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9.14 p.m.

Lord Sainsbury of Turville: My Lords, I congratulate the noble Lord, Lord Rowallan, on bringing forward this Bill. It raises the vitally important issue of in-patient care for mentally ill people. Your Lordships will be aware, I am sure, of the intense pressure on acute psychiatric beds, especially in inner cities. The Bill attempts to address that pressing issue. It is surely right that health authorities should have costed and timetabled strategies for developing local psychiatric care.

However, the Bill, I believe, is less helpful than it could be because it seeks to address in-patient provision as if it existed in a vacuum. Most people who suffer from mental illness live in the community and have done so for decades. For 95 per cent. of people who suffer from severe mental illness this is also the best place for them to be. It is essential therefore that reform and improvement to our system of mental healthcare addresses support for people in the community as well as the adequate provision of in-patient care. These are not separate options which can be pursued independently. We have to make progress on both fronts simultaneously.

Studies of pressures on acute beds have shown that patients often remain in hospital because they have no accommodation to go to, and there is little or no skilled support available in the community. Equally, we know that community mental health teams often find it hard to cope because they do not have ready access to beds

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when the condition of a patient is deteriorating. Simply investing in beds will not solve the problem, as these beds will then be rapidly occupied by people who cannot be discharged due to lack of appropriate housing or support. More beds may be needed in many places but they must form part of balanced and comprehensive services. If investment in beds did take place at the expense of community services as a consequence of this Bill, that could make the crisis in mental healthcare worse rather than better.

A poorly balanced strategy also makes little financial sense. Maintaining someone in a hospital bed or similar environment costs around £50,000 a year whereas providing someone with a severe mental illness with suitable residential accommodation and a high level of support outside hospital costs £10,000 to £20,000 a year. The maths speaks for itself.

I would argue that developing targeted systems of care for severely mentally ill people is the single highest priority within mental health. We are relying far too much on a limited range of services. Little account has been taken of the international evidence that shows how to run mental healthcare successfully. Severely mentally ill people require the same range of services and support as do other disabled or vulnerable people. Crucially, this includes adequate supported accommodation, and something useful or interesting to do during the day.

Successful services will particularly require skilled and dedicated workers to be in touch with patients frequently--sometimes daily or twice daily. They must be able to offer a range of health and social support services. These workers should be organised into what is known as assertive outreach teams that have a specific responsibility for delivering services to the most mentally ill people. On 9th March, the Sainsbury Centre for Mental Health will be launching Keys to Engagement, a report which will set out clearly and forcefully the arguments for assertive outreach.

Finally, I would like to say a word about mental health legislation generally--the third part of a mental health strategy besides community support and places of safety. I believe there is now a need to review mental health legislation to see what more can be done to support and enable staff to work with the most ill people. We need to examine what can be done to help ensure patients can be taken into hospital rapidly when they begin to show signs of illness in the community instead of waiting until they become very ill. As always, we need to be balanced in our approach, and I would like to make it clear that I am not supporting the draconian style of community treatment orders, which I do not feel would be widely acceptable in our country. But the time has come to see what can be done to make mental health legislation fit more effectively with modern mental health services.

Like other noble Lords before me, I very much welcome the opportunity to have a debate on this vital subject. But I cannot emphasise too strongly the need to develop mental health policies and mental health law that address the whole spectrum of mental health services including hospital, residential care and intensive support outside hospital. A piecemeal approach to this issue simply will not work.

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9.18 p.m.

Lord Mottistone: My Lords, I congratulate my noble friend Lord Rowallan not only on introducing the Bill but also on the great interest he is taking in the very important problems of mental illness, for the reasons that he told us.

The principles of the Bill are strongly supported by both SANE, which helped Dr. Julian Lewis prepare the Bill in its earlier stages, and by the National Schizophrenia Fellowship. Your Lordships will be aware, although perhaps not those who are present now, because there have certainly been some changes on the Benches opposite compared with a year ago, that I am chairman of SANE and that I have been supporting the National Schizophrenia Fellowship in this House for over 15 years.

