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4.13 pm
Susan Kramer (Richmond Park) (LD): Let me say to the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who has drawn the short straw in having to reply for the Government, that I appreciate that, since the earlier debate ended well before its expected time, he has had to step into the breach. Under those circumstances, if I raise issues that are unfamiliar to him, will he do me the kindness of investigating them? We are considering significant matters that have an impact on some of the most vulnerable people—certainly some of the most vulnerable children—in our society.
I want to consider a subsection of the issues that are covered by today’s debate: assessment and treatment of families with severe mental health disorders. I was drawn into the matter because the Cassell hospital is in my constituency. It is a specialist hospital, which deals with, assesses and treats families with severe mental health disorders. It also assesses and treats adults and adolescents and is considered exceptional in its field. It provides a service to a vast area of southern England.
I was brought into the matter originally because the Cassell hospital had to amalgamate its adult and adolescent wards. I innocently assumed that I would come across the more general problem of cutbacks in spending on mental health that local primary care trusts’ financial difficulties had forced on several areas. There is an element of that, but it is not the key problem.
I came to understand, through being exposed to experiences at the Cassell, that a major issue was a reinterpretation of the Children Act 1989. Section 38(6) requires:
“Where the court makes an interim care order, or interim supervision order, it may give such directions (if any) as it considers appropriate with regard to the medical or psychiatric examination or other assessment of the child”.
In the early days of implementing the clause, it was interpreted to mean that assessment inevitably led to treatment. In other words, when a problem was assessed and a treatment could be prescribed, it was expected that the treatment would be followed through and funded by the local authority or the PCT, whichever was appropriate.
In 2005, a court case that was brought before the Lords of Appeal overturned that specific interpretation. Consequently, the courts concluded that the requirement to fund affected assessment but not treatment. It has changed the whole way in which families with severe mental health disorders are treated and managed in the UK. That decision by the Lords of Appeal in November 2005 reinstated the distinction between medical or psychiatric assessment and the treatment of the child.
Although that sounds like a nuance in the law, it runs foul of current practice in child psychiatry. Medical treatments under the NHS in the circumstances that we are considering are not neatly captured because psycho-social treatments are frequently the approach that needs to be taken. That is why specialist centres, such as the Cassell, are so engaged in the process.
Let me provide some sense of the impact of the case. A test case, generally known as Ray G, was one of the cases that shows the importance of linking assessment and treatment. It is the case of a family who were treated at the Cassell hospital. The mother was not initially able to provide the child with the care it needed, due to her own traumatic history of neglect. Initially, the child therefore had a fraught relationship with the mother.
Under a court order, the family—mother, father and child—engaged in an assessment, and treatment followed that assessment. When that transition into treatment was contested by the local authority—we all recognise that treatment is expensive—the High Court approved the treatment and the family is now doing exceedingly well. The child is flourishing and the family remains intact. The social justification for assessment and treatment being combined is well illustrated by that instance.
Following the reinterpretation of the law, however, families can be assessed but, if the local authority chooses not to fund the treatment—as they frequently do, because treatment is expensive—the family is then sent back into the circumstances that caused the court to look at their case in the first place. They are returned to the local authority, where services are typically inadequate.
Another case has been brought to my attention. I do not have a pseudonym for the person concerned, so I shall not use any names. An 18-year-old mother had suffered extreme emotional and physical neglect at home, as is frequently a key factor in such cases. When she became pregnant, she hoped for something better for her child. Initially, she cared well for the baby, but as the baby grew more demanding, that care fluctuated and raised the concerns of the local authority.
Mother and baby were removed to a foster care placement, but the concerns continued unabated. There were scant local resources to provide support to the mother, who had never lived away from home. She became so distraught that she threw the child on the bed in despair. The result was a court attendance and an assessment at a specialist centre—the Cassell hospital, where most of my information on this issue has come from.
There, the mother’s difficult history of neglect and deprivation was gradually understood, explored and worked through, as was her wish to provide something different for her daughter. The history was so protracted as to warrant a specialist investigation. The child began to flourish, and the mother engaged well. At the end of the assessment, a recommendation for a move to treatment was made by the clinical staff.
The local authority refused to fund the treatment, however, and demanded an immediate return to the original, unsafe, foster care placement that had previously proved inadequate. That was in no way supportive of the child’s experience or in keeping with the welfare of the family or the child, given that it would have involved an abrupt change of setting and the loss of relationships with the staff. The mother was distraught at the thought of returning to the place in which she had not coped before. In this case, the Cassell made the decision to fund the treatment for free. As a consequence, mother and daughter are now doing well. They have returned to the community and
are out of the care system altogether. They have a positive future ahead of them.
