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Mr. Dobson: In relation to my hon. Friend's last point, the national health service ombudsman can deal with NHS issues and the local government ombudsman can deal with social services issues. There is nothing in law to prevent them from mounting a joint exercise in respect of issues at the boundary. I share her desire not to go back to the old institutions. The provision of care in the community certainly has been under-resourced, but it is not just a matter of under-resourcing. There was over-optimism among some of those concerned about the capacity of patients to cope outside institutions and a failure to provide the necessary back-up. The law is undoubtedly out of date and some of the practices have not been very sound. We are trying to address all three aspects. As I said in my statement, we want to work in collaboration with patients and carers in each locality because all the evidence is that when that is done effectively, it results in a better service for everyone and that is what we are after.
Mr. Dafydd Wigley (Caernarfon): The Secretary of State will be aware that people suffering from learning difficulties--or mental handicap, as it was once known--sometimes need to take drugs in the community. Can he confirm that his statement does not apply in any way to those with learning difficulties, and that each case will be considered on its merits? Does his statement apply only to England or to Wales and Scotland as well?
Mr. Dobson: The statement applies to England alone. We are talking not about the treatment of people with learning difficulties, but about mental health.
Mr. Martin Linton (Battersea): Does my right hon. Friend accept that the provision of more mental health
beds will be a great step towards ensuring that people who should be in hospital are not kept in hostels? That would be some reassurance for the colleagues and relatives of Jennifer Morrison, who was killed in a hostel in my constituency only two or three weeks ago, and, indeed, for the neighbours of the hostel. Although care in the community was a bipartisan policy, we cannot be totally uncritical of the previous Government, who, between the mid-1980s and mid-1990s, oversaw the closure of 50,000 to 60,000 beds in psychiatric hospitals without making care in the community a reality by ensuring that resources and the provision of hostels kept pace.
Mr. Dobson: I share my hon. Friend's proper concern for the relatives and friends of Jennifer Morrison, who--as we should always remember--died doing the job that we had asked her to do, in difficult and, as it turned out, fatal circumstances. The necessity is to provide services that are suited to the needs of each individual. A place in a hostel may be appropriate for some, whereas a place at home--provided that there is back-up--may be appropriate for others. In some cases, people should be held in secure accommodation. We must recognise the fact--some practitioners, I believe, do not like to recognise it--that people can move backwards and forwards across that spectrum; we are trying to ensure that we can respond sensitively and quickly to those changes.
Mr. David Faber (Westbury): The right hon. Gentleman's statement and some of his subsequent replies will have a somewhat hollow ring for my constituents in Warminster, where we learned with dismay this weekend that the mental health unit in the local hospital would close. The hospital is not large, if I may use his word; it is a small community hospital that serves a rural area, and its future will be threatened by the closure of the unit. Is he aware that his refusals to meet local health workers to discuss the closure or to answer my questions on it in the House have been viewed at best as discourteous by those who work in the hospital and by those whose family members are being treated there? Given the nature of his statement, will he or one of his Ministers undertake to meet those health workers and local people as soon as possible?
Mr. Dobson: I am not aware of the current state of any closure proposals for the unit to which he refers. I may have to take a decision on it, but I do not know off hand whether that is the case. If I do have to take a decision, I am, as ever, willing to meet the elected Members for the area or to get one of my colleagues to do so.
Mrs. Alice Mahon (Halifax): I warmly welcome the measures that my right hon. Friend has outlined. I have never understood the argument that it is better to sleep rough or languish in prison than to be given proper short-term asylum and appropriate treatment--if one of my loved ones was involved, I know which option I would prefer. Will he consider the tragedy of the high number of suicides among teenagers? Does he envisage special measures to deal with that vulnerable group?
Mr. Dobson: I thank my hon. Friend, too, for all her efforts on this issue over the years, in and around Halifax,
in the House and in other places. The increase in the number of young people who commit suicide is one of the most disturbing aspects of our society. No one has a ready explanation for that increase or for the general increase in mental illness among children and young people, but we hope that the specific measures that we are taking--not only through mental health services, but through the education service--will help to tackle the problem. We also hope that the changes that we are proposing as a result of the Utting inquiry into children in care will help, especially as a much higher proportion of children in care are mentally ill and a higher proportion of them subsequently commit suicide. Until we have a better explanation for the problem, however, it is hard to do anything about it.
Rev. Martin Smyth (Belfast, South): I welcome the statement. Along with my hon. Friend the Member for Macclesfield (Mr. Winterton), I served on the Social Services Committee, and we tabled an amendment--which was not accepted--pressing for secure units and places of asylum. Having said that, I must confess that the general plan of community care has worked tremendously well and, in parts of Northern Ireland, it has been going on for 40 years to good effect.
May I press the Secretary of State on the number of occupational therapists who are being recruited? There is still a great need for such people to help folk with mental illness. Is there a process of reaching out to the Department of Social Security? Recently, I had a constituency case where benefit for a schizophrenic person was reduced from including the major care component to a lower care component. As a result, her husband was not able to look after her and she was readmitted to hospital. Surely there should be greater cross-referencing between the different branches of the caring professions.
Mr. Dobson:
The hon. Gentleman's last point is valid, and we are looking at how we can provide a better package of care that includes money and direct help. We are trying to formulate that package, but it is rather difficult. If he has any further ideas, I will be happy to consider them.
Many therapists--not just occupational therapists--can make a contribution to helping people cope with living in the community, and we must try to make the system work as best we can. There was a time--it is still the case in certain circumstances now--when asylum was regarded as a good concept, and as a place of safety and security. However, the asylums became so disreputable that the concept suffered, and the bad reputation and stigma that attached to the word "asylum" have, to some extent, dominated much of the subsequent discourse on the matter. They have made some people reluctant to look at the idea of providing the secure care that is needed by some people.
Mr. Neil Gerrard (Walthamstow):
I welcome my right hon. Friend's statement, including what he said about the way in which the current system has failed a small number of desperately ill people. In my constituency, a young man, when seriously ill, murdered someone else. The most tragic part of the case was that his family had been trying desperately to get help for him and to get him into secure accommodation. They were not able to do so.
Does my right hon. Friend accept that if we bring in a new and renewable form of detention order, there may be some clear-cut cases but, with any such order, there will be difficult, borderline cases where decisions have to be made as to whether an order is brought in or not? What safeguards does he envisage for the bringing in of such orders? What protection will be provided to someone who might be subject to such an order?
Mr. Dobson:
My hon. Friend rightly refers to the small number of what might be described as spectacular and awful failures, but the failure of the system went further than just the people who became a danger. There are many vulnerable people who are walking the streets and who are not getting the attention that they deserve. We should not forget them.
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