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Noble Lords: Question!

Lord Hunt of Kings Heath: My Lords, perhaps I may remind the noble Lord that discussion on a Statement should be confined to brief comments and questions for clarification.

Lord Thurlow: My Lords, I apologise. On the question of co-ordination between local authorities and

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the health service, is there any possibility of moving towards a single point of responsibility, as Sir Roy Griffiths originally said was necessary?

Baroness Hayman: My Lords, I am grateful to the noble Lord for his welcome for what we have done. He used the word "package". It reflects a recognition that it is essential that we address all the necessary elements--the elements of extra resources for investment; of making sure through the national service framework what services are needed; of assessing needs in various areas; and of the necessary legislation that will underpin and provide a framework in which services can be provided.

As to the 24-hour beds, we hope to see action on those from the money already provided. Some of last year's winter pressures money, for example, was put into mental health. We hope to see a very swift response in relation to 24-hour beds. By making sure that the range of services, the 24-hour beds and the medium secure beds, are available, that in turn takes away some of the pressure on the acute beds, from which people cannot move because there are no alternatives.

There has been recognition in all the contributions made today that we need a range of services--both the community and inside hospitals, as well as half-way house type services--to reflect the range of need of a very wide group of patients.

Lord Renton: My Lords, does the noble Baroness accept that mental illness and mental handicap are quite different--because mental handicap is incurable--and that very few mentally handicapped people are aggressive? Will she confirm that the Statement does not broadly apply to the mentally handicapped people in our society? I hope that early in the new year she will make an equivalent Statement about the treatment of those who are mentally handicapped.

I wish to ask the noble Baroness one question with regard to mental illness? Will she confirm that the present small number of secure hospitals for containing people who are suffering from mental illness and extreme aggression will be retained, bearing in mind that the people in those hospitals are nearly always sent there by the criminal courts?

Baroness Hayman: My Lords, I am grateful to the noble Lord, Lord Renton, whose commitment to the needs of people with mental handicaps and learning disabilities is well known throughout the House. I am happy to give him the reassurance that he seeks. They are a completely different group of people, and we are dealing in this Statement with people suffering from mental illness.

High security services will continue to be based on the three special hospitals for the foreseeable future. We are committed to better integration of high security psychiatric services with other parts of the NHS. One of the measures we will be taking will enable better integration by removing the barrier currently preventing high security services being managed by NHS trusts.

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This will require primary legislation. I can assure the noble Lord that public safety will remain the prime concern of those who manage such services.

Lord McNair: My Lords, I am not sure whether the Minister has had a chance to read what I said on 19th October. If she has, she will be aware that I am unlikely to be convinced that the increase in spending on the mental health services will solve the problem. I wish to raise one point. The increase in the number of young people to which the Statement refers may well be partly the result of the tendency of the psychiatric services to seek out new clients by labelling different groups of people in society, in this case particularly children. For example, they label children with an attention deficit hyperactivity disorder, and then often proceed to introduce them to a life of drugs by prescribing them drugs such as Ritalin.

Baroness Hayman: My Lords, I recognise the concerns of the noble Lord. I read his contribution in October but I was not sure how well I had retained it until today. I shall revisit it. Regardless of the point the noble Lord makes about issues such as attention deficit disorder, there is a worrying rise in child and adolescent mental illness and a worrying disparity of services throughout the country. It is important that we deal with these young people as and when their difficulties arise. There are ways in which this can be done, but services are very patchy. That is why we have made it a priority. We are determined to see that those children receive the services they need. The preponderance of some of these problems has to be seen particularly in conjunction with children who live away from home with our broader response to the Utting Report and its recommendations.

Baroness Pitkeathley: My Lords, I too thank the noble Baroness for this very welcome Statement. She will understand that I particularly welcome the support for the informal carers for the family, most of whom want to go on caring and are often subject to intolerable burdens. Recognition that family care, where possible, is not only the best but the most cost-effective form of care is welcome indeed.

I also welcome the Minister's assurance that community care has not failed in many aspects. Anyone who has worked on the back wards of the old mental hospitals--as I have--knows that much community care has been a resounding success, not only for those with mental illness but for older people and those with learning disabilities. It is important that we recognise that.

Does the Minister agree with me that any reform of community care law in order to make it stronger to deal with the small minority who are the subject of the Statement today should not be at the expense of preventive work to ensure that crises do not happen in the first place. Does she also agree that some of the money, the welcome extra resources, should be put into preventive services such as counselling, early intervention and family support groups.

Baroness Hayman: My Lords, I can reassure my noble friend that the national service framework will be

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looking across the whole range of services that are necessary. It is much more cost effective to put money into preventive services if we can be assured of their quality and know that they are effective than to wait for crises to occur. In the whole debate about provision within the community and provision within hospitals and institutions, what we are not trying to do--and what no one wants to do--is recreate the Victorian institutions of the past for everyone regardless of their degree of need. What we are trying to do is ensure that there is a broad framework with a range of provision that meets the needs of the most severely ill in order to protect them and society as a whole.

My noble friend asked about carers. There is a recognition of the enormous amount of care that is being provided by families within the community. As she is only too well aware, we will be producing in the new year a strategy for dealing with carers not only in the field of mental illness but across the whole range of provision.

Lord Annaly: My Lords, I wish to flag up two areas of importance, having spoken on this issue this morning to a psychiatrist who deals with mental health. The taking of medication causes problems to people with mental health difficulties. They fail to take their medication and then start to run into behavioural difficulties. I wonder how the assertive outreach teams will work in practice. I am delighted that, according to the White Paper, they are working well in Birmingham. However, will nurses have to go out and sometimes apply force in order to get people to take their medication, bearing in mind that a good deal of medication needs to be taken on a daily basis? How will that work in practice? It is almost a combination of a policeman's job, supported by a nurse, to actually achieve that.

Secondly, I see the renewable detention places, which will provide 24-hour beds, as being a problem of cost. If they are not to be on the scale of old institutions, I imagine that they will be quite small. Will they be a combination of a secure centre, like a prison, and something else? I see them as being costly to run if they are to be spread across different areas. They will be costly in manpower as well. Will the Minister comment on that point?

Baroness Hayman: My Lords, the extra resources we are providing over the three-year period are a recognition that it is a costly business to provide the range of care that is needed--whether it is the range of staff to provide beds manned for 24 hours, whether it is the appropriate drug treatment, or whether it is the counselling and preventive services to which my noble friend referred earlier. It is because of those cost implications that we are putting large sums of extra money into mental health services.

The noble Lord asked specifically about non-compliance with treatment. The assertive outreach teams are working successfully within the current legal framework in trying to persuade people to recognise their need to comply with treatment. However, by

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definition, non-compliance itself brings with it a lack of insight into the problem. That is why we have asked the expert group advising on the review of the Mental Health Act to make specific recommendations about how one aspect of policy, under which non-compliance with treatment for some patients is no longer to be an option, could be incorporated and supported. As I said earlier when this point was raised, we have to recognise that there are civil liberty implications. We have to have a balanced programme which ensures that patients who want to live independently can do so in a situation in which the safety of the community and of themselves is not threatened.

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