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Dr. Doug Naysmith (Bristol, North-West): I want to consider some aspects of mental health services, which are important to some of my constituents. I know that they are important because three constituents came to see me here on 7 June. They came with approximately 2,000 others from all over England and Wales as part of a lobby that the Mental Health Alliance organised. The alliance is a consortium of 51 organisations which represent mental health service users, carers, professionals and service providers. It includes many well respected names and organisations in mental health.
I found through talking to other hon. Members that my three north-west Bristol residents, Judy, Phil and Gladys, were typical of the lobbyists: they were gentle, polite, well briefed but persistent in making their points and in asking why mental health service users seemed to be treated differently by the national health service from those with other forms of illness.
A previous Secretary of State said that mental illness is as common as asthma. Yet it is not well understood. People are frightened of it, and it carries a stigma that adds to the burden of illness. As part of a programme to create modern and dependable health and social services, the Government want radical change to improve the treatment of mental illness. They want to provide a system in which patients, carers and the public are safe, and security and support are available to all who need it.
A 21st century service must be aimed at reducing the stigma of mental illness, encouraging social inclusion, supporting patients when they return to work and providing a balance between safety, sound treatment and supporting measures. The Government have made a good start by increasing resources for mental health services and giving clear guidance about the way in which services should be run and, in many cases, improved.
Several documents contribute to the Government's policy. They include "Modernising Mental Health Strategy", a Government strategy document published in 1998; "The Mental Health National Service Framework", which was published last year; and the Green Paper on the reform of the Mental Health Acts of 1959 and 1983. The Green Paper followed last year's publication of the expert committee's findings on the reforms.
Despite all that activity, mental health service users continue to have severe reservations about the services on offer and those proposed for the future. They want a reduction in the use of compulsory powers, an individual enforceable right to a comprehensive assessment of need--and for those needs to be met with good and effective services--and a free independent advocacy service. They want new legislation to ensure that, as far as possible, people are allowed to make their own treatment
decisions, and to protect properly those deemed to lack the capacity to make such decisions, and the right to draw up legally enforceable advance statements on their care and who should be involved in it. They also want full information on any proposed treatment, and informed consent to be sought in every case. Although they support the formation of new independent tribunals, such bodies must reflect the community they serve and must include people with broad experience, including service users, who must be properly trained.Judy, Phil and Gladys focused on the first two of those points--compulsory treatment and the right to a comprehensive service--and the need to ensure that appropriate and effective medication is available without artificial restrictions. The aim of any new legislation should be to reduce the need for the use of compulsory powers. In many cases, compulsion is a negative experience for users of services; it risks harming their psychological well-being and their relationships with family, friends and mental health professionals. It can be highly stigmatising, and should be used only as a last resort and in strictly limited circumstances.
I accept that compulsion may be needed in some cases to protect others from harm. However, I share the expert committee's concerns about overplaying the issue of public safety. Its report states:
- It is important to emphasise that the legislative response to the perceived danger posed by people with a mental disorder must be proportionate to the actual risk.
- wish to avoid extending the scope of compulsion to situations in the community where it is not needed and where it would be counter-productive.
New legislation should offer people an individual enforceable right to a comprehensive assessment of their needs and to have their identified needs met with good quality and effective services. Recently, a survey undertaken by the National Schizophrenia Fellowship found that more than one in three people had been turned away when seeking help. One in four people seeking hospital admission had been refused. Black people and those from ethnic minorities are less likely than white people to obtain help that is relevant to their needs. They are more likely to be subject to compulsory powers and other coercive treatment, and to suffer unmet need.
Many of those who are turned away from services find that their mental health deteriorates to the point where they are subject to compulsory admission. The introduction of rights to assessment and to services could encourage earlier treatment, thus reducing the need for
compulsory powers. The Government's expert committee, set up to review the Mental Health Acts, proposed a right to assessment of mental health needs and stated that that should include a system for recording any unmet assessed needs.The Government rejected that recommendation, arguing that the national service framework includes a requirement for any service user with a common mental health problem who contacts their primary health team to have their mental health needs identified and assessed. However, that does not give individuals an enforceable right to such an assessment; nor does it include a procedure for recording unmet need. Without an enforceable right to assessment, the current situation, in which people are turned away from services, is unlikely to change.
