Mental Illness

Part of the debate – in the House of Commons at 10:36 am on 17th January 1996.

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Photo of Alan Milburn Alan Milburn , Darlington 10:36 am, 17th January 1996

I congratulate the hon. Member for Hendon, South (Mr. Marshall) on securing the debate and pay tribute to all the speeches that hon. Members on both sides of House have made. We have had an informed debate about an extremely important topic.

As my hon. Friend the Member for Birmingham, Selly Oak (Dr. Jones) said, this is a timely debate, coming hard on the heels of the confidential inquiry report, which highlighted the tragic toll of homicides and suicides involving people with severe mental illness. The hon. Member for Macclesfield (Mr. Winterton) showed how that death toll is tragically continuing. It is unusual for a month to go by without a further newspaper report highlighting some of the fault lines in the mental health services provision system.

As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, however, all the tragedies tend to obscure many of the successes. It is right to have a sense of perspective. In responding to the confidential inquiry, the Minister has been quick to point out, for example, that the overwhelming majority of people who suffer from mental illness are not a threat, either to themselves or to others. Even people with schizophrenia are more likely to be withdrawn and quiet. If they do harm at all, they are more likely to harm themselves than anyone else.

It is right to strike a balance in these debates and to emphasise that mental illness is not a single problem: it covers a multitude of problems and a multitude of people, but the switch over recent years to care in the community has brought public attention to the plight of mentally ill people. I welcome the care in the community approach because it recognises that most mentally ill people prefer life outside hospital and prosper as a consequence. No one wants a return to the old, large, remote, anonymous asylums. where sometimes brutal care was hidden from public gaze. Care in the community is both more humane and more effective, but the tragedy is that recent failures have dented public faith in the policy to such an extent that I now believe that there is almost a crisis of confidence.

As my hon. Friend the Member for Selly Oak said, yesterday's publication of the confidential inquiry is but the latest in a long catalogue of reports that have highlighted the inadequacies in current health care provision and, indeed, policy. Christopher Clunis and Jonathan Zito may well have become household names, but many others have fallen victim to the failures in the current approach to mental health policy. Let us not forget that yesterday's report analysed 240 suicides and 39 homicides. The battle to overcome the fear of, and ignorance about, mental illness has been badly compromised by those incidents. Whether the number of homicides and suicides is rising is not the question—what is worrying is the extent of public concern about those incidents. Too often, in too many parts of the country, that concern has slipped into fear.

There is now a danger that the care in the community approach, which the Opposition support, will cease to command public support unless urgent action—the need for which was highlighted in yesterday's report—is taken. The hon. Member for Hendon, South referred to a failure to ensure that patients complied with treatment. There have been pleas this morning for more powers to be made available over those who suffer from mental illness. However, by and large, my view is that there are sufficient powers on the statute book. The problem is a lack of implementation.

Hon. Members have highlighted three main problems. The first is a failure of co-ordination between the relevant agencies involved. The second—it was dramatically highlighted in yesterday's report—is that the staff who work with the mentally ill are often overworked and overstressed. The third is that, all too often, appropriate accommodation, whether in the community or in hospital, is not available. The confidential inquiry loudly and clearly referred to the number of overcrowded wards and the lack of appropriate hospital and community facilities. That lack of support is compromising the implementation of care in the community.

The Government have been warned time after time that there is a serious problem. This latest report comes hard on the heels of many others. The mental health policy, as implemented over recent years, has given us the worst of all possible worlds—too few beds in hospitals, inadequate facilities in the community and a shortage of specialist staff in both.

The hon. Member for Hendon, South referred to the dramatic decline in acute provision in our hospitals. The closure rate over recent years has not been accompanied by a similar dampening in demand for acute services. When the Mental Health Act Commission reported last November, it highlighted average occupancy rates of 130 per cent. in some inner-city hospitals—and not just in London. There is a temptation to think of it as a purely London problem, but it is not. The report also referred to occupancy rates in excess of 100 per cent. in Devon, Cheshire and East Anglia. It is a nationwide problem.

It is all too common for psychiatrists to have to spend hours on the telephone desperately trying to find an acute bed for someone who is severely mentally ill. Quite simply, there are not enough appropriate beds available for patients when they need them. There are not enough facilities in the community. The Audit Commission, in its recent report "Finding a Place", argued that comprehensive mental health care facilities in the community had been slow to develop. As a consequence, in too many parts of the country the cart has been put before the horse. There was a rundown in acute provision before the introduction of appropriate community facilities. There must be a balance in provision to deal with the serious concerns that have been highlighted both in today's debate and in yesterday's report.

There is need for emergency action to deal with the shortfall in provision and the issues of public confidence that have been raised. I have four brief suggestions. First, there should he a moratorium on further acute bed closures pending the development of an appropriate community infrastructure. Secondly, there should he immediate implementation of the care programme approach in all parts of the country. There has been yet another delay in implementation—with the latest deadline now being the end of March—yet the programme was duc to be implemented in April 1991. Thirdly, there must he urgent action to deal with the problem of staff shortages, which is compromising patient care. Fourthly, over time, there should be changes to the mental health funding allocation formula so that cash ends up going where it is most needed. We all know that the inner cities experience a particular problem. Without urgent action, I fear that, before too long, the House will again be debating the same issues, but also a new round of tragedies involving mentally ill people.