House of Commons
Wednesday 17 January 1996
The House met at half-past Nine o'clock
PRAYERS
[Madam Speaker in the Chair]
Mental Illness
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Wells.]
9.34 am
Mr. John Marshall (Hendon, South): Today marks the anniversary of the introduction of Wednesday morning Adjournment debates. Everyone who has taken part in them agrees that they have been an outstanding success, enabling Members to articulate a number of topics of concern to their constituents and the wider public in a non-partisan way.
Despite what my hon. Friend the Member for Hertford and Stortford (Mr. Wells), the Government Whip, may say, Wednesday morning debates have tended to be non-partisan. That may be helped by the fact that members of the press do not arrive in the House of Commons until 2.30 pm; they leave at 4 pm and then write about the short working day of Members. My right hon. Friend the Leader of the House is to be congratulated on this innovation and I make no apology to the House for introducing yet again the subject of the treatment of the mentally ill, about which I have spoken in a previous Wednesday morning debate.
Yesterday's papers reported widespread concern about the operation of care in the community. It is obviously difficult to talk about the subject because we hear only about the cases that fail. There are a large number of successful cases of care in the community, but my concern and that of the House and the country is that there are too many unsuccessful cases. Certainly, the views of the relatives of those affected is that sometimes the psychiatrists do not listen to the parents and relatives of those afflicted with schizophrenia as often as they might.
Mr. David Martin (Portsmouth, South):
In addition to the concerns of parents and relatives are those of our constituents who live next to, opposite or in the same block of flats as people who have been released into the community. They sometimes feel that they are given insufficient back-up when there are major problems with a neighbour who perhaps ought to go back into secure care, and that their concerns are not sufficiently taken into account when they ask for action along those lines.
Mr. Marshall:
I thoroughly agree with my hon. Friend. About a dozen or 15 people from a council-owned block of flats came to one of my earliest surgeries, and I wondered what on earth had gone wrong. They explained that the problem was all to do with a Mr. Campbell. I asked whether he was the caretaker and they replied,
"No. He is a patient who has been released into the
My hon. Friend is quite right to say that the neighbours frequently suffer. It was with great difficulty that I was able to get a psychiatrist to look again at Mr. Campbell. In far too many cases, neighbours and individuals who are divorced from the problem become victims of it.
Yesterday's papers were full of the murder of the south London schoolteacher Suzanne Steckel by her son Gilbert, who then committed suicide. Gilbert had discharged himself from the Maudsley hospital, which is a mental hospital. Two lives were lost unnecessarily because of the ease with which he was able to discharge himself.
Secondly, there was a report that 61 murders had been committed by schizophrenics, who were involved in more than 200 suicides. That represents five unnecessary deaths every week. It is not sufficient to say that the trend is downwards from 109 murders in 1979. There are still too many unnecessary killings and deaths as a result of people being released prematurely from hospital.
Yesterday, a report in The Times stated that the Royal College of Psychiatrists attributed suicides and homicides to three factors--a failure of communication, lack of face-to-face contact between patients and doctors, and patients not taking their medication. An article in The Independent yesterday by Nicholas Timmins, a widely respected journalist writing on social issues, described the lack of psychiatric hospital beds. The Royal College of Psychiatrists estimates that London has a bed occupancy rate of 120 per cent. and that Londoners can be sent into secure accommodation as far afield as in Yorkshire or Wales, 200 miles away. The article pointed out that the bed manager of Gordon hospital in London has the telephone numbers of 37 secure units, so that when he receives a request for a secure bed, he has 37 units to call, on the off-chance that he will be able to locate such a bed.
All that is bad enough, but The Independent this morning contained another article by Nicholas Timmins, with further worrying comments:
The Mental Health Act Commission believes that the figure should be 2,000 rather than 1,200, and says that there was an underestimate of how many beds were needed to allow for occasional relapses. The commission reported the discovery of previously undetected cases by new community teams, said that there were too few 24-hour nursed beds outside hospitals and noted the premature discharge of patients from mental hospital to free beds for even more drastic cases.
