Experts split over control of mentally ill: MPs condemn community supervision orders

DOCTORS and mental illness groups were at loggerheads yesterday about how psychiatric patients should be treated and controlled to avoid tragedies such as the murders of two men by schizophrenics.

The Royal College of Psychiatrists, backed by the British Medical Association, had called on the Government to introduce community supervision orders which would have allowed some patients who had been discharged from hospital to be forced to return and to take medication if their conditions deteriorated and they were a danger to themselves or others.

The royal college's retiring president, Professor Andrew Sims, said yesterday that such supervision orders could have prevented acts of violence, such as the random killings by two schizophrenics, Christopher Clunis and Michael Buchanan, who were convicted last week of the separate murders of Jonathan Zito and Frederick Graver.

Both had a history of violence and had been discharged from mental hospitals into the community with no adequate after-care or supervison.

After a two-month inquiry, an all-party committee of MPs has rejected supervision orders as 'unworkable', saying the proposals were fundamentally flawed and an unacceptable breach of civil liberties.

Instead, the Select Committee on Health recommended that the law should be changed to introduce voluntary 'crisis cards' or 'treatment contracts' detailing the treatment to which the patient consented in the event that he or she became ill or suffered a relapse into a psychotic state.

The committee's report, written before last week's court cases, was welcomed by the Royal College of Nursing and by mental health charities such as Mind.

They said the 'crisis' in community care could be resolved by formal assessment procedures, a range of essential services and 24-hour crisis support and co-ordination between health, social care, housing and criminal justice agencies.

The select committee's recommendations will go to Virginia Bottomley, the Secretary of State for Health, who ordered a separate internal inquiry in January after Ben Silcock, a schizophrenic, was mauled when he climbed into the lions' den at London Zoo. The inquiry is to report soon.

Launching the report yesterday, Marion Roe, the select committee's chairwoman, said: 'The committee does recognise that there is a balance to be struck between the civil liberties of people with severe mental illness and the rights of the wider community to security and peace.' However, she said community supervision orders were not the answer.

Professor Sims said: 'For a relatively small number of people who lose contact with their key worker and stop medication and begin to neglect themselves, or occasionally become a danger to themselves, or to other people, a community supervision order would make a difference.

'In such a case, a patient would leave hospital on a CSO, under which a community psychiatric nurse would be legally empowered to visit them regularly.

'If that person ceases to see the nurse and stops their treatment, the nurse would be able to get them re-admitted for immediate treatment. The nurse would be able to get the system alerted and the patient treated before anything untoward could happen.'