Mr. Hilton Dawson (Lancaster and Wyre):
The hon. Gentleman is making a speech the like of which I have never previously heard from him. Is he prepared to acknowledge that the Conservative Government left the Labour Government with an enormous problem, which they have had to tackle?
We should not get into arguing about who introduced what, and who have been in office for the past five years. The principle of care in the community was correct, but mistakes were made in implementing the policy, both under the Conservative Government and under the current Government.
Claire Ward (Watford):
Will you say sorry?
Yes, I would say sorry to patients who have suffered unnecessarily because of the poor implementation of policybut I must say that I find the hon. Lady's approach of sitting in a debate on a very serious subject making stupid sedentary points rather pathetic.
We require a balance to be struck that will ensure the most appropriate treatment and environment for patientsa balance in which those who need treatment in a hospital setting can receive it, and in which only those able to cope in the community are placed there. We must accept that achieving that balance is made more difficult under this policywhich is discredited in the minds of the publicbecause of a series of crimes committed by mentally ill people who had fallen between the gaps or come off their medication.
I do not need to go through that litany today. As Michael Howlett of the Zito Trust said:
"People don't just attack people in the street out of the blue. There's always a build-up over weeks or months. These incidents are usually as a result of services breaking down and the danger signs not being spotted."
The Sainsbury Centre for Mental Health published a briefing on acute in-patient care a few weeks ago, which stated:
"We have yet to develop realistic plans to deliver acute inpatient care which is therapeutic and supports recovery. Unless we develop and implement such plans, nationally and locally, we will see an increasing cycle of decline in acute mental health care, with increasing user dissatisfaction, incidents and inquiries and the loss of high-quality staffall despite the best efforts of so many committed staff. The situation is little short of a crisis, and has to be addressed now. In some instances the quality of care is so poor as to amount to a basic denial of human rights."
Incidentally, that briefing describes not the situation five years ago, but the situation now.
Hugh Bayley (City of York):
I congratulate the hon. Gentleman's party on bringing this issue before the
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House, and I congratulate him on his speech. My question is about the funding and control of mental health services. The hon. Gentleman has gone on record talking about fees, charges and private insurance for health care. Does he agree, however, that for mental health care that is a dead end? Whatever the failings of our mental health care system, privatised health care systems such as that of the United States are much worse. Does he agree that we must have a state-funded system with a proper framework, such as the national service framework?
I have stated on the record that we are not looking towards the American system for mental health care or any other type of health care. I am sure that the whole House would agree that it is essential that those who require treatment for mental illness get it free at the point of use, irrespective of their ability to pay. Whether a range of providers could provide that care, funded by the NHS, is an entirely different matterto which I shall return, giving examples, later.
When discussing the issue of danger in connection with patients with mental illness, the question we have to ask is: a danger to whom? Events involving just a few stigmatise the many, and can lead others to overlook the danger that some mentally ill people pose to themselves. The case of Ben Silcock is a good example. Hon. Members will remember that he was severely mauled after climbing into the lion enclosure at London zoo while mentally disturbed. It is also worth remembering that the incidence of suicide, particularly in prison, is far higher than the number of cases in which mentally ill patients harm someone else. Sadly, about 1,000 schizophrenic patients in this country commit suicide every year. That is a figure that we should focus much more on.
It will always be the duty of the Government to protect the public from harm, if necessary by detention or compulsory treatment, but politicians must take care to adopt a balanced approach that does not stigmatise, and thereby worsen the plight of, those who pose no risk to anyoneexcept, possibly, themselves. I look forward to the Secretary of State outlining some of the measures that the Government are introducing in their draft Bill today. I hope that they will be dramatically different from some of the proposals in the White Paper.
In a joint statement, the Royal College of Psychiatrists and the Law Society have warned that they would find proposals too closely based on the White Paper unacceptable:
"We call upon the Government to halt any further attempt at legislation based on the White Paper 'Reforming the Mental Health Act' and to begin meaningful consultation on a statutory scheme that takes account of mental incapacity on the successful Scottish model."
The Secretary of State needs to address those reservations.
The statement goes on to say that the question of resources needs to be considered and that an Act based on the framework of the White Paper
"would collapse under the weight of its own regulatory framework . . . The proposals would be . . . costly to implement . . . The new Mental Health Review Tribunals alone would require the time of 600 (extra) psychiatrists. It would be impossible to recruit such numbers. Those in post would be diverted from . . . patient care."
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It is well known that reservations were expressed about proposals relating to those with dangerous and severe personality disorders. The statement said:
"In order to accommodate such a risk, the criteria for compulsion have been so widened that large numbers of patients would find themselves inappropriately placed under . . . the Mental Health Act . . . increased numbers would overwhelm already over-stretched acute ward and community teams. Patient care would suffer and the level of risk would be increased rather than reduced."
I should be grateful if the Secretary of State would deal with three issues, the first of which relates to compulsory treatment in the community. In what circumstances will a patient receive enforced treatment, particularly medication, in the community? Secondly, if the Government intend to remove the criterion of treatability under the draft legislation, how will patients with personality disorders who are detained be affected? Who will decide which patients can be detained and for how long, and how do we get round the fact that there is no suitable definition of severe personality disorder? Experiments to determine whether patient behaviour can be predicted through case studies have produced extremely poor results, yet predictability of behaviour will be central to the Government's proposals. Thirdly, when is the proposal likely to become law?
The hon. Member for City of York (Hugh Bayley) referred to private sector provision. I have been extremely impressed by the way in which other countries that I have visited deal with mental illness. I was especially impressed by a psychiatric hospital in Denmark, which stood in stark contrast to those in the UK that I have visited. I noted the sense of calm, and the profound sense that patients were treated as individuals, and with great dignity.
Hon. Members may be aware of examples such as the Hotel Magnus Stenbock, in Helsingborg, which is well known in mental health circles. It is a good example of what might be termed a halfway house for those moving between an institutionalised setting and the community. It has 21 single rooms and offers a balance between private and social space. It offers not just structure and crisis accommodation but a place of safety, and develops a sense of community and acceptance. It is run by the RSMH, a multi-million pound organisation of mental health care users that sustains and nurtures self-help care models throughout Sweden.
Perhaps the most striking comment on that hotel was made by a shopkeeper who runs a nearby store. One might have expected the local population to object to the proximity of such an hotel, but on the contrary. The shopkeeper said:
"The proximity of the hotel has not had any adverse effects on business, sometimes the general public are a little wary of users, but they see the staff in the shop are not afraid and are treating the hotel residents the same as all the other customers. It makes them more comfortable. We believe everyone has the right to be treated as a human being and at some point in everyone's life we all encounter problems, some more severe than others."
That is symptomatic of the way in which Scandinavian countries deal with mental illness. They regard it as an illness that is no more to be afraid of than cardiac or respiratory illness; they do not attach to it the stigma that the United Kingdom does. As it involves a private sector organisation, that example shows that such services do not have to be provided by the state.
Mr. Andrew Miller (Ellesmere Port and Neston):
I apologise to the hon. Gentleman for missing the first
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couple of minutes of his speech. The facility that he has just described sounds remarkably similar to the Countess of Chester site, launched by the Secretary of State a couple of months ago, in which £14 million has been invested. Does he recognise that such provision can be made within the framework of the NHS, and is it not a pity that we have had to wait for so long for the end of buildings that were condemned in the 1980s?