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Dr. Fox: Sadly, we have not seen the end of enough such buildings. The updating of facilities is to be commended, but that is not just a question of changing the bricks and mortar. A cultural problem exists in this country and we need to overcome it, but the stigma attached to mental illness makes it difficult to achieve progress.
I shall now turn to another hidden scandal in the UK—the situation that pertains in our prisons. Enoch Powell may have lit a funeral pyre beneath mental asylums when his Mental Health Act 1959 began the process of shutting them, but today some 70 per cent. of the prison population have a mental health or substance abuse problem, or both. We once hid our mentally ill in asylums, but we now unwittingly locate far too many of them in our prisons.
The incidence of mental disorders among the prison population far exceeds that in the population as a whole. It is a troubling thought that, at the beginning of the 21st century, anyone who is mentally ill and has a brush with the law could be subject to inadequate treatment in Dickensian settings in our prisons. Facilities for patients often amount to little more than sick bays with limited primary care cover. The assessment of a prisoner arriving at a prison typically takes five to seven minutes, and is often conducted by a retired GP or a locum with no specialist knowledge of mental health.
The level of training of staff often does not match the complexity of the conditions with which prisoners present. Prisoners are therefore less likely to have their mental health needs recognised or to receive psychiatric help or treatment, and are at an increased risk of suicide. The number of suicides in 1999 was twice the figure in 1990.
A report by John Reed, the medical inspector for the inspectorate of prisons, has stated:
- "A period in prison should present an opportunity to detect, diagnose and treat mental illness in a population hard to engage with NHS services. This could bring benefits not only to patients but to the wider community by ensuring continuity of care and reducing the risk of reoffending on release."
- "Many are quietly mad behind their cell door and are not getting any treatment. Care for mentally disordered offenders in prison is a disgrace."
A second problem is that prisoners with mental health problems remain in the Prison Service and are not diverted to the NHS as the Reed report, among others,
recommended. It is inappropriate for prisoners with severe mental health illness to be in prison. Sir David Ramsbotham has said:
- "In my view mentally ill prisoners requiring 24-hour nursing care should be in the NHS, not prison."
Dr. Fox: That is greatly preferable, but it is also essential that people who go to prison with an undiagnosed mental illness are not under-treated and then return to the community with a much greater chance of reoffending. That is part of caring for the vulnerable, but it also involves enlightened self-interest for the wider society. Whether patients are in the criminal justice system or not, it is in everybody's interest to ensure that they are properly treated in the right setting, so that they are not released from custody with a treatable condition.
I have read the draft Bill, and we will examine closely the Government's proposals for a shift from prison to NHS treatment. If my cursory reading is any guide, those proposals will certainly command the support of the Opposition.
Mr. John Battle (Leeds, West): I remind hon. Members that Armley prison is in my constituency. I do not want to rehash history, but I remember that in 1996 some hon. Members pleaded with the then Government to halt the bed closure programme because it would mean a shift from care in the community to care in custody. That is what has happened. Without going over the past, will the hon. Gentleman be generous enough to acknowledge that for some months we have had 10 pilot mental health in-reach programmes in prisons to address that problem? Is he aware of that fact?
Dr. Fox: I am aware of it and I welcome it, but we should treat the matter as one of even greater urgency. I hope that the Secretary of State will outline the proposals in the Bill to do just that; it is something that we have been urging the Government to do. If that is what the Secretary of State confirms this afternoon, he will have our support.
The Wanless report looked at the costs of mental illness and the potential savings that a better system might bring. Derek Wanless pointed out that MIND had estimated the total cost of mental illness at £37 billion a year, of which £11.8 billion was accounted for by lost employment. In 1995, more than 91 million working days were lost as a result of mental illness. The Home Office estimates that the overall cost of crime is £58 billion a year, and a significant proportion of crime is carried out by those with a mental illness.
When asked about the cost benefits of better mental health care, Wanless said:
- "It is difficult to estimate the exact value of potential savings, but it does not seem unreasonable to assume that there might be a 5 per cent. reduction in the costs of mental illness and a 2 per cent. reduction in the costs of crime . . . giving a net saving across government as a whole of some £3.1 billion a year."
Mr. David Hinchliffe (Wakefield): The hon. Gentleman is making a thoughtful speech, much of which I agree with. In respect of prisoners, he referred to the Reed report, which recommended strongly—as have a number of individual inquiries—the break-up of the special hospital system and the development of more regional secure units. Would it be his policy to follow those lines and develop further regional secure provision, with a view to moving prisoners who are wrongly in prison into more appropriate places?
Dr. Fox: I could not honestly say that I have come to a fixed view on the best way to provide more appropriate care. There is a need for further research as to how best to manage the transition from the prison setting to a more appropriate setting for the treatment of mental illness. Perhaps the pilots referred to by the hon. Member for Leeds, West (Mr. Battle) might give us some valuable information.
We accept that health policies cannot hope to eradicate the problems of an entire society—that vision was shattered after 1948—but what health policies can do is to seek to support those who suffer in what can at times be an atomised and alienating society. That is why the Conservative party has decided to make mental health a central part of our health policy agenda. The issue must become a matter of public concern, not just private misfortune. An enlightened society is one that realises—as they have in many Scandinavian countries—that it is to the benefit of everyone for mental illness to be treated adequately, and, if possible, prevented.
I give the House this final thought: perhaps we need to bring back one other concept that we seem largely to have forgotten—the concept of sanctuary. We started out with Bedlam, then we had madhouses; Lord Shaftesbury gave us asylums, then we looked to the community. Now we must speak of what all the differing environments ought to provide—a sense of sanctuary.
Recently I visited a mental health counselling service in Aylesbury, where those involved described their office—particularly movingly, I thought—as a place where patients came to feel safe. That is a good guiding principle.
Last week I visited the Hillside clubhouse in Holloway. I am ashamed to say that I did not know about the clubhouse network, but I was struck from the moment I went through the door by the fact that those with mental health problems looked on the clubhouse as somewhere they could go to feel safe. It offered them companionship, constructive activity and the chance to go and get a paid job in the community. It supported them without compelling them. Everyone found their own level and progressed at their own pace. It was not somewhere they were forced to go but, equally, it was somewhere that would keep in touch if they stopped coming along. In short, it offered genuine care in a real community, and it was a sanctuary within an ever more complex society.
Concern about the social welfare of those in society who have no one to speak up for them and often cannot speak for themselves is an essential part of any programme for a truly national party. There can be few groups more vulnerable than those with mental illness. We have decided to make mental health central to our policy not because it is fashionable, and not because we have identified some interest group or section of the population whom we can make politically beholden to us as a consequence. We are not doing it because we see some short-term gain to be had by pretending to interest ourselves in so-called soft social issues for a few months. We are doing it because we believe that it is the right thing to do, and that is what politics ought to be about.
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