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6.11 pm
Mr. Peter Viggers (Gosport): Time is very limited, but I welcome the opportunity to make a brief contribution to the debate.
There is a wide range of mental health problems, including anxiety disorders, attention deficit disorder, dementia, depression, eating disorders, mood disorders, obsessive compulsive disorders, personality disorders, psychotic disorders—including schizophrenia—self-harm, sleep disorders, stress disorders and substance abuse. I am sure that all of us, at various times, have come across those problems in our constituencies. Mental handicap, of course, has its own special problems. One is aware of the love and affection that people with special needs engender in their carers and next of kin.
We must remember that mental illness does not affect a different category of person. As has already been pointed out, one in four of the population suffers from some form of mental illness—and that definition does not even take into account questions of mental fitness. All of us are less than mentally fit at various times. Like physical illness, mental illness should be regarded as a normal part of life. However, that does not mean that it is not stressful for all involved. We recognise that mental illness and lack of mental health impose immense stress and pressure on carers. I am sure that we all wish to pay tribute to those who help people suffering from a mental health problem.
In some cases, mental health problems can be extreme. It is extraordinary that one third of all young men between the ages of 16 and 18 who are sentenced in court are diagnosed with a primary mental disorder. It is even more extraordinary that 70 per cent. of prisoners have mental illness or suffer from drug abuse. That leads to two conclusions: first, there should be a major new initiative, involving the national health service, to care for the mental health of prisoners. The second conclusion, which is not directly related to this debate, is that we must reconsider the treatment of heroin abusers. Locking them up in prison cannot be the answer if they have access to heroin in prison, and leave prison with greater problems than they had when they entered it.
In 1999 the Government promised to introduce a mental health Bill. It took until December 2000 to produce a White Paper, and now we have a draft Bill, which I welcome. I also welcome the Secretary of State's response to my submission that when the Bill has had a Second Reading—I am sure that we all wish it well on that occasion—it should be sent to a Special Standing Committee, so that all the issues can be considered on a non-partisan basis. The Bill would effectively go before a Select Committee, during which members of the Committee could cross-examine experts and form a view before considering it in a Standing Committee. That would be entirely appropriate.
The problems in the national health service include a shortage of psychiatrists, an acute shortage of psychiatric beds, a shortage of social workers in psychiatry and a shortage of people who can treat the large number of people who suffer from dementia. About 5 per cent. of those over 65 suffer from dementia, as do 20 per cent. of those over 80. Those elderly people are unlikely to see a psychiatrist at all.
My greatest sympathy is reserved for the young. In some cases of acute mental illness, young people have to wait a long time to see a psychiatrist. The waiting time in my constituency is 18 months. This is a matter of resources; we need more resources for psychiatrists, and the latest modern drugs.
The time constraints are severe tonight, but I welcome the chance to have made this brief contribution. The debate will have served its purpose if it pushes the Government to give a higher priority to mental health services, and helps all of us to regard mental health care as an important part of the national health service that is worthy of debate and support.
6.16 pm
Lynne Jones (Birmingham, Selly Oak): Today's debate has been interesting and enlightening. I agree with many of the comments made by previous speakers, and congratulate the Conservative party on making mental health the subject of this Opposition day debate.
There is much consensus between Government and Opposition on this issue. It was, after all, a Conservative Secretary of State for Health who coined the term "spectrum of services", acknowledging that there had been a failure to put adequate services in place in the community. It is sad that the hon. Member for Woodspring (Dr. Fox) did not acknowledge the failures of the Conservative Government. I agree with much of the Opposition's motion, but I am sad about its failure to acknowledge the positive progress that the Government have made. They have made the vision of the spectrum of services a reality by increasing the number of assertive outreach teams, improving talking treatments and psychology services and investing in the physical infrastructure in our acute wards.
There will be considerable investment in new mental health services in Birmingham. An acute hospital that is not very old is to go. It was provided in the late 1980s, and when I went there, I was appalled at the lack of therapeutic atmosphere in the building. It was a very constrained building that had obviously been subject to a great deal of cost cutting. At last we will get new services; many will be for in-patients, provided locally rather than at the main hospital base. The Government are making that investment. The Conservatives are right to say that we have a long way to go, but it is churlish not to acknowledge that great progress is being made.
I have not yet had an opportunity to look at the draft Bill, but I welcome its publication. I agree with the hon. Member for Gosport (Mr. Viggers) that it should be subject to Special Standing Committee procedure. It is now nearly 20 years since the last major piece of mental health legislation. The draft Bill represents the opportunity of a lifetime, and we must ensure that we get it right. We must ensure that we balance the emphasis on public protection—which I think is over-emphasised—with people's right to receive appropriate care. That right
is not in place at present. Every time we use compulsion it is an indication less of failing in the individual than of failing in the services provided for people in need.The Government are initiating a 10-year programme to build up capacity. Goodness knows, more money is needed, and we must be vigilant in ensuring that money allocated for mental health services is not diverted to deal with other pressures. However, no matter how much money we put into services, it is also essential that we have enough staff with the necessary skills.