Premature discharge is one of the real issues that we must examine. Individuals are released so that others in a worse situation can take their beds. They are released before the suitable time, then are taken back into hospital. It would be much better if their treatment could run its natural course in hospital, so that patients might be released into the community with a chance of real success.
As a Member of Parliament representing a London constituency, one tends to talk about the capital--but the situation that I have described is not unique to London. The Mental Health Act Commission states:
I am glad that my hon. Friend the Member for Macclesfield (Mr. Winterton) is in his place to represent that distinguished county. All those issues were raised in yesterday's newspapers, but earlier this year homicides were committed by Wayne Hutchinson, who was guilty of killing two individuals and wounding another three. It was commented that he had been "released by mistake". Earlier this year, Martin Murcell was gaoled for life for the murder of his stepfather and the attempted murder of his mother. In January, doctors reporting on an experimental scheme run by the Institute of Psychiatry in south London noted that 92 patients had been released, resulting in the suicides of three patients, while another killed a young baby.
Last December, Dr. Imweldo in Hampstead was attacked in his surgery when he attempted to defend another doctor, who happens to be a constituent of mine. We read about such cases in the newspapers and all have personal experience of individuals not receiving the treatment which they need and which we and their relatives can see that they need.
There is a tradition in the House to declare one's interests. My interest is as vice-president of the Jewish Association for the Mentally Ill--although I assure hon. Members that it advises me rather than relies on my advice. I pay tribute to the work of JAMI's volunteers and those of the National Schizophrenia Fellowship. Most are relatives of victims of schizophrenia. Some have lost their loved sons and daughters through suicide, but they have not become introspective and miserable. Instead, those parents and relatives decided to use their experience to help other victims of schizophrenia.
The treatment of mentally ill people in this country and every other has undergone a revolution. In the middle ages, the mentally ill were burnt as witches or kept chained in unpleasant and unsavoury surroundings, and that does not happen today. The Victorian asylums that Mr. Enoch Powell was so anxious to close were a remarkable improvement on the dismal surroundings of the past. When people sought to close asylums, they forgot that asylums were a place of refuge--that the mentally ill did much better in them than they would have done at home or in the community. Of course, the rules of the 1940s were far too restrictive--it was much too easy to have someone committed to a mental hospital. The Mental Health Acts of 1959 and 1983 went from one extreme to another. Admission to a mental hospital is now seen as the last resort. The power to section remains, but it is used far too reluctantly.
There has been a failure by psychiatrists to acknowledge the problems of care in the community, under which it has been assumed that persons so mentally ill as to require treatment were sufficiently mentally acute to acknowledge the need for that treatment. Drugs are a powerful weapon in dealing with schizophrenia, but a most unpleasant weapon. We all remember being given a nasty dose of medicine as children and being told by
our mothers, "The nasty medicine is the most effective." I once persuaded my mother to try the medicine, and with the sort of logic that would not befit a politician I said,
"You've taken the medicine, so I do not need to take it." She replied, "Yes, you do. The nasty medicine will make you better."
One may say to a schizophrenic, "You are sufficiently cured to enter the community, but not to avoid the need to take nasty medicine." Some patients may willingly accept the first piece of advice, but be reluctant to accept the second. The result is that such patients become a danger to themselves and to other people. A policy born of compassion was misguided in part because it failed to recognise that asylums were a haven for troubled souls and that some individuals needed treatment in institutions rather than in the community. Others will need periods of treatment in hospital, to enable them to return to the community.
Three areas require development. There should be a moratorium on patients, or at least we should reverse the policy of reducing the number of beds for the mentally ill. The dramatic decline from 145,000 beds in 1961 to fewer than 45,000 today has been too drastic.
The remarks of Dr. Searle were quoted in The Independent on 26 September. He said that he had left Hackney
Dr. Searle now lives in Bournemouth--
There was an article in The Independent on 15 June last year, which stated:
The reduction in the number of beds has been far too drastic. I am concerned about what will happen to patients at Napsbury when the closure takes place. I would prefer Napsbury not to close. It is an issue of great concern in north London. I ask my hon. Friend the Minister to explain how many beds will be provided elsewhere if and when Napsbury closes.
