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Mr. Tam Dalyell (Linlithgow): On a point of order, Mr. Speaker. In view of the fact that there has been some unflattering sedentary comment—it was very ill-informed, may I say—from those on the Opposition Front Bench, could some of us register that on this vitally important matter, expertly raised by my hon. Friend the Member for Aberdeen, Central (Mr. Doran), there should be some sort of response under privilege? That is what we are given privilege for. Some of us would like to hear a proper response to the very important matters that he raised, but I would guess that it had better be under privilege.

Mr. Speaker: Order. That is not a matter for the Chair.

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Mr. Speaker: I have to notify the House, in accordance with the Royal Assent Act 1967, that Her Majesty has signified her Royal Assent to the following Acts:

State Pension Credit Act 2002

NHS Reform and Health Care Professions Act 2002

Land at Palace Avenue, Kensington (Acquisition of Freehold) Act 2002.

25 Jun 2002 : Column 752

Opposition Day

[15th Allotted Day]

Mental Health

Mr. Speaker: I wish to inform the House that I have selected both amendments in the name of the Prime Minister for the Supply day.

4.4 pm

Dr. Liam Fox (Woodspring): I beg to move,

There will be much in this debate on which both sides of the House will agree, and some that we will want to debate, but we can begin by recognising that the way in which a society treats those who are least able to play a full role is a measure of how civilised that society is. Sadly, we accept a level of care for people with mental illness that we simply would not accept for many more readily identifiable physical illnesses. If we walked from the House up to the Strand or into the centre of London and saw people, many of whom may have a mental illness, sleeping rough in front of our biggest institutions, most of us would regard that as a policy failure that a humane society should not be willing to tolerate.

It will come as a surprise to many outside the House, and perhaps to many hon. Members, too, that one in four of us will at some point in our lives suffer from a mental health problem. I doubt whether there is one person in the Chamber who has not experienced the impact of mental ill health on someone in their life, be it a relative, a friend or a colleague.

Stephen Hesford (Wirral, West): Will the hon. Gentleman give way?

Dr. Fox: I have barely started; I shall give way shortly.

Mental illness is society's unspoken epidemic, and as one of our last social taboos it is too rarely discussed. All too often, people regard it as a weakness and stigmatise those who suffer from it. If we are to diffuse the stigma surrounding mental ill health, we must dispel the ignorance surrounding the whole subject.

The spectrum of mental ill health is incredibly broad, as hon. Members will know from their constituency work. It encompasses many different groups—the mum with post-natal depression, the dad struck by depression because of a period out of work, and the son or daughter with a behavioural disorder who underperforms academically or is disruptive in the classroom. It is also about college friends who commit suicide, seemingly for

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no reason, a soldier returning from overseas unable to adjust to the realities of normal life, and, perhaps most commonly, elderly patients slowly being ravaged by the dehumanising erosion of Alzheimer's disease.

Although the safety of the public must always be at the top of our priorities, we need to move the debate away from an obsession with the mercifully few incidents when someone with a mental illness harms someone else, and remind ourselves that it is in the interests of public safety to ensure that there is adequate and appropriate treatment for all those who need it.

Stephen Hesford: Does the hon. Gentleman consider it appropriate to dump an important debate that was on the Order Paper until last night, and substitute it at the last minute—

Mr. Speaker: Order. That is not a matter for debate.

Dr. Fox: I wonder what people outside this House who think that this is a very important issue will make of such an imbecilic intervention.

Sadly, too many politicians pay more attention to the potential dangers posed by psychiatric patients, and to their compulsory treatment, than to the far more important issue of appropriate treatment for all patients. I hope that the Government have avoided that mistake in the Bill that they are publishing this afternoon. Members on both sides of the House will be aware that on the ground the situation is often bleak, with widespread staff shortages, acute and day bed shortages, wide gaps in community provision and a lack of effective step-down care for those returning to the community. Things are made worse by the knowledge that although funds are earmarked in the health budget, they all too often fail to reach those in need. Cutting the mental health allocation is an easy way of balancing the budget. The mentally ill are the least likely to complain, make a fuss or write to newspapers.

