Mental Health

– in the House of Commons at 3:53 pm on 25th June 2002.

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Photo of Michael Martin Michael Martin Speaker of the House of Commons 3:53 pm, 25th June 2002

I wish to inform the House that I have selected both amendments in the name of the Prime Minister for the Supply day.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health 4:04 pm, 25th June 2002

I beg to move,

That this House
expresses its deep concern at the plight of those who suffer mental ill-health and notes that almost every family will have experience of some form of mental illness;
is concerned at the inadequate treatment so many receive, the shortages of staff and beds, the gaps in community provision and the lack of choice;
condemns the lack of support and respite for carers, the lack of early intervention with the young and the unmet needs of the elderly;
further notes that many vulnerable people with mental health problems are in prison and receiving inadequate medical care;
expresses concern at the rise in the suicide rate of those suffering from mental illness;
regrets the diversion of mental health funding into other clinical areas;
and calls on Her Majesty's Government to act to raise awareness of the scale of mental health problems and to ensure that patients are treated in an appropriate and dignified way.

There will be much in this debate on which both sides of the House will agree, and some that we will want to debate, but we can begin by recognising that the way in which a society treats those who are least able to play a full role is a measure of how civilised that society is. Sadly, we accept a level of care for people with mental illness that we simply would not accept for many more readily identifiable physical illnesses. If we walked from the House up to the Strand or into the centre of London and saw people, many of whom may have a mental illness, sleeping rough in front of our biggest institutions, most of us would regard that as a policy failure that a humane society should not be willing to tolerate.

It will come as a surprise to many outside the House, and perhaps to many hon. Members, too, that one in four of us will at some point in our lives suffer from a mental health problem. I doubt whether there is one person in the Chamber who has not experienced the impact of mental ill health on someone in their life, be it a relative, a friend or a colleague.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I have barely started; I shall give way shortly.

Mental illness is society's unspoken epidemic, and as one of our last social taboos it is too rarely discussed. All too often, people regard it as a weakness and stigmatise those who suffer from it. If we are to diffuse the stigma surrounding mental ill health, we must dispel the ignorance surrounding the whole subject.

The spectrum of mental ill health is incredibly broad, as hon. Members will know from their constituency work. It encompasses many different groups—the mum with post-natal depression, the dad struck by depression because of a period out of work, and the son or daughter with a behavioural disorder who underperforms academically or is disruptive in the classroom. It is also about college friends who commit suicide, seemingly for no reason, a soldier returning from overseas unable to adjust to the realities of normal life, and, perhaps most commonly, elderly patients slowly being ravaged by the dehumanising erosion of Alzheimer's disease.

Although the safety of the public must always be at the top of our priorities, we need to move the debate away from an obsession with the mercifully few incidents when someone with a mental illness harms someone else, and remind ourselves that it is in the interests of public safety to ensure that there is adequate and appropriate treatment for all those who need it.

Photo of Stephen Hesford Stephen Hesford Labour, Wirral West

Does the hon. Gentleman consider it appropriate to dump an important debate that was on the Order Paper until last night, and substitute it at the last minute—

Photo of Michael Martin Michael Martin Speaker of the House of Commons

Order. That is not a matter for debate.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I wonder what people outside this House who think that this is a very important issue will make of such an imbecilic intervention.

Sadly, too many politicians pay more attention to the potential dangers posed by psychiatric patients, and to their compulsory treatment, than to the far more important issue of appropriate treatment for all patients. I hope that the Government have avoided that mistake in the Bill that they are publishing this afternoon. Members on both sides of the House will be aware that on the ground the situation is often bleak, with widespread staff shortages, acute and day bed shortages, wide gaps in community provision and a lack of effective step-down care for those returning to the community. Things are made worse by the knowledge that although funds are earmarked in the health budget, they all too often fail to reach those in need. Cutting the mental health allocation is an easy way of balancing the budget. The mentally ill are the least likely to complain, make a fuss or write to newspapers.

The evidence that mental health is not considered to be a priority is stark. Buckinghamshire mental health NHS trust has had £1 million that was originally earmarked for mental health diverted into other areas. Half of all GP practices in Cumbria offer counselling to patients in need, but there are plans to axe that £78,000 service. The Avon and Wiltshire mental health partnership trust faces service reductions amounting to £0.5 million. On a smaller scale, but equally important to patients, the acupuncture clinic at the department of psychiatry at North Manchester general hospital is threatened with closure. It costs £60,000 a year to run. As for big organisations, Saneline requires £1 million a year. It deals with more than 1,000 calls a year from distressed people, but is still under threat.

It is clear that far from being a priority, mental health care is too often an afterthought in today's NHS. The burden falls across our whole society. Our inner cities bear more than their fair share of that burden. People who are homeless or have alcohol or drug addictions frequently have mental health problems. They end up in inner cities, where amid the hustle and bustle of city life they become invisible to those who otherwise might help them. Of course this is not simply an inner-city issue. The crisis in our countryside has led to an increase in mental health problems, such as the well documented tragedy of farming suicides, which touched my constituency in north Somerset when a father and son, whom I knew well, committed suicide.

The Conservative party has always been at the forefront of mental health reforms. Lord Shaftesbury began to change the perception of mental health problems from a private misfortune to a matter of public concern. He highlighted the atrocious conditions in many London asylums, and changes began, albeit slowly, to occur.