We need a change in the philosophy of psychiatrists. I accept that psychiatry is not an exact science. If someone is suffering from pneumonia, the doctors know what to do. Psychiatrists, however, do not always know what to do when dealing with psychiatric problems. It is too easy to leave mental hospitals and it is too difficult for some people to enter them.
Mrs. X, as I shall call her, is one of my constituents. She has written to many Members claiming that she is being pursued by Mossad, by the Japanese, by MI5 and by various other organisations. The lady's quality of life is quite impossible. I once went to see her. She met me outside the block of flats in which she lives. She said,
"We must speak very softly because we are going to be overheard." When I went inside I asked her, "Have you got a doctor?" Her immediate reaction was, "I don't need
a psychiatrist." I had referred to a doctor, not a psychiatrist. It was clear that the lady's quality of life was appalling.
I went to a meeting in honour of former Prime Minister Rabin. Mrs. X was standing outside with a poster that went from her head down past her knees. Her quality of life is such that she feels persecuted. She is a victim living in the community who would be much better treated somewhere else.
I have another constituent who became convinced that my right hon. Friend the Member for Brent, North (Sir R. Boyson) was about to kill her. We had 19 telephone calls on our answering machine one weekend. She kept on saying, "It is Roddy Boyson. He is coming to get me." I could not think of anyone less likely than my right hon. Friend to attack a lady living in west Hendon. I could not believe that my right hon. Friend was going to live on the west Hendon council estate so as to attack this poor lady. Her quality of life was very poor. I cannot believe that she benefited from being in the community. She would have been very much better if she had been cared for elsewhere.
There is talk about civil rights, and I believe that everyone has civil rights. The parents of patients have rights. They would much prefer to see those patients in hospital rather than in the community. Potential victims have civil rights. The right to life is the greatest right of all. We must weigh the rights of neighbours, patients and individuals when considering whether people should be in hospital or in the community.
When we adopted the policy of care in the community, I believe that the Treasury was seduced by the capital that it could see flowing into its coffers. It did not realise that proper care in the community would be very expensive, involving purpose-built homes, adequate supervision and the training of many staff. The Royal College of Nursing believes that we need to double the number of community psychiatric nurses if care in the community is to work.
For far too many, care in the community has been a poor-quality service. I shall always remember my first meeting with members of the NSF. I turned to one lady and asked, "What is your problem?" She replied, "It is my daughter." I asked, "Where is your daughter?" She said, "I don't know. My daughter will be sleeping on a park bench somewhere in London tonight." That girl and her family were cheated by care in the community. The Economist was surely right when it commented that care in the community
That has been the outcome for some. The irony is that some of those who are released into the community for care in the community end up committing crimes and find themselves in a different institution, a prison rather than a hospital.
I welcome the suggestion in The Daily Telegraph of 28 December that the Government will produce a charter for the mentally ill that will provide for easier access to hospital treatment and for consultation with carers and relatives before patients are released into the community. One of the great failings of the care in the community policy is that we have not listened to parents, relatives and carers. All too often, their wishes and knowledge have been ignored. They know the patients best. They should be able to tell psychiatrists more than perhaps psychiatrists sometimes want to hear.
"At one end of the system, approaching a quarter of Broadmoor's 450 patients could be discharged to a less secure environment if space was available . . . At the other end, ordinary acute wards are having to handle growing numbers of seriously disturbed patients because they cannot be moved up to more secure accommodation. More medium secure accommodation beds are being provided-- numbers are due to rise from 700 to . . . 1,200 by December".
"Occupancy levels of 100 per cent. and above have been reported from areas as far apart as Devon, East Anglia and Cheshire".
"because it was so appallingly bad".
He continued:
"You had to throw out people who were very mad in order to admit people who were very, very mad. They are still doing that, having to discharge people who down here"--
"I would be admitting."
"Hackney operates at 140 per cent. capacity instead of the 80 per cent. recommended to allow for emergency admissions. Admissions are restricted to psychotic patients threatening suicide, violence or facing imminent breakdown. Often, to make room for them, others are discharged before they are ready. Many seriously mentally ill patients are shunted in and out as their condition slightly improves with hospital care and then deteriorates without it."
"has turned out to mean neglect on a street corner."
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