Government plans to extend compulsory plans of treatment over the mentally ill have suffered a series of blows in the House of Lords.
Peers voted on Monday that compulsory community treatment – primarily to ensure patients take their medication when living in the community – should only be used on people who would otherwise be in and out of hospital, so-called revolving door patients.
The government’s mental health bill stipulates that such forms of compulsory treatment – known as community treatment orders (CTOs) – could apply to anyone who had been sectioned.
Earlier this month peers voted for three other fundamental amendments to the bill.
The first was that all forms of compulsory mental health treatment should only be applied if there is a therapeutic benefit. This is known as the “treatability test”.
The House of Lords backed by 186 votes to 115 an amendment ensuring that a person could only be detained if the treatment would be “likely to alleviate or prevent a deterioration in his condition”.
The bill proposes abolishing the need for there being a condition of therapeutic benefit. Ministers argue this would allow dangerous people diagnosed with personality disorder – who some clinicians regard as untreatable – could be detained.
Peers also voted overwhelmingly to back an amendment preventing people from being sectioned solely on the basis of their substance misuse, sexual orientation or cultural beliefs.
And a third amendment, requiring that renewal of a detention be agreed by a psychiatrist and responsible clinician, was agreed by 147 votes to 108.
Peer Baroness Meacher suggested the bill as it stood could allow “the rather ludicrous possibility” that an occupational therapist or nurse could renew a detention against the advice of a psychiatrist.
In January peers also voted that mental health patients should have an impairment of decision-making ability before being compulsory treated. The bill does not include such a condition.
Peers have also backed an amendment stating that children detained under mental health legislation be placed in age-appropriate accommodation.
The government argues the new law for England and Wales would both improve care for patients and protect the public by preventing some of the 50-60 annual homicides committed by those diagnosed with a mental illness.
The bill is likely to reach the House of Commons after Easter.