Mentally ill face paying for after-care

The Government is considering changing the law to allow councils to charge severely mentally-ill patients for accommodation and community care services.

Coupled with a new mental health Bill published yesterday, the move would mean health authorities and social services departments could compel discharged patients to take employment in order to pay for a compulsory care programme.

The care plan, to which a patient must agree before being discharged, could include being required to live in a private residential home or hostel, being required to work or take education or training courses. Services they now get free, but in future might have to pay for, include residential homes, day-care centres, home helps and meals on wheels.

The Mental Health (Patients in the Community) Bill will provide a system of supervision of the care in the community of patients who have been detained in hospital under the Mental Health Acts in England, Wales and Scotland.

The Bill will establish a new power of supervised discharge for patients if there is a substantial risk or serious harm to the health or safety of the patients or the safety of other people. The patient, who must consent to the "after care under supervision" order, may be required to reside at a specified place or to attend for medical treatment, occupation, education or training.

If a patient refuses to comply once in the community, the Bill gives the patient's community supervisor, usually a community psychiatric nurse or "any person authorised by the supervisor", the "power to convey" or compulsorily transport him or her to the place he/she is required to reside or attend for medical treatment, occupation, education or training.

In a separate development, the Department of Health yesterday confirmed that it is reviewing the Mental Health Act 1983 which states that social services departments cannot charge for after care services for section 117 patients (formerly detained psychiatric patients).

The admission came after a leaked letter, from Tom Luce, a senior departmental official, to the Association of Directors of Social Services, which said: "The department's lawyers have confirmed that charges cannot be made for services provided under section 117 of the Mental Health Act. I realise that this is very unwelcome news for local authorities, and we are urgently considering ways in which the position might be rectified".

A spokesman for the department said: "The ADSS approached the department about the issue of section 117 and ministers have not yet decided the way forward. The Luce letter is an official point of view, not ministerial".

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