The evidence that mental health is not considered to be a priority is stark. Buckinghamshire mental health NHS trust has had £1 million that was originally earmarked for mental health diverted into other areas. Half of all GP practices in Cumbria offer counselling to patients in need, but there are plans to axe that £78,000 service. The Avon and Wiltshire mental health partnership trust faces service reductions amounting to £0.5 million. On a smaller scale, but equally important to patients, the acupuncture clinic at the department of psychiatry at North Manchester general hospital is threatened with closure. It costs £60,000 a year to run. As for big organisations, Saneline requires £1 million a year. It deals with more than 1,000 calls a year from distressed people, but is still under threat.

It is clear that far from being a priority, mental health care is too often an afterthought in today's NHS. The burden falls across our whole society. Our inner cities bear more than their fair share of that burden. People who are homeless or have alcohol or drug addictions frequently have mental health problems. They end up in inner cities, where amid the hustle and bustle of city life they become invisible to those who otherwise might help them. Of course this is not simply an inner-city issue. The crisis in our countryside has led to an increase in mental health problems, such as the well documented tragedy of farming suicides, which touched my constituency in north Somerset when a father and son, whom I knew well, committed suicide.

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The Conservative party has always been at the forefront of mental health reforms. Lord Shaftesbury began to change the perception of mental health problems from a private misfortune to a matter of public concern. He highlighted the atrocious conditions in many London asylums, and changes began, albeit slowly, to occur.

The increase in asylums and other custodial institutions was such that by 1954 the population of psychiatric hospitals peaked at 152,000. That is more than twice the current prison population. Enoch Powell took the first, decisive step from that model of care. He said that the Mental Health Act 1959 "lit a funeral pyre" beneath the decaying network of asylums. He was at his most eloquent on the subject in 1961, in what has become known as his "water tower speech". He spoke of asylums that stood

His broad goal was to move treatment of the mentally ill away from remote asylums and into local hospitals closer to the community.

The development of new drugs meant that the possibility of treating patients in the community slowly became a reality. It began with the findings of the committee that considered mental health. The now Lord Parkinson chaired it at the request of the now Lord Fowler when the Conservatives were in opposition in the 1970s. Policy development culminated in the Mental Health Act 1983 and the National Health Service and Community Care Act 1990, which my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) introduced.

Most people accept that it was right in principle to close the old asylums and have patients treated close to or in the community. The concept of care in the community was supported across the political spectrum, although experienced hon. Members might suggest that widespread political consensus sometimes leads to the worst legislation. My right hon. Friend the Member for South-West Surrey (Virginia Bottomley) wrote in a letter to The Times in 1998:

The suicide rate is increasing again, the family unit is increasingly breaking up, there is homelessness, abuse and the absence of a sense of community in many inner-city areas. Those factors all contribute to the increased prevalence of mental health problems among people of all ages, including, perhaps most worryingly, the young.

Care in the community has provided many thousands with an opportunity for a quality of life that is far better than the life that they would have experienced inside restrictive institutions. Criticism cannot be laid at the door of the medical, nursing and voluntary staff—the latter are forgotten too often—who have made a Herculean effort in the face of great difficulties. I reject the criticism from some that care in the community was nothing more than the unfortunate or catastrophic meeting of a desire for financial savings with a naive passion for the rights of the individual.

However, the pendulum swung too far, too fast. Many believe that care in the community was implemented too quickly, and too often with inappropriate patient selection. In too many places there was too little investment in training, finance and related matters. At times there has

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been too little care, scant support and a form of community that exposed the vulnerable—the public and the patients—to danger. Individuals were sometimes placed in complex urban environments with which they simply could not cope. They lacked understanding of their condition, and their institutionalised background made them unable to deal with the complexities of modern living. When they needed help, their cries went unanswered.

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