I am grateful to the Joint Parliamentary Secretary for his courtesy in coming to the House tonight, as I know that he had another important engagement which he has now cancelled. I am sorry to cause the hon. Gentleman inconvenience, but I wish to raise a matter of substantial importance in the City of Cardiff. I have not hitherto taken part in the debates in the House on the question of mental health, but recently I paid a visit to the Whitchurch Mental Hospital, Cardiff, and I must say that my deep interest was aroused and my concern for those who are involved in the work of the hospital has found expression in this debate.
I want to pay a tribute to the doctors, the nurses, the psychiatrists and the social workers and the whole splendid team who, under the leadership of Dr. Spillane, pursue the interests of them mentally sick at Whitchurch Hospital. Like those in other mental hospitals, they work under substantial difficulties. For instance, the workroom which I visited was crowded almost beyond capacity. But I gladly pay tribute to the substantial improvements that have taken place in this hospital since my previous visit, unfortunately a long time ago. Bright decorations and modern furniture have made the wards much more attractive and, I believe, the life of the patients much more variable.
I was shocked to learn that a great number of patients in the hospital ought not to be there at all. Devoted medical skill and care and the use of modern drugs have together served to bring these patients to a point where they could live in the community if they had suitable accommodation. Some of them have been long years in the hospital and the only reason they are there today is either that they have no family to which they may return or that for a diversity of reasons their family declines to take responsibility for caring for them. I can think of no greater agony than for a restored person in a mental hospital to be aware that he has to go on living there simply because he has no home to which to return. It is a palpable injustice which society perpetrates upon these people that they should have to endure further years in the mental hospital like lost souls in an indifferent society.
In a Written Answer today the Parliamentary Secretary was good enough to tell me this:
I understand that about 160 patients in this hospital could live in the community if suitable accommodation of various kinds were available. Fourteen have been housed in local authority accommodation during the past six months. The local authorities concerned proposed a substantial increase in their provision of residential homes.
I gather that Whitchurch Mental Hospital is in no different plight from that of other mental hospitals throughout the country and that this is not a local but national problem. There must be, if it is a national problem on the same scale, many thousands of unfortunate people in this unhappy plight. There is an urgent need for more adequate community services for both the mentally sick and their families.
At the present rate of absorption into local authority homes it will take years more before these recovered people can begin to take their place in the life of the community. The Minister will correct me if I am wrong, but I understand that Cardiff has a community centre for eight people, with another soon to be forthcoming, but that this is only a trickle when we need a flood.
The Mental Health Act, 1959, which I regard as a giant stride forward in legislation for the mentally sick, put upon local authorities a special responsibility for the provision of these hostels. I am thinking not merely of short-stay hostels, but those which cater for people who are able to go to work but whose standard of behaviour at home may not be good enough, even in supervised lodgings; people who need the care of responsible, trained social workers. It is vital that qualified trained personnel should be in charge of these community centres. The hostel is not merely an alternative form of accommodation—to get these folk out of hospital. It is part of the plan for rehabilitation.
I hope that the Minister will tell the House what steps are being taken to ensure an adequate supply of trained social workers who may operate under the guidance of trained psychiatrists. Dr. Martin, Senior Lecturer in Social Medicine at the University of Edinburgh, in a remarkable article on 2nd April, in New Society, pointed out that each local health authority had submitted its own proposals for the number of social workers to be employed during the next 10 years, the number of hostel places to be provided and so on, and went on to say that psychiatric social workers still accounted for a good deal less than one-tenth of all social work staff in community mental health services.
Nearly all the social work in the community is carried out by untrained staff, in spite of the fact that workers in this setting function with a high degree of independence.
Dr. Martin pleads, as an expert, for a shift of psychiatric social workers from the hospital into the community setting.
I ask the Minister what steps he is taking to increase the number of such excellent day hospitals for the mentally sick as that supervised by Dr. Joshua Bierer at Marlborough. I understand that the present danger of the modern and enlightened mental hospital—and there are more than a few of them—is that it can produce the type of patient who actually prefers the hospital and its security to taking the risk of reentering community life.
Dr. Bierer's solution is a comprehensive day hospital based on the community and providing facilities geared to meet the individual needs of each patient. Could the Minister tell us to what extent these hospitals are being matched by community centres? I know that to find suitable lodgings for folk who are fit to leave the mental hospital is a giant's task. I suggest to the Minister that where community centres are provided he ought to invite to serve on the house committee enlightened and dedicated employers and trade union representatives who can help in the rehabilitation of these people by employment.
I should also like to ask to what extent refresher courses are available for the personnel engaged in this remedial work. As I give way to the Minister. I should like to pay my tribute to the National Association for Mental Health for its valiant efforts to create community concern for these people. We in this House believe in the dignity of the individual and the rights of personality in finding expression, and I am deeply moved by the plight of people who want a chance to live a full and honourable life again.
I believe that it is our obligation, and the Minister's obligation in particular, to provide that opportunity and I shall be grateful if the hon. Gentleman can enlighten us on the development of the community centre.
