Select Committee on Health Memoranda


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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