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Mr. Heald: The hon. Gentleman talks about money that the Government have earmarked not going into mental health services, which is a particular concern. However, is it not the case that he does not even believe in the earmarking in the first place, so the idea that the money would go into mental health is not correct?
Dr. Harris: The difficulty with earmarking is that there will always be something that is not earmarked, unless one centrally earmarks funding for every service. That is why I do not believe that the earmarking of funding is the right way forward. I hope that I have answered the hon. Gentleman's question. I believe that I have been consistent in holding the position that earmarking for the pleasure of allowing the Secretary of State to make announcements about his priorities does a disservice to neglected areas. However, I pay tribute to the hon. Gentleman's interest in mental health, which has been even longer held than that of his hon. Friend the Member for Woodspring, if I may put it that way.
The elderly mentally ill are affected by shortages not only in acute beds, but in residential care and community care services, owing to the impact of the huge funding gap in social care. It is well recognised that social services departments now spend £1 billion more on social care than the standard spending assessment. The Government's failure to meet that gap means that other services are having to be cut. Until the Government put some of the new resources—more than they plan to—into social services, the false economy of beds being blocked will remain. As the Secretary of State knows, bed blocking is a phenomenon not only for acute hospitals, but for acute mental hospitals.
Mr. Milburn: On the £1 billion gap, is it Liberal Democrat policy to eradicate it?
Dr. Harris: Yes, it is. We were clear about that in our alternative Budget. If the Secretary of State looks at the detail, he will see that putting £1 billion of new money into the gap would prevent the inexorable rise in regressive council tax and facilitate the local development of services for growth areas instead of propping up the service. I do not want to be distracted too much into social care, but I assure the Secretary of State that my comments are not inconsistent with what we have said before.
A survey that we carried out in the past year showed that 72 per cent. of social services departments were unable to meet the demand for nursing elderly mental
illness beds and that 68 per cent. were unable to meet the demand for residential elderly mental illness beds. Fifty-eight per cent. reported shortfalls in the provision of specialised dementia care and 62 per cent. reported shortfalls in provision for older people with challenging behaviour. In dealing with mental illness, we must recognise that we are also dealing with illness that presents as dementia, especially among the elderly. They are affected by underfunding in every budget on which they rely; they are the Cinderella of Cinderellas.We have had a brief opportunity to look at the draft Bill. I hope that the Secretary of State accepts that we need to spend more time on the detail and that we can do so in Government time, perhaps in Westminster Hall. The Bill has two main flaws. It provides for too much detention without proper treatment, and for inappropriate treatment in the community without enabling people to get back into hospital when they need to.
Mr. Tom Clarke: Before the hon. Gentleman develops his argument, which he is doing very well, I ask him to focus on those people who, whether they like it or not, remain in the community, and who were the subject of the Donaldson report on chronic fatigue syndrome and ME. Does he agree that in so far as there is a psychiatric input—which is debatable—no time should be lost in referring GPs to the findings of that report, and that it would be a great mistake if the National Institute for Clinical Excellence was asked to spend too much time on it?
Dr. Harris: Not enough information on those difficult conditions is available to or absorbed by those in primary care, on whom the burden most falls. There have been reports in recent days about the amount of unnecessary paperwork that GPs have to get through, and I hesitate to say that they should do even more reading without some being taken away from them. The right hon. Gentleman's remarks are on the record. All hon. Members have constituents with chronic fatigue syndrome or ME, and we know what an ordeal they have to go through to get recognition of their condition, let alone the treatment and care that they and their families need.
Returning to the draft Bill, it is going too far to detain people who should not be detained for intervention that cannot in all cases be described as treatment. Again, we need more time to develop that, but the Secretary of State knows the arguments against the provisions.
It is important to hold a debate on compulsory treatment orders. There are arguments in favour of compulsory treatment and the Select Committee on Health made important points about it in its report in July 2000. We look forward to hearing the Chairman's views on the matter. The Health Committee was ambivalent and raised anxieties about it, but did not automatically rule out such a provision. The Government must show even greater recognition of the anxieties than the Secretary of State did.
It is feared that expanding the definition of mental disorder to include those with personality disorder, and expanding the definition of treatment to include habilitation—teaching people how to live independently—will mean that the definitions are too broad to reassure those of us who are worried that too many civil liberties will be lost in the name of public protection. It is worrying that the
Secretary of State uses language such as, "If people refuse treatment, they will be compulsorily detained." If those people are deemed capable of refusing treatment, it means that although they may be mentally disordered, they may also be competent to decline treatment. If they do that, the Secretary of State will add an extra group of people to those who can currently be compulsorily detained.The principles of non-discrimination and autonomy for people who are capable of giving and, importantly, refusing consent for treatment must be respected. Otherwise we enter new territory that is dangerous for Governments without greater support from key organisations such as the Royal College of Psychiatrists.