I am well aware of the keen interest of the hon. Member for Cardiff, West (Mr. G. Thomas) in the subject which he has raised tonight, and I should like, if I may, to compliment him on the manner in which he has put his points, and to thank him for giving us the opportunity to consider this very human problem.
The patients with whom we are concerned tonight are those who were admitted to hospital some years ago as genuine psychotics. They have now recovered from their psychoses, but are unable to leave hospital because, as the hon. Gentleman has said, for one reason or another suitable accommodation is not available. I should like to make it clear that this is not a new problem; indeed, I think that the hon. Gentleman himself recognised that.
It is not a problem peculiar to Whitchurch, but a national problem. It stems in part from a change in the attitude to mental health discussed by the Royal Commission on the Law relating to Mental Illness and Mental Deficiency, and given legal recognition in the Mental Health Act, 1959. As the House knows, the essence of the change is, where possible, a movement away from the retention in hospital towards care in the community.
In any consideration of the problem, we must recall that psychiatric patients range from those who cannot be released into the community because of their deep need for special supervision and treatment in hospital to those who, by any standard, are able to move out of hospital back to their own homes to fend for themselves within the community. Between these limits there are many gradations of fitness, and many shades of ability to make the change from the one environment to the other. The patients with whom we are now concerned no longer need hospital treatment, but need to be helped in the community.
I agree entirely with what the hon. Gentleman said about Whitchurch Hospital and the devoted staff who work there. This is certainly a very good hospital. Today, 95 per cent. of admissions are on a voluntary basis. Indeed, this was one of the first hospitals to run an associated day hospital. I noted what the hon. Gentleman said about day hospitals. This is something that must come gradually, and grow. It is a developing idea.
There is no waiting-list for beds at Whitchurch, but there is pressure, and I readily recognise that a measure of relief would be provided if some of the patients about whom we are here concerned could be found places elsewhere. Moreover, I have no doubt that the hospital's staff are very anxious to achieve this. I am advised that there are altogether about 160 patients who could leave the hospital if satisfactory accommodation was available for them in the community. They are between 45 and 70 years of age, but predominantly in the 50 to 60 age group. There are about the same number of men as women. They are all long-stay patients who have been 10 years or more in hospital. None of them is detained against the patient's will and all are free to leave, but precisely because they have no homes to go to, either because their households have long since disintegrated, or because their relatives are unable or unwilling to accept them, the hospital has for a long time been their home.
In saying this I remind the House that a custodial atmosphere of locked doors and rattling keys is not to be found in this hospital, and, indeed, should not be found in any psychiatric hospital. The present position is that a proportion of these patients is suitable for a welfare home of the kind provided for old people. A proportion would require greater supervision or segregation in special hostels. Thus, to a large extent, this is not a problem of enabling a fully fit person to set up house again in society at large, but of transferring people, who are now free from disabling mental illness but who are still enfeebled by the effluxion of time, from one type of institutional care to another.
It is essential that we should appreciate fully the condition of the people with whom we are concerned. I entirely agree with the very human approaches of the hon. Member in this. It is precisely because of this that I ask the House to consider the condition of these people so that we can set out to do whatever will be most helpful to them. As I have said, most of them are in the 50 to 60 age group and have been in hospital quite a long time. Clearly, the accommodation which we aim to provide for them must give them some protection from the stresses of the world at large while helping them wherever possible to come to terms with those problems and difficulties of life which are commonplace to most of us.
The movement toward a greater degree of care within the community for persons suffering mental illness and of rehabilitation of former patients is still at a comparatively early stage. We have much to learn in this field. We are learning all the time. The solution of these problems will no doubt lie in more than one direction. The hon. Member has referred to the establishment of small groups of former patients in hostels. This is a very interesting development. It is one whose progress we are watching very carefully. As the hon. Member will no doubt be aware, a scheme run by one Welsh local authority won the first award in a national scheme for encouraging enterprising local authority services. I have seen the kind of work which is being done in this field and have been deeply impressed by it. But it is not something which can be planted down overnight; it must grow experimentally and we must watch its development very carefully.
This problem is not peculiar to Wales. We find this sort of thing all over the United Kingdom now. These hostels help to bridge the gap for former patients returning to the community, and those which I have seen have had some remarkable successes. I know, however, that the hon. Member will realise that I am not being insensitive to the problems of these people when I say that until the most suitable kind of accommodation is available they are best cared for in the hospital where, although the arrangement is not ideal, as I readily concede, they do enjoy a settled environment with which they are familiar.
Whitchurch Hospital accepts patients predominantly from the area of the Cardiff County Borough Council. Some parts of Glamorgan also send patients to Whitchurch, but this is essentially a matter for Cardiff Corporation. Cardiff provides accommodation for cases from Whitchurch. There is one hostel, to which the hon. Gentleman referred. There are also a number of welfare homes providing 427 places to which patients from Whitchurch are admitted—12 were admitted in the year 1963–64—that is to say, if they are found acceptable by the Welfare Department. Naturally, these patients have to take their turn along with the many pressing cases of aged people from the community at large applying for accommodation. The present wafting list of 231 for this local authority accommodation includes 11 patients at Whitchurch Hospital.