These are obviously difficult and complex cases. The Government clearly expressed their intent in supporting the original interpretation of section 38(6) of the Children Act, in which treatment followed assessment. The collective resources of the NHS and the local authorities were focused on keeping the family together and giving it a chance to recover from an environment of severe mental health disorder. It seems to me that we cannot read the Children Act or listen to the language of Ministers without believing that that is the intent.
Since the reversal of the interpretation of that section in 2005, however, the Government have taken no new action and introduced no new legislation to reinstate their original intent. The consequence has been that, in specialist hospitals such as the Cassell, families are being assessed as capable of treatment and in need of treatment, but the treatment is not being funded and the families are being returned to the local community. As I understand it, the courts themselves have now become inhibited. Judges are asking, “If the treatment cannot follow the assessment, why am I sending this family for assessment in the first place?” So the assessment process itself is breaking down.
When I first began to look into this matter, I thought that I was dealing with the standard funding issues relating to mental health. When this case was raised, however, I became aware that I was dealing with a piece of legislation. As I have discussed the matter with colleagues, I have begun to understand—perhaps this is new only to me—that I am entering a minefield of problems. We are starting to hear of cases in which children are being very easily removed from families in which mental health issues have been raised. If those issues are evident in the form of neglect or even abuse, they raise massive concerns with social services in the local authority.
Rather than trying to treat the family and enable it to overcome the problems and become successful, children are simply being removed from home and put into foster care or adopted. That is surely not the purpose of the 1989 Act or the Government’s intent.
My goal is to ask the Minister to become a champion for those families. I ask him to investigate what is happening on all those issues and to consider amending the law so that its original purpose and original interpretation, with which the Government were satisfied, is reinstated. I also ask him to go further and take up the issue of families with severe mental health disorders.
The Minister will be well aware that when children are removed from a family, even the most difficult family, it is a highly traumatic experience. Many would argue that there is almost no way to repair the damage that is done to a child who is removed. Sometimes it is inevitably the necessary and better option, but there is a general agreement, both across most of the professions and in the language used by the Government, that if the family can be helped to recover and restore itself to a positive environment, that is better for the child and family as a whole. That is why I took the opportunity offered by this debate to raise such issues.
4.26 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Richmond Park (Susan Kramer) on securing the debate. The problem may well affect a relatively small number of families in our society, but that does not make it any less important. Enduring and severe mental health issues are a challenge for the individual child and young person’s development, but they can also have a major effect on family dynamics, and relationships. We should be trying to create a system that not only assesses but treats a family holistically and does everything that it can to support a family to get through and to cope with those psychiatric or psychological problems, enabling the family to remain together. Unfortunately, in some circumstances it is in the interests of both the child and the family for the child or young person to be removed from that home environment. However, in many circumstances, with the right preventive and holistic support, that child and young person can be supported to remain within the family environment.
The hon. Lady has identified a major problem as a consequence of a court judgment. It has changed some of the decisions that have been made within the health service in terms not only of the assessment but of the treatment of families in such circumstances.
In recent times—I should put the matter in context—we have made major progress in respect of mental health services for children and young people. Child and adolescent mental health services teams have built up in every part of the country, from a very low base, after the Government set a target and, as a result, there is a much more comprehensive range of child and adolescent mental health services in every community. The Mental Health Bill, which finally passed all its stages in this House yesterday, deals with age-appropriate treatment for young people with mental health problems. That is another advance with regard to mental health provision.
I acknowledge, however, that the hon. Lady has identified an anomaly and possibly an unintended consequence. The ministerial team at the Department of Health has undergone a major change, so it is not entirely clear who will be responsible for which policy area, but that will be finalised today or tomorrow. I assure the hon. Lady, however, that I will take responsibility for ensuring that the Department looks specifically at the consequences of the court judgment, its impact on the way services have related to families and, where appropriate and necessary, that the Department makes changes to ensure that those families have access to the kind of treatment that would give them the best chance of getting through those difficult and stressful life experiences and of coming out the other end with as decent a life as possible.
I do not want to go on any longer than is necessary. The hon. Lady has raised an issue of import and significance and I give her and the House a commitment that we will take it seriously and respond directly to her in the next few weeks on the progress that we have been able to make.
Adjourned accordingly at half-past Four o’clock.
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