb, doi: 10.1136/bmj.39133.464444.DB).

As the report stage of the bill ended in the House of Lords, ministers were facing a decision on how far they would try to reverse the defeats when the bill, which has yet to be debated by MPs, goes to the House of Commons.

The key amendment this week, passed by 173 votes to 140, would restrict the use of compulsory treatment orders to patients who had previously been committed to hospital for treatment and who relapsed on release and to cases where the treatment was likely to alleviate or prevent a deterioration in the patient's condition.

Andy Bell of the Mental Health Alliance, an umbrella group of 78 organisations, said that the amendment, which was tabled by the Conservative health spokesman Earl Howe and backed by Conservatives, Liberal Democrats, cross benchers, and rebel Labour peers, was "hugely important."

He said, "CTOs [compulsory treatment orders] are on a practical level the most important new provision in the bill. They are extremely controversial. They're something that service users and their families are very, very concerned about.

"The view that we've come to is that there is an argument for having something that is on a par with similar jurisdictions in other parts of the world, including Scotland, but that the CTOs the government were proposing were too broad. We hope the government will come back with something that is more proportionate and that responds to the limitations the Lords have put on it."

The health minister Lord Hunt of Kings Heath said during the debate that he was "prepared to take this back for further discussion." He said that community treatment orders were "one of the pillars of the legislation," adding: "We don't believe that it's going to be overused, nor do I believe it is going to be a substitute for hospital treatment."

Earlier defeats on the bill, which provides for compulsory detention for people with severe personality disorders who have committed no crime if they are judged a danger to themselves or others, include an amendment passed by peers allowing compulsory detention for treatment only if the treatment is likely to alleviate the patient's condition or prevent it getting worse.

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