Access to appropriate and effective medication is also important. Regrettably, a number of people do not receive that. In recent years, several new medicines, known as atypical anti-psychotics, have become available for the treatment of schizophrenia. Those medicines significantly improve the quality of life for patients. They have a more favourable effect on both positive and negative symptoms and there are fewer side effects. There is better compliance than with the older, typical medications.
The older typical anti-psychotic treatments can have horrendous side effects--including difficulties with movement and uncontrollable shaking--some of which are irreversible even when the patient has come off the medication. That makes patients reluctant to continue with their treatment and often results in relapses and returning to hospital.
The new medicines offer better value for money than the older treatments, certainly over the medium to long term. The Government's mental health strategy document recognises the benefits of the new atypicals, and the 1999 independent report "Safer Services--A Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness" found that too many patients were prescribed older medicines and that there was a subsequent lack of compliance.
The Government are making extra resources available to assist in meeting the demands for new drugs and to train staff. People with schizophrenia should be treated fairly and prescribed the most appropriate medication, irrespective of where they live. Nevertheless, there is widespread evidence and concern that there are many gaps in service provision at a local level, that funding is inadequate and that many patients are being denied access to effective modern treatments.
At this time when, as we heard yesterday, incredibly exciting things are about to happen in the national health service, and when services for people with mental health problems are very much on the agenda, I am glad to have had the chance to raise the concerns of my three constituents--and many others--with my hon. Friend the Minister. I urge him to raise the points as strongly as he can with the appropriate Ministers at the Department of Health and the Home Office.
1.12 pm
Mr. John Randall (Uxbridge): I welcome my hon. Friend the Member for Beaconsfield (Mr. Grieve) to his new portfolio. I am sure that he will show as much expertise in this post as he did in his previous one.
I was going to use this important opportunity to raise one subject, but other matters have come to mind. These debates are a useful forum for Back Benchers to raise all manner of subjects. I do not think that I could be called in any sense of the word a moderniser, because I am the fourth generation in the family furniture business and could probably be described as an hereditary retailer--and I know the views of Labour Members on hereditaries. Although I do not think that I can normally be classed as a moderniser, I suggest to the Minister that there might be opportunities to have one or two more such debates in the parliamentary year. They give Back Benchers the opportunity not only to express their views, but to listen to the views of others. Although the more traditional Adjournment debates provide for such opportunities, they are not always used in that way. This debate is an interesting and useful exercise for us all.
I echo the words of my neighbour, my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson), about Harefield hospital. I pay tribute to the excellent work and sincere efforts that he has made on behalf of the hospital. The campaign has been felt acutely throughout the area and not just within the immediate confines of Harefield. My constituents lobby on the matter and the campaign has all-party support.
As hon. Members may know, Harefield was, until the general election, part of the Uxbridge constituency. My predecessor, the much-respected Sir Michael Shersby, was laid to rest in Harefield churchyard, and anyone who has visited the church will know why my hon. Friend the Member for Ruislip-Northwood was correct to describe the area as rural Middlesex.
Sometimes, when I sit on these Benches. the words of a Gilbert and Sullivan song come to mind. I think of a lot
- Of dull MPs in close proximity,
All thinking for themselves is what
No man can face with equanimity.
As a great fan of Gilbert and Sullivan, I remember that one of my first deeds on entering the House was to help the all-party Gilbert and Sullivan group to lobby the Arts Council for some money for the D'Oyly Carte company. That fell on deaf ears, but bearing in mind that the Arts Council is now a little better off, will the Minister point out to his colleagues in the appropriate Department the need for some middle and lowbrow entertainment, as well as the rather highbrow stuff that sometimes passes over my head? Perhaps we should at some stage consider whether there should be not just the national opera houses but a national light opera house. Light opera is very often an entry into--as people would tell us--more sophisticated music, although the likes of Birtwhistle and so forth are still a long way above my head.