My noble friend Lord Rowallan explained the purpose of the clauses of the Bill, with which I agree. I wish to underline particular points. With regard to Clause 1, there is no doubt that the over hasty shutting down of mental health wards and the removal of beds by all health authorities throughout the kingdom during the past 20 years has had two very adverse effects.

Before I go on to tell noble Lords about those effects, I have to say that when I listened to the noble Lord, Lord Hunt of Kings Heath, and the noble Lord, Lord Sainsbury of Turville, I agreed with practically everything they said, if not everything. However, particularly in the case of the noble Lord, Lord Hunt, I felt that his speech was devoted to the White Paper which he mentioned and not to the Bill. Much the same really applied to the speech of the noble Lord, Lord Sainsbury, which was concerned with what the debate ought to have been about rather than the Bill. The Bill is important but its contents are not the only things that matter. I ask the noble Lord, Lord Sainsbury, whether you must wait until you can have a monster revision of the 1983 Act, which is what he was roughly suggesting, and not tackle immediate problems because there are some immediate problems. I shall mention two of them which relate to Clause 1.

First, the shutting of beds too quickly over a long period has meant that, in too many cases, there is now not enough suitable accommodation for all the mentally ill people who are at times beyond the capabilities of any form of care in the community, whether with their families or in some sort of public care. Secondly, there is now not enough suitable accommodation for all the mentally ill people who seek temporary protection from the stresses of any community as voluntary patients.

Clause 1 invites health authorities to assess how, in their area, the balance of beds needed to rectify the current shortage for the two types of patient I have mentioned can best be provided. It does not require immediate extra expenditure but points to the best direction for that to be provided when the moneys are available.

Clauses 2 and 3 deal with the more immediate need to provide safety and reassurance for people who are in the care of mental hospitals either as patients in instances where care in the community cannot cope or as voluntary patients of the type I have described.

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Action to provide such safety factors should be taken soon in those hospitals which need them. It seems to me that at this stage they are not getting the encouragement that they need. It has become obvious to me over many years of studying the problem that, by the way in which the National Health Service is run, the Government have been able to escape criticism for far too long on shutting down beds because they could say, "Oh well, it is all being done by the local health authorities; it is not our business at all." In fact for a long time they would not even say they had the figures. They said they were being collected locally. Therefore one could not obtain the relevant statistics. If one has not come across such a response in a parliamentary framework, one might not quite appreciate this point. Governments can escape and not do things when they want. They can blame someone else; they can say that someone else is responsible. That is a matter which needs to be tackled. As Back Benchers in this House we need to keep a sharp eye on that. I am not being in any way critical of the present Government. I am really being critical of my own noble friends, one of whom is sitting on the Front Bench but did not have to deal with this subject.

It seems to me that what my noble friend Lord Rowallan is trying to do, and what Dr. Julian Lewis was trying to do in another place, is to help the Government reverse the swing of the pendulum of care for the mentally ill. It has swung too far towards the community and away from care in proper buildings. I spent much of 10 years before the election trying to persuade my noble friends in the previous government that they were allowing local health authorities to push the pendulum too far and too quickly towards community care. At the time I felt that many noble Lords who now support the Government, and who are not present tonight, agreed with me. They are perhaps not here because they seem to have forgotten their earlier concern.

Before I realised that there was such an early change of heart on the part of Back Benchers opposite, I was most surprised that the Government used the blunt instrument of talking out a Commons Private Member's Bill showing what seemed to me to be their contempt for the efforts of those who really care for the sad fate of mentally ill people when there are not enough of the caring facilities they really need. I hope that we shall see, as a result of this Second Reading debate, more understanding shown in this House and by the Government, and that they will make an effort to see how they can help the Bill achieve an acceptable wording which can be made to work and so help the legislation through both Houses of Parliament.

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