Mrs. Humble: Does the hon. Gentleman acknowledge that the anger and bewilderment of people in the community who are assaulted by neighbours must be weighed in the balance? The police will not act because doctors advise them that the person is not fit to plead, and the health service will not act because it claims that the person has an untreatable mental illness. The problem persists, and there is anger in the community.
Dr. Harris: I understand the hon. Lady's point. The Secretary of State dealt with the matter when he asked, with an expansive shrug of shoulders, what Governments can do when faced with the problem that she outlined, and talked about the difficulties in the current law of ensuring that such people are treated. I acknowledge that the difficulty needs wider debate. However, I believe that steps must be taken before we go down the path that the Secretary of State suggests.
First, we must provide greater community support and early intervention, which is not currently available. Many tragedies could be prevented not simply by detention, but by early detection and intervention, and greater support.
Secondly, we must understand the principle of reciprocity. I do not believe that people who are subject to greater powers under the draft Bill will recognise that they are being fairly treated until the Government provide enhanced treatment facilities. I hope that they will do that with the extra funding for the NHS so that there is no delay in getting a hospital bed, or, as the hon. Member for Wakefield (Mr. Hinchliffe) said, in getting out of a hospital bed into other treatment. There should not be a delay before allocation to a community health team. There should not be such a shortage of professionals that oversight is inadequate.
We have an additional duty to ensure that patients who are capable but threatened with compulsory treatment are not rationed out of health care. I am conscious of the time, and the debate could continue, but I wanted to draw attention, before Second Reading of the Bill that is now in draft form—I hope that it will be amended—to the fact we could hold significant debates on this issue.
The hon. Member for Woodspring (Dr. Fox) made an important point about mental health in prisons. There are significant difficulties in prison, where all the problems in the community are writ large because there is a concentration of people many of whom have mental health problems. Despite the best efforts of those who work under siege in prisons, the health service facilities there are not adequate. The Government must pay greater attention to those concerns.
The problem of dual diagnosis has not yet been raised, although I am sure that all hon. Members will know that it is a major issue, involving mental illness coexisting
with drug dependency. It is prevalent particularly among the prison population, but also in the population of drug users outside. Whatever resources are needed for each of those groups, the problem requires a combination of behaviour that is mediated not primarily through the judicial system but through enhanced treatment.The Secretary of State felt that many of the people who had caused problems in the community through horrific and tragic incidents had not been in touch with mental health services at the time, even if they had previously been. I would suggest that that is an argument in favour of increasing the responsiveness of existing mental health services, and that that has to be done before the Government pursue other options. Otherwise, in the words of a civil servant to a conference in 2000, we shall be dealing not with a
- "health act for vulnerable people in need",
I shall not repeat the points that I made in an earlier intervention about treatability, but I am concerned that the number of people subject to detention on the basis of personality disorder will be dictated not by medical evidence—particularly if the pilot schemes and trials do not give the results that the Government want—but by the treatment of those people by the tabloids.
In their joint statement, the Royal College of Psychiatrists and the Law Society have raised a number of concerns about the draft mental health Bill founded on the White Paper, some of which were mentioned by the hon. Member for Woodspring but others of which were not. Until now, I have not read a briefing by a royal college so critical of Government policy and couched in such strong terms, and I hope that the Secretary of State will have an opportunity to read it. The statement says:
- "The proposals"—
- "would be costly and complex to implement. Government funds would be better spent in the provision of more effective clinical services for patients.
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 direct patient care."
- "It is right that new legislation should reflect the move from hospital to community care. But the proposals as they stand would introduce powers that are ethically dubious and practically unworkable. They take no account of alternatives such as the use of leave and discharge with treatment conditions."
It is damaging and disappointing that the Government stand poised to implement the much needed updating of the Mental Health Act 1983 with what could be considered repressive legislation, and to lock up people
with untreatable personality disorders indefinitely. The public must be protected from the risk of attack, but the best way to achieve that is to ensure that there are adequate resources in terms of psychiatrists, community psychiatric nurses, community care managers, drug therapies and talking treatments. The public, and, to a much greater extent, the mentally ill themselves, are at much greater risk from under-resourcing than from the absence of detention powers or compulsory treatment orders.The Conservatives have claimed that community care has failed, but it was never properly tried, because it has never been given the funding that it requires. I hope that all hon. Members will recognise the desperate need for resources and for improving the morale of people working in the mental health service, and for those things to be done before powers that are too draconian are taken in legislation.
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