My hon. Friend the Member for Southend, West (Mr. Amess) and others have raised some transport problems. Government planning guidance is increasingly making parking provision in Uxbridge difficult. Although I understand the aims involved, the guidance is stifling development in town centres, especially before suitable local public transport options have been implemented. As such options seem to be a long way off, can some of the guidance be relaxed in the short term so that town centres are not entirely killed off?
I raised with the Deputy Prime Minister on the Floor of the House some months ago the possibility of extending the Central line to Uxbridge--a siding comes
very close to the Metropolitan and Piccadilly lines. I was told by the Deputy Prime Minister that the Government considered the matter when they first came to office and rejected it. However, a subsequent exchange of letters between myself and his Department has revealed that, in fact, the Government did not consider the matter, but had they done so, they would have rejected it. I wonder whether it might sometimes be a good idea to admit such things. Such ideas, which have sometimes been around for a long time, should be considered before they are rejected out of hand.Although we are still very much in the cricket season, I should like to use this opportunity to press the Minister to mention to Ministers in the Department for Culture, Media and Sport not only D'Oyly Carte but sport. I know that grassroots sport and football have been in the news and that work is being done on the issue, but I would like a little more emphasis on non-league football. Not only is such sport an opportunity for many to enjoy supporting their local side, but it can play an important community function.
I am lucky in having in Uxbridge the excellent Ryman division one team, which is aptly named Uxbridge. We have been delighted to be joined in that division--we may leave them behind when we are promoted to the premier next season--by the team of Northwood in the constituency of my hon. Friend the Member for Ruislip-Northwood, and by Yeading, which plays in the other constituency that covers Hillingdon. The hon. Member for Hayes and Harlington (Mr. McDonnell) puts too much emphasis on Hayes FC in the Nationwide conference, but he must not forget poor old Yeading.
Finally I turn to the more serious matter on which I originally intended to say just a few words. As we go away for the summer recess, I take hon. Members' minds back to last year and the NATO action in Yugoslavia. Since then, we have heard little of what has happened in Serbia, Yugoslavia or, indeed, Kosovo, as only a small amount of information is coming out. I remember some of the wilder claims and statements made during the course of the NATO action, and I should like to know a little more about what is happening. I hope that there will be a debate on the subject soon after we return.
Of course, the Select Committees on Defence and on Foreign Affairs have produced reports, some of which contain pretty damning statements, but I do not want to dwell on those now, but on the humanitarian aspect. As many of us, hopefully, are leaving for a break with our families, we should bear in mind the plight of refugees in Yugoslavia. There are more refugees in Yugoslavia than any other European country. As a result of sanctions and the NATO sanction, there is a great deal of deprivation in Serbia. One of the most alarming statistics that I heard recently was that 68 per cent. of the population cannot afford three proper meals a day. Obviously, the innocent and most vulnerable will suffer, not Milosevic's party elite.
The International Red Cross is doing work in Serbia, and, within that, the British Red Cross is doing what it can. However, there is a case to be made for a small change in British policy, as isolating the country from all significant spheres of activity is damaging those people who want to support change to a more western form of democracy. Most of the intelligentsia have left and, in many respects, the aims of the west's action have not been achieved--indeed, the very opposite has been achieved.
Without being too radical, I think that we should start by having links at an ordinary level, so that the Yugoslav people realise that the British people have no argument with them. Perhaps we could have sporting and cultural links and, in time, trade links.There is a danger of being seen to support a regime which most if not all people in this country are against. However, it is time to look seriously at what is happening. Serbia is probably the most important country in that region, and we must consider the Balkan area for the sake of Europe's security and peace. We cannot afford to ignore that region any longer.
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