Memorandum by the Department of Health
PUBLIC EXPENDITURE QUESTIONNAIRE 2001
Table 2.4.9
ADMISSIONS TO NHS FACILITIES UNDER THE MHA
1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL,
ENGLAND: 1999-2000 (2)
Source: KP90.
Footnotes:
1 Includes all changes from informal status
to detention under the Act, and detentions where the patient was
initially brought to hospital under Section 136 (Place of Safety
Order).
2 The figures in brackets are the totals
for 1998-99.
Table 2.4.10
ADMISSIONS TO PRIVATE FACILITIES UNDER THE
MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN
HOSPITAL, ENGLAND: 1999-2000 (1)
Source: KP90
Footnotes:
1 The table only includes health authorities
in which there were private mental nursing homes that had detained
patients during the year.
2 Includes all changes from informal status
to detention under the Act, and detentions where the patient was
initially brought to hospital under Section 136 (Place of Safety
Order).
3 The figures in brackets are the totals
for 1998-99.
Table 2.4.11
ALL CONSULTANT EPISODES (1) OF PATIENTS WITH
A MENTAL ILLNESS BY HEALTH AUTHORITY OF RESIDENCE, 1999-2000
Notes:
1 Hospital in-patients are assigned to a
Consultant who is responsible for their treatment, and their period
of care under a Consultant is termed a "Consultant Episode".
2 Health Authority of residence is the Health
Authority in which the patient lived before admission. This however
may not be the same area where the treatment took place. The Health
Authority codes were introduced in 1996-97, previously the District
Health Authority codes were used.
3 The figures are provisional as no adjustments
have been made for the shortfalls in data.
4 The population rates have been rounded
to the nearest 2 decimal places.
APPEALS
22. The Mental Health Review Tribunal is
an independent body which hears applications and references by
and on behalf of patient's detained under the Mental Health Act
1983 as amended by the Mental Health (Patients in the Community)
Act 1995. This includes patients admitted for assessment and/or
treatment, hospital orders, guardianship, after-care under supervision
and restricted patients which have come through the courts or
transferred to hospital from prison. In some cases the nearest
relative can also apply for the patient's detention to be reviewed.
Most hearings are a result of applications by the patient or the
patient's legal representative.
23. The Act places a duty on Hospital Managers
to refer a case to the Tribunal at the end of specified periods
where a patient has not had a hearing during that time. The Home
Secretary in restricted cases is also obliged to refer cases to
the Tribunal periodically and has a discretion to refer a patient's
case at any time.
24. In the calendar year 2000 there were
20,421 applications and references for appeals. During the same
period 6,882 cases were aborted mostly because the patient was
discharged by the hospital or the application was withdrawn before
the hearing. There were 11,535 decided cases resulting in 959
discharges (absolute, conditional or delayed).
2.4c Could the Department provide a table
showing, over the last four years, the numbers of people with
mental health problems and with learning disabilities who have
been in special hospitals, prisons and regional secure units?
HIGH SECURITY
HOSPITALS, MEDIUM
SECURE UNITS
AND PRISONS
25. Table 2.4.12 shows the total number
of patients in the high security hospitals at 31 December in each
of the last four years and the number of patients who were classified
as having a learning disability (coming within the Mental Health
Act 1983 categories of mental impairment or severe mental impairment).
Overall patient numbers show an ongoing downward trend and will
probably continue to do so for the immediate future, particularly
since the NHS Plan has placed a renewed emphasis on the efforts
to move inappropriately placed patients out of the high security
hospitals. A high degree of priority will be given to the movement
of women patients, many of whom do not require the levels of physical
security provided by the high security hospitals.
26. We will need to keep under close review
the impact on high secure hospital admissions once mental health
prison in-reach teams are up and running. Whilst these teams should
prevent some admissions by improving the standard of community-type
care available in prison, they are also likely to improve the
identification of prisoners who require transfer to hospital for
treatment of mental health problems. Some of these individuals
will require a high security setting, although the effect on hospital
facilities providing medium and other levels of security is likely
to be more significant.
27. Broadmoor and Rampton Hospitals are
involved in pilot projects for the assessment and treatment of
people with severe personality disorder. The impact on high security
hospital patient numbers arising from the development of the policy
for dealing with this client group will become clearer as the
pilot projects are evaluated.
28. The 31 December 2000 figures indicate
a continuing downward trend for the numbers of high security hospital
patients with learning disability. This trend is expected to continue
since high security hospitals are widely regarded as unsuitable
facilities for most people with learning disabilities.
