Mentally ill to be better supervised: Changes to community care likely to include the power to recall patients

Improvements in the community care system to provide closer supervision of severely mentally ill people who have been discharged from hospital are to be announced by the Government today.

Changes to the 1983 Mental Health Act are to be introduced following a seven-month review by the Department of Health after a series of incidents in which former psychiatric patients have harmed themselves or others.

The measures, to be announced by Virginia Bottomley, Secretary of State for Health, are expected to include tighter restrictions on the discharge of patients from hospital; closer supervision and tracking of patients after discharge; and the introduction of supervised discharge into the care of a key worker, so patients failing to take medication can be forcibly readmitted to hospital.

The report's proposals on supervised discharge may be similar to existing provisions of guardianship, but may also include powers to require the patient to reside at a specific place, attend for treatment and allow access by key workers.

The power of recall to hospital could be used when the patient's health and well-being are at risk. The period in which a patient can be recalled is expected to be increased from 6 to 12 months. Plans are also thought to include the right for patients to apply to a mental health review tribunal for cancellation of the supervised discharge.

Mrs Bottomley's 10-point plan to improve services follows criticism that the community care policy is failing severely mentally ill patients and leaving the public at risk. Supporters of the policy of closing hospitals and beds and caring for patients in the community - pursued by successive governments - argue that more resources and facilities are needed to make it work.

Mrs Bottomley ordered the review after Ben Silcock, a schizophrenia sufferer, was badly mauled after climbing into the lions' den at London Zoo. Pressure on the Government to act has increased with recent high-profile cases, including that of Christopher Clunis, a paranoid schizophrenic, who killed Jonathon Zito at a London railway station three months after being discharged from Guy's hospital in London.

The National Schizophrenia Fellowship, representing sufferers and carers, says only a small minority of sufferers are dangerous to others while between 20 and 30 per cent commit suicide or try to harm themselves.

Martin Eede, chief executive, said yesterday: 'We hope the minister will take steps to ensure people are not discharged too early, will be given a named key worker legally responsible for their case and will provide the extra pounds 500m necessary to fund the necessary improvements.'

The ethnic origin of NHS patients will be monitored from next year to help assess the health needs of black and Asian people and improve services for them.

The Department of Health hopes this will shed light on disproportionately high rates of diagnosis for schizophrenia among black communities, and the alleged racial discrimination they suffer from health professionals.

Compulsion and care, page 23