Rules for Care in Community tightened: Psychiatric hospitals issued with new guidelines for discharge of patients. Rosie Waterhouse reports

STRICT new guidelines on procedures before mentally ill people are discharged from hospital into the community were revealed by the Government yesterday.

The guidelines, disclosed by Virginia Bottomley, Secretary of State for Health, come in the wake of a series of incidents involving patients who were discharged from hospital without adequate support under the Government's Care in the Community policy. They are intended to help prevent such tragedies as homicides and suicides by people who are prematurely released or inadequately supervised.

But the new rules, campaigners and opposition MPs complained yesterday, could lead to 'bed blocking' and worsen the beds shortage at psychiatric hospitals highlighted last month by the Mental Health Act Commission.

The guidelines may be revised after the publication of a report expected next month on the case of Christopher Clunis, a paranoid schizophrenic who killed a random victim, Jonathan Zito, after being discharged from Guy's Hospital, London, without adequate supervision.

The guidance seeks to ensure that patients are discharged only when they are ready to leave hospital; that any risk to the public or to themselves is minimal and is managed effectively; and that they get the support and supervision they need from the responsible agencies.

The guidance includes new measures and draws together existing discharge procedures which are supposed to operate under the Care Programme Approach. They include Mrs Bottomley's proposals for supervised discharge orders, key workers for the more seriously mentally ill, and supervision registers of patients most at risk of harming themselves or others.

Before discharging a patient, clinicians and staff must take full account of his or her needs and capabilities including whether, with adequate supervision and medication, the patient could still present any serious risk to him or herself or others; whether the patient's needs for therapy, supervision or sanctuary require continuing in-patient treatment; and whether the patient could be cared for effectively and safely in the community, if necessary in approved accommodation.

Liz Lynne, the Liberal Democrats' health and community care spokeswoman, said: 'The whole policy hinges on the availability of beds in hospitals for people with mental health problems. If, as has been recently reported, the beds are simply not available, then people with mental health problems will be forced out into the community simply to provide a bed for a person with even more serious problems.'

Jayne Zito, the widow of Jonathan Zito, who has joined the mental health charity Mind's campaign for better care in the community, said: 'It is not enough to identify and 'mark' individuals - adequate resources need to be in place to provide an effective service. We call on Virginia Bottomley to introduce national minimum standards so everyone has a legal right to appropriate care, be that secure provision or somewhere decent to live in the community.'

Majorie Wallace, chief executive of the mental health charity Sane, said the new measures would help only if the Government halted or reversed its programme for closing psychiatric beds and hospitals. 'The Government is hellbent on closing another 70 psychiatric hospitals over the next six years. In the big cities the psychiatric hospitals are already overfilled . . . It is an impossible situation,' she said.