We do not have enough staff at the moment. The Sainsbury Centre for Mental Health has pointed out that in the existing establishment, one in eight positions is vacant. If the ambitions of the Government, expressed in the national service framework and other plans, are to be realised, we shall need an additional 8,000 staff—a 12 per cent. increase.
Psychiatry is a Cinderella service in more ways than one. It is not attractive to newly qualified graduates, and we need to ensure that it becomes more attractive. One reason why people shy away from mental health services is the culture of blame in our society, which creates problems in many services, including social work. Because of the stresses and strains on a service, things go wrong—and it is too easy to blame individual clinicians or social workers for their mistakes. That is not to deny that bad mistakes are sometimes made, or that there is some culpability. In many cases, however, people are working against the odds and we should acknowledge that.
We must deal with the blame culture, and we should move away from too much emphasis on public protection. The only time there is any great publicity or press interest is when a tragic event, especially homicide, occurs. In that context, it is commendable that the Opposition have initiated a debate on mental health when that type of public interest is not current. It is also commendable that they have adopted mental health as one of their priorities; it is already a priority for the Government, so there is much consensus, on the basis of which we can move forward.
At the last meeting of the all-party mental health group, we discussed mental health appeal tribunals. We heard about patients who had to wait more than 20 weeks for their case to be reviewed by a tribunal. The Royal College of Psychiatrists has pointed out that the process is extremely staff-intensive. A mental health appeal tribunal chair told the all-party group about the constraints on the tribunal service, including the shortage of psychiatrists to serve on the panels and the fact that the psychiatrists who have to provide reports for the tribunal are over-stretched.
The White Paper proposed automatic referral to a mental health tribunal after 28 days of compulsory treatment; my right hon. Friend the Secretary of State suggested that the Bill would include such a provision. There is concern, however, that even more psychiatric time will be taken up in dealing with the process, so there is a danger that there will be even more delays in the system. The Government need to consider that point.
Although there is consensus among us, omitted from many contributions to the debate was the need to make the experiences of users of the service central to its provision. We should have respect for them and involve them in decisions about their care. A survey carried out by the National Schizophrenia Fellowship showed that a
quarter of mental health service users did not even have the opportunity to discuss their medication, while 62 per cent. said that there was no discussion of any possible alternative.I am pleased to acknowledge the report produced recently by NICE, which made it clear that the choice of anti-psychotic drugs should be made jointly by the patient and the clinician. The report also noted that the use of atypicals should be a primary consideration, and there should be an end to postcode prescribing of such drugs. Compliance with medication is an important issue, and the use of the more modern drugs must be more widespread. Those drugs are not new; they came out 10 years ago, and it is one of the great failures of our service that they were not taken up.
Advance directives should have higher status; they should be given statutory recognition. If treatment is to be compulsory, the people who make such decisions should take into account the wishes of patients, who should have had the opportunity to express those wishes when they had the capacity to do so. Consideration of such wishes should be a statutory obligation, and patients should be encouraged to carry crisis cards.
The social security system is important to the well-being of mental health service users. I urge Ministers in the Department of Health to ensure that they have input to the development of services by the Department for Work and Pensions. Compulsion causes great stress to people who are already suffering from mental ill health. I draw the attention of the House to early-day motion 1345, which notes the poor availability of benefits to long-term patients, who receive only about £15 a week. The chief executive of the mental health trust in my area has pointed out that she has to use valuable trust resources to subsidise patients who cannot afford such basic needs as haircuts and shoes.
Carers are important. Too often, confidentiality is given as an excuse for excluding them. Obviously, if a service user expressly wishes to exclude relatives, that wish should be respected—although questioned. However, family members are too often excluded by default, because clinicians and service providers do not discuss the needs of the whole family with the service user. We must give greater priority to the involvement of carers. People who suffer from mental ill health, as well as those who suffer from personality disorders—the distinction is sometimes blurred—have often experienced trauma in their lives, and family members can help to provide support and enlightenment.
We need joined-up services. We need good services that take into account the fact that many mentally ill people also suffer from alcohol or drug abuse. Too often, services are either not provided at all or are provided separately, without appropriate links.
More and more health and social services are being provided through partnership arrangements. However, that means that when people want to complain about a service, there is no single point of reference. The local government ombudsman deals with complaints about social services, while the health service ombudsman deals with complaints about the health service. Will the Government consider appointing an ombudsman specifically for mental health service users and their carers?
Much has been said about stigma. We will not be able to give priority to mental health services until we deal with the stigma. The hon. Member for Woodspring began by saying that in mental health we accepted services that would not be acceptable in any other aspect of health services, and he is right. Too often, people are afraid to speak out about their experiences; they hide their feelings under the carpet.
One day, the shame attached to visiting a psychiatrist will be no greater than the feelings that people have when they visit any other medical practitioner. People will seek help when they need it. They will be able to talk about their experiences. Indeed, they will be proud of their ability to do overcome all the problems associated with mental ill health in our society. Their family members will not suffer the stigma of having someone with a mental illness in their families. The Government are putting in place the policies to achieve that, and we all have a role to play in ensuring that the day when people can talk about their experiences comes sooner rather than later.
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