Table 2.4.12
TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH
SECURE HOSPITALS
Source: HSPSCT
NUMBER OF
PEOPLE WITH
MENTAL HEALTH
PROBLEMS IN
MEDIUM SECURE
UNITS
29. The position remains, as in previous years,
that we are unable to supply data over the last four years for
the number of people with mental health problems and with learning
disabilities who have been in medium secure units. Since last
year's submission, we have commissioned a survey of medium secure
facilities in England and Wales providing services for adults
with a mental illness or with a learning disability. Reports of
the survey were received in February this year, and revealed for
England:—
Adult mental illness
- medium secure beds (1,283 in the NHS and 656
in the independent sector).
- The beds are provided in 27 NHS facilities and
11 independent facilities.
- Just less than 99 per cent of the beds were open.
- Average occupancy was high (90 per cent+) in
almost all the facilities.
Adult learning disability
- medium secure beds (352 in the NHS and 45 in
the independent sector).
- The beds are provided in 10 NHS facilities and
one independent facility.
- Over 99 per cent of the beds were open.
- Average occupancy was very high (98 per cent+)
in almost all the facilities.
30. The development and modernisation of
mental health services, which is one of the Government's core
national priorities, has placed a focus on the local development
of services to meet the needs of the local population. In line
with this policy, Regional Specialised Commissioning Groups (RSCGs)
took over responsibility for the commissioning of high and medium
secure psychiatric services with effect from 1 April 2000. Each
RSCG obtains the funding for these services from the Health Authorities
within its Region. The RSCGs are providing a more focused mechanism
for identifying the needs of their population and developing integrated
local services accordingly. As part of this process, they are
assessing to what extent additional medium secure beds are required,
and are planning accordingly. This includes determining what role
the independent sector should play in the provision of such services.
PREVALENCE OF
MENTAL HEALTH
PROBLEMS IN
THE PRISON
POPULATION
31. The health of prisoners is the responsibility
of the Prison Health Policy Unit and Prison Healthcare Taskforce,
both of which are joint units reporting to the Prison Service
and the Department of Health. As indicated in last year's response
to the Select Committee, it is not possible to say exactly how
many prisoners have mental health problems at any one time. However,
a study of the Psychiatric Morbidity of Prisoners in England and
Wales, completed by the Office of National Statistics in 1997
on behalf of the Department of Health, does provide some useful
information.
32. The ONS study estimated that around
90 per cent of prisoners have a diagnosable mental health problem,
substance abuse problem, or both. For young offenders, that figure
rises to 95 per cent. At any one time, around 5,000 prisoners
have serious mental health problems. There are more than 7,000
self harm incidents a year.
33. These are disturbing figures and the
Government recognises that much needs to be done to improve the
quality and range of mental health care available to prisoners.
The National Service Framework for Mental Health makes clear that
the 7 standards it sets out apply equally to prisoners. Similarly
the NHS Plan makes specific commitments to improve services for
prisoners, principally the 5,000 or so inmates who, at any one
time, have severe and enduring mental illness. NHS funding is
being made available to help fulfil this commitment.
34. The Prison Health Policy Unit and Task
Force are currently developing a strategy document for modernising
and developing mental health services for prisoners. This document,
due to be published in October, will set out what services are
expected to look like in 3-5 years' time so that they better reflect
NHS services and the standards in the NSF. Prisons will be asked
to work with their NHS partners to develop specific mental health
needs assessments for their specific population in line with the
strategy document, together with an action plan to fill any gaps
identified. For some prisons, these action plans may be quite
quickly achievable, while others will need to take a longer focus
of perhaps three years, depending on the needs identified and
the capacity of the NHS and Prison Service locally to respond.
35. One area in which specific statistics
are available is in relation to the numbers of prisoners transferred
to psychiatric hospitals for in-patient treatment as restricted
patients by direction of the Home Secretary under section 47 and
48 of the Mental Health Act 1983.
36. The overall figure for transfers from
prison to hospital rose more than threefold between 1989 and 1994,
but has remained relatively stable since. Of the 1,113 restricted
patients admitted to hospital in 1999, the last year for which
statistics have been published, 742 were transferred under Section
47 (sentenced) and Section 48 (unsentenced or untried). Of these,
276 were under Section 47 and 466 under Section 48. The 466 transferred
under Section 48 account for 42 per cent of all admissions. The
276 Section 47 transfer figure compares with a 1993 figure of
284.
37. The figures are taken from the Home
Office Statistical Bulletin on Statistics of Mentally Disordered
Offenders in England and Wales, which is published annually. The
information is based upon data obtained from the Mental Health
Unit at the Home Office which is responsible for authorising the
transfer of prisoners under sections 47-48 of the Mental Health
Act 1983. The information is in the public domain.
2.5 SPECIAL
ALLOCATIONS
Could the Department list any special allocations
and likely allocations in 2001-02, and indicate any likely allocations
in 2002-03?
1. Extra resources of £155 million
were made available for 2001-02. This included £40 million
to assist plans for winter, and £115 million to be used by
regional offices to target specific problems.
2. At this time there are no plans to award
any special allocations for 2002-03.
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