The hon. Gentleman wants me to say something about the measures being taken to increase the scale of accommodation of this kind. As I told him in our exchange at Question Time this afternoon, Cardiff's record in providing residential homes is good. Cardiff is a progressive local authority. In the next 10 years the city plans to provide a further 445 places in welfare homes, and some of these will be filled by patients from the Whitchurch Hospital. The city also proposes to provide a further 88 places in mental health hostels.
But this, as I said earlier, is not just a local problem. It is a national one. Guidance which has been given to hospital authorities on the subject by my Department has laid down that the aim of hospital care should be, wherever possible, to enable the patient to return to life in the general community either independently or with help from the local authority or from other sources. But hospital authorities should not expect to return to the community large numbers of patients in mental hospitals who are not strictly in need of hospital care but who, pending the provision of hostels, have nowhere to go. This would be heartless. It might, in some cases, be cruel in the extreme.
The point has been made to local authorities regarding mental patients who are already in hospital that it would obviously be undesirable and impracticable to seek to uproot all of those who have been settled there for many years. It has been pointed out, however, that there will be increasing numbers of patients, including elderly persons, who, while they cannot for one reason or another be discharged to their own homes, could suitably be cared for in a local authority home after they have gained all the benefit they can from specialist hospital treatment.
In the context of this debate we should remember that the initial effect of an expansion of community mental health services, such as the child guidance services and early detection of incipient mental disorder, is more likely to be a reduction in the number of patients coming into hospitals than the departure of patients already there who need hostel accommodation. We are in a field where changes are taking place very rapidly and I should not like to forecast what the pattern is likely to be in five to 10 years time.
The hon. Gentleman was also concerned about the question of training for social workers. I can tell him that local health authorities are building up their staff of psychiatric social workers and other persons with advanced training. Of the 70 psychiatric social workers who qualified last year in the United Kingdom, 22 went into the local authority mental health service as distinct from the child guidance service, compared with 14 going into the hospital service.
In England and Wales the total number of psychiatric social workers or others with advanced training, in terms of whole-time equivalents, employed by local health authorities, was 106 compared with 91 at the end of 1962. In Cardiff, there is a course in specialised social work at the University College. The hon. Gentleman will probably know something about that. Also, the local education authority is running its own course in social work. Thus, the city itself, in these two ways, is making a contribution towards solving the problem.
The provision of residential accommodation on a national scale is also encouraging. As my Department's Annual Report for 1963, published last week, shows, the building of residential hostels gained momentum during the year. Twenty-eight hostels for the subnormal, providing 554 places, were opened in England and Wales, and nine hostels for the mentally ill, providing 228 places. Loan sanctions were issued for the cost of building 31 more hostels for the subnormal, to provide 751 places, and nine hostels for the mentally ill, to provide 207 places. The building of residential hostels now forms roughly half of the value of the local authorities' mental health building programme, whereas in recent years training centres have been predominant. This indicates the contribution which my Department is making to help towards the solution of the problem.
By the end of the next 10 years, local authorities in England and Wales plan to provide well over 200 hostels for the mentally ill, with over 5,000 places, at a cost during that time of over £8 million. This is in addition to the accommodation provided in ordinary welfare homes for people who are mentally infirm as well as elderly.
The hon. Gentleman stressed the importance of ensuring co-operation, a theme constantly recurring in his exchanges with me on the subject, that is, co-operation between all concerned in the administration of our Health Service in tackling the business of easing the return of former psychiatric patients to the community and helping them to lead as fruitful and active a life as possible within the community. I entirely agree that co-operation is the key to success in this as in other fields.
When the Mental Health Act was passed, the Minister at that time placed great emphasis on the need for co-operation in achieving those aims which the Act set out to achieve. My right hon. Friend and I, and the Welsh Board of Health, continually stress the vital importance of effective co-operation, and I am very glad of the opportunity which this debate provides to stress the point once again. I have taken note of what the hon. Gentleman said about the management of hostels. He will appreciate that this is a local authority responsibility, but I do not doubt that the City of Cardiff will be interested in what he has said.
The subject of our debate tonight is extremely important, and I am sure that the hon. Gentleman will join with me in expressing the hope that our consideration of it for a few minutes will serve to encourage to even greater efforts all those involved in the work of rehabilitating people who have suffered mental illness.
I have mentioned the staff of Whitchurch Hospital already, but, in conclusion, I should like to pay a tribute again to them and to all the medical staffs engaged in the care and treatment of mental patients. I understand their anxieties in this particular case. We must do all we can, through effective co-operation, to help solve the problem. I am, therefore, most grateful to the hon. Gentleman for raising the subject and, in particular, for the way in which he did it.