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6.31 pm
Hywel Williams (Caernarfon): I, too, welcome this debate. I have a long-standing interest in this issue; I am a former social worker, approved under the Mental Health Act 1983. May I say immediately that I was disappointed to find that clause 9(4)(b) of the draft mental health Bill notes that the applicants will not be approved social workers, but approved mental health professionals? When I looked at the explanatory notes, I saw that those approved mental health professionals are
- "to undergo training and have a set level of understanding of mental health legislation and in assessing the non-medical aspects of treatment."
I worked under the previous legislation—the Mental Health Act, which has already been mentioned—and I know very well the weaknesses of the mental welfare officer system applied under that Act. I also know very well the weakness in relation to the independence of mental welfare officers. We now have a once in a generation opportunity to reform mental health legislation. I welcome the draft mental health Bill and look forward to contributing to debates on it.
Care in the community has not been the failure that some people claim. Care in the community has been underfunded. It has not been afforded sufficient priority, and the particular difficulties and opportunities of providing services in rural areas, of which I have great experience, have certainly not been properly addressed. However, it would be ludicrous not to accept that there have been failures, and we need to learn lessons from those mistakes. It is right to pay tribute to people, such as Mrs. Zito, who have suffered and to those who have done so much to draw attention to those failings and to remedy them.
One can understand the Government's wish to consider the safety of the patient and others as a key factor. That is a key factor, but it is not the only one. Care in the community is, and will remain, the first choice most of
the time for most of the people with mental health problems. That is a matter of practicality, as well as one of principle.I hope that some of my concerns will be addressed in the legislation and the developments that flow from it. I am concerned about the quality and the quantity of services in rural areas. After all, we are seeking equality of service throughout the United Kingdom. There are particular costs and difficulties in rural areas—for example, in gaining access to day facilities and to proper assessments if and when compulsory measures are considered. Any new legislation must take account of those issues; it must not be framed only with the urban context in mind. Securing equity of service to rural dwellers requires substantial additional investment in rural services, and we will look for assurances about that specific extra investment from the Government.
Lastly—I should say that I have heavily edited my speech, but hon. Members will have the benefit of hearing my opinions at another time—I am particularly concerned about language issues. I share that concern with hon. Members from other parts of the United Kingdom where there is a measure of societal bilingualism, such as parts of Scotland, and with black and ethnic communities, where many people who could be subject to compulsory mental health treatment may not speak English as their first language, if they speak it at all.
Proper communication is essential to a proper assessment. In fact, the 1983 Act requires that social workers interview patients in a suitable manner. However, the code of practice under that Act clearly takes an ability to speak English as the given context. Other languages are seen as just that—they are other—despite the Welsh Language Act 1993, under which Welsh and English are treated equally. The code of practice apparently suggests that the answer to language problems is to find an interpreter.
Most Welsh or Scots Gaelic speakers can also speak English, but when dealing with highly personal problems, such as mental health issues, they would prefer to use their own chosen language. I am sure that that is the case for speakers of so-called ethnic languages. If I were suffering from a mental health problem, I would need an interpreter, although I think that I am perfectly capable of conducting myself in English. I would prefer to be interviewed in Welsh, and I am sure that that would be infinitely more productive.
Any new legislation and any new code of practice must respond to that issue and ensure that own-language provision becomes easily accessible, which involves rights to advocacy and assessment. Welsh should be used on the same basis as English in the mental health services without remark or hinderance, and I hope that the Minister will give an assurance on that in summing up.
6.36 pm
Valerie Davey (Bristol, West): I will be brief and just make one main point. The basic premise on which I approach health matters is that prevention is better than cure. I want to refer to the work that the Government have started—I hope that it will continue—with young people. Taking up the theme that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) touched on, I contend that prevention work would be best applied to that issue. No one wants to label such children. I am thankful that
relatively few children need acute treatment, but we must not ignore those who do, and the Channel 4 television programme, "Young Minds", has recently added to our awareness of the issue.Last week, a small group of hon. Members from the Select Committee on Education and Skills visited a remarkable school in Moscow, where, among other things, we met a permanent member of staff—a psychiatrist. The work that she does with not only individual children but the parents, families and the community at large, as well as 200 other teachers, spoke to us of a very important role. She is working with other such people in Denmark and Belgium, but not in Britain. We could learn lessons from that preventive work.
Those with serious mental illness often say that their childhood experiences have led to their developing mental illness later in adulthood. So, in working with children, we should be more aware of the climate in schools, families and communities that leads to mental health, and I ask the Minister, given her previous work, to link up with the work on health that is being done in the Department for Education and Skills to ensure that, to echo the words of the Government amendment, there will indeed be "new services for children".
6.39 pm
Mr. Oliver Heald (North-East Hertfordshire): We have had an excellent debate on what everyone has agreed is an important and topical subject. Let me first refer to what was said by the hon. Member for Bristol, West (Valerie Davey). It is true that concentration on children's services and early intervention are vital, which is one reason for the reference to early intervention in the motion.
The great frustration for the party in opposition is that all its members can do is talk about issues. Part of the privilege of standing at the other Dispatch Box is the ability to do something. I agree with the Secretary of State that deeds, not words, count. Nevertheless, choosing the subjects to be debated can enable us to make a difference. Nearly everyone who has spoken today has agreed that simply by raising the subject of mental illness the Opposition have done something worth while.
As the hon. Member for Leeds, West (Mr. Battle) has said, as the hon. Member for Wakefield (Mr. Hinchliffe)—Chairman of the Select Committee—has said, as the hon. Member for Birmingham, Selly Oak (Lynne Jones) has said, as my hon. Friend the Member for Gosport (Mr. Viggers) has said, and as so many others have said, the stigma attached to the issue of mental health is one of the biggest obstacles to changing the way in which mental health services are delivered.
I agree with the hon. Member for Wakefield that the old system of asylums was awful, and had to be changed. He defended care in the community, as did the hon. Member for Caernarfon (Hywel Williams). I do not believe, however, that anyone could accept that that policy was implemented adequately. I have talked to carers and others who experienced its implementation. It is impossible to justify the inappropriate placing and the turning away of so many people, and the fact that the facilities they needed were not available. I still defend the liberation of tens of thousands of people who did not need to be in long-stay mental institutions, but we must recognise the realities of what happened.
As the hon. Member for Birmingham, Selly Oak said, we must recognise progress where the Government have achieved it. Today, after five years, we have a draft Bill
on mental health. I am pleased that we have it, but five years is quite some time for us to wait for a change in the law that was promised so long ago. I am also pleased that it has now been decided that atypical medicines will be available to schizophrenics, but that too has been a long time coming. It has taken two years for the National Institute for Clinical Excellence alone to act.There has been progress. It is, however, the job of Oppositions to hold Governments to their word—which we are trying to do—and also to talk to those involved with mental health. It is our job to go and see what is best practice, what works and what does not, so that when the time comes for us to present our policies they are well informed and based on practice.
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