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Dr. Lynne Jones (Birmingham, Selly Oak): I thank my right hon. Friend for the high priority that is being given to mental health services. Does he agree that the sooner people with signs of mental illness seek help, the better the outcome; and that a measure of the success of the Government policies is a reduction in delays in people's seeking that help? What measures in the White Paper does he consider will assist in achieving that aim?
Mr. Milburn: My hon. Friend is absolutely right. Clearly, the sooner the health service can assess those who might have a mental illness and get on with treating them, the better. I am afraid that, as she knows, the deficiencies in the Mental Health Act 1983 have in some cases prevented clinicians from doing their jobs. They have often faced the dreadful problem of treating patients in hospital, discharging them into the community and finding that they then disappear altogether from the services' attention. They know full well that those patients are causing disturbance and nuisance to others and are very possibly a danger to themselves and others, yet those clinicians can do nothing about it, other than wait for the patients' readmission into hospital. Such a pattern has not been good for clinicians and it certainly has not been good for patients or the wider community.
The reforms that we are introducing to expand the services and get crisis intervention teams and outreach teams out of the hospitals and into the community will make a real difference to many patients.
Dr. Julian Lewis (New Forest, East): Does the Secretary of State accept that there is a continuing risk to female in-patients in psychiatric institutions from assaults arising from the continuation of mixed-sex wards? Is he aware that, in December 1997, when the Government talked out my private Member's Bill, by which I sought to address the issue, the right hon. Member for Brent, South, then Under-Secretary of State, Department of Health, who had responsibility for such matters, assured me:
- A central monitoring system is being developed which will provide further regular information on authorities' performance against those objectives--[Official Report, 12 December 1997; Vol. 302, c. 1331.]
- At the moment, information on which hospitals in England have eliminated mixed sex accommodation is not available, as data are collected on a health authority basis.--[Official Report, 30 October 2000; Vol. 355, c. 248W.]
Mr. Milburn: We cannot publish information that we do not have, and the last thing that the hon. Gentleman would want us to do is to make up the data.
Dr. Lewis: The Government ought to have it.
Mr. Milburn: We will get it, and when we do so, we will make it available. This Government, unlike the previous Government, are determined to eliminate mixed-sex accommodation.
Mr. Tom Clarke (Coatbridge and Chryston): May I welcome one of the most comprehensive and profound statements on an important issue that we have heard for a very long time? May I press my right hon. Friend on advocacy? Will the Government implement or adapt existing legislation--for example, the Disabled Persons (Services, Consultation and Representation) Act 1986? Will he accept that, when people leave long-stay hospitals, advocacy would be helpful in preparing proper assessments, involving advocates, social services and so on? I very much welcome the new thinking on prisons, but many people take the view that, in Britain, we send many mentally ill people to prison unnecessarily and that that may well apply to people with learning disabilities.
Mr. Milburn: I am grateful to my right hon. Friend, as is the House, for the work that he did on behalf of those with disabilities, especially in the 1986 Act, in which I suspect he has more than a vested interest. Advocacy services are very important because we are talking about a very vulnerable group of people and their reintegration into the community is not easy, especially if they have spent time in prison or in specialist mental health services. They need more information on how to contact services, on their legal rights and so on. Although decent advocacy services exist in some parts of the country, their availability is patchy. We propose that people, especially those detained under compulsory powers in our proposed new mental health legislation, should have access to specialist advocacy services. We are consulting on the best way to do that, and we expect to publish the results of that consultation in the spring.
Mr. Dafydd Wigley (Caernarfon): May I press further the point on advocacy that was made by the right hon. Member for Coatbridge and Chryston (Mr. Clarke)? The Secretary of State said that compulsory treatment can go ahead only after a full assessment by doctors and with the agreement of the independent mental health tribunal. Will a professional advocate also be available and will the Secretary of State ensure that resources are available for that purpose?
Mr. Milburn: Yes. I assure the right hon. Gentleman that that is precisely one of the safeguards that we seek to put in place. Every patient should have access to the specialist advocacy services for which he has argued for many years.
Ms Bridget Prentice (Lewisham, East): My right hon. Friend may be aware that, in April 1999, I introduced a ten-minute Bill on protection and restraining orders, and it covered the very people referred to in the White Paper. The issue of treatability was one of the problems that I faced, so I very much welcome the fact that he has said that that issue will be examined. Will he go further and tell me that the White Paper will make provision for people with severe personality disorders who recognise that they are a danger either to themselves or to others? What opportunity will such people have to refer themselves, and to whom will they go?
Mr. Milburn: My hon. Friend makes an extremely good point that relates to one of the gaping holes in the existing legislation. Not only have people out there been dangerous, but people in prison who have been dangerous
and who have a severe personality disorder have warned prison officers, on their discharge, that they are danger to others. None the less, they have been discharged. That has got to change for the protection of the individuals concerned, their families and the wider community. In future, as we roll out the new specialist services for those with a severe personality disorder, we shall provide precisely the help, treatment and care that they need.
Mr. Andrew Rowe (Faversham and Mid-Kent): Does the Secretary of State share my perception that even the best-intentioned members of the public have no idea how to respond to someone displaying clear signs of personality disorder? Does the taskforce considering the removal of stigma intend to consider public education in that respect?
Mr. Milburn: Yes, and that is one of the jobs that we must do. The hon. Gentleman knows that we spend a certain sum of money each year trying to educate and inform the public about what mental illness means. Although, today, we are concentrating primarily on those with the most severe mental illnesses--they are sometimes the greatest threat to themselves and to others--overwhelmingly those with mental health problems do not fall into that category. We must continue to make and reinforce that point, so that the public get the right idea and not the wrong one.
Laura Moffatt (Crawley): I very much welcome today's announcement. Does my right hon. Friend not agree that one of the saddest experiences is to watch someone daily losing touch with reality when the professionals are not able to intervene? [Interruption.] I knew that that was coming, but this is a serious subject. Sometimes health teams cannot intervene and take part in active treatment.
The proposals announced will allow for the compulsory administration of drugs through the community health teams. Does my right hon. Friend not agree that those teams will need much help and advice when taking part in such work in conjunction with the acute services? The sensitive relationship that they have with patients might become slightly different, so we should consult those teams on how we carry out the new arrangements.
Mr. Milburn: I very much agree with my hon. Friend, who is an expert on this subject, and I assure her that there will be the comprehensive training that she seeks. It will be necessary, because there will be a big change in the law and, therefore, big changes to services and the way in which clinicians relate to patients. Overwhelmingly, clinicians will conclude that we are taking the right approach, because they are as frustrated as anyone else about their inability to get the right care and treatment, including medication, to those who need it most.
Dr. Evan Harris (Oxford, West and Abingdon): Does the Secretary of State accept that, although many of his proposals are welcome, there will be concerns about the tendency to seek to minimise risk to the public to such an extent that it impedes civil liberties? In particular, I refer to the redefinition of the term "treatability". When
unfortunate and tragic incidents occur, there is always an inquiry and Ministers have to appear on "Newsnight" for an inquisition and the press and the public think that there is a higher risk than actually exists. Is the Secretary of State aware that there will be some concern about his proposals on the basis of the balance between civil liberties and the reduction of risk?
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