The increase in asylums and other custodial institutions was such that by 1954 the population of psychiatric hospitals peaked at 152,000. That is more than twice the current prison population. Enoch Powell took the first, decisive step from that model of care. He said that the Mental Health Act 1959 "lit a funeral pyre" beneath the decaying network of asylums. He was at his most eloquent on the subject in 1961, in what has become known as his "water tower speech". He spoke of asylums that stood

"isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside."

His broad goal was to move treatment of the mentally ill away from remote asylums and into local hospitals closer to the community.

The development of new drugs meant that the possibility of treating patients in the community slowly became a reality. It began with the findings of the committee that considered mental health. The now Lord Parkinson chaired it at the request of the now Lord Fowler when the Conservatives were in opposition in the 1970s. Policy development culminated in the Mental Health Act 1983 and the National Health Service and Community Care Act 1990, which my right hon. and learned Friend Mr. Clarke introduced.

Most people accept that it was right in principle to close the old asylums and have patients treated close to or in the community. The concept of care in the community was supported across the political spectrum, although experienced hon. Members might suggest that widespread political consensus sometimes leads to the worst legislation. My right hon. Friend Virginia Bottomley wrote in a letter to The Times in 1998:

"In an institution, an individual can be monitored 24 hours a day. In the community, reporting and fail-safe mechanisms are necessary if tragedies are to be avoided."

The suicide rate is increasing again, the family unit is increasingly breaking up, there is homelessness, abuse and the absence of a sense of community in many inner-city areas. Those factors all contribute to the increased prevalence of mental health problems among people of all ages, including, perhaps most worryingly, the young.

Care in the community has provided many thousands with an opportunity for a quality of life that is far better than the life that they would have experienced inside restrictive institutions. Criticism cannot be laid at the door of the medical, nursing and voluntary staff—the latter are forgotten too often—who have made a Herculean effort in the face of great difficulties. I reject the criticism from some that care in the community was nothing more than the unfortunate or catastrophic meeting of a desire for financial savings with a naive passion for the rights of the individual.

However, the pendulum swung too far, too fast. Many believe that care in the community was implemented too quickly, and too often with inappropriate patient selection. In too many places there was too little investment in training, finance and related matters. At times there has been too little care, scant support and a form of community that exposed the vulnerable—the public and the patients—to danger. Individuals were sometimes placed in complex urban environments with which they simply could not cope. They lacked understanding of their condition, and their institutionalised background made them unable to deal with the complexities of modern living. When they needed help, their cries went unanswered.

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I've only just found this, take that Hesford!

Submitted by Ann Onymous

Photo of Mr Hilton Dawson Mr Hilton Dawson Labour, Lancaster and Wyre

The hon. Gentleman is making a speech the like of which I have never previously heard from him. Is he prepared to acknowledge that the Conservative Government left the Labour Government with an enormous problem, which they have had to tackle?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

We should not get into arguing about who introduced what, and who have been in office for the past five years. The principle of care in the community was correct, but mistakes were made in implementing the policy, both under the Conservative Government and under the current Government.

Photo of Claire Ward Claire Ward Labour, Watford

Will you say sorry?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

Yes, I would say sorry to patients who have suffered unnecessarily because of the poor implementation of policy—but I must say that I find the hon. Lady's approach of sitting in a debate on a very serious subject making stupid sedentary points rather pathetic.

We require a balance to be struck that will ensure the most appropriate treatment and environment for patients—a balance in which those who need treatment in a hospital setting can receive it, and in which only those able to cope in the community are placed there. We must accept that achieving that balance is made more difficult under this policy—which is discredited in the minds of the public—because of a series of crimes committed by mentally ill people who had fallen between the gaps or come off their medication.

I do not need to go through that litany today. As Michael Howlett of the Zito Trust said:

"People don't just attack people in the street out of the blue. There's always a build-up over weeks or months. These incidents are usually as a result of services breaking down and the danger signs not being spotted."

The Sainsbury Centre for Mental Health published a briefing on acute in-patient care a few weeks ago, which stated:

"We have yet to develop realistic plans to deliver acute inpatient care which is therapeutic and supports recovery. Unless we develop and implement such plans, nationally and locally, we will see an increasing cycle of decline in acute mental health care, with increasing user dissatisfaction, incidents and inquiries and the loss of high-quality staff—all despite the best efforts of so many committed staff. The situation is little short of a crisis, and has to be addressed now. In some instances the quality of care is so poor as to amount to a basic denial of human rights."

Incidentally, that briefing describes not the situation five years ago, but the situation now.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation

I congratulate the hon. Gentleman's party on bringing this issue before the House, and I congratulate him on his speech. My question is about the funding and control of mental health services. The hon. Gentleman has gone on record talking about fees, charges and private insurance for health care. Does he agree, however, that for mental health care that is a dead end? Whatever the failings of our mental health care system, privatised health care systems such as that of the United States are much worse. Does he agree that we must have a state-funded system with a proper framework, such as the national service framework?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I have stated on the record that we are not looking towards the American system for mental health care or any other type of health care. I am sure that the whole House would agree that it is essential that those who require treatment for mental illness get it free at the point of use, irrespective of their ability to pay. Whether a range of providers could provide that care, funded by the NHS, is an entirely different matter—to which I shall return, giving examples, later.

When discussing the issue of danger in connection with patients with mental illness, the question we have to ask is: a danger to whom? Events involving just a few stigmatise the many, and can lead others to overlook the danger that some mentally ill people pose to themselves. The case of Ben Silcock is a good example. Hon. Members will remember that he was severely mauled after climbing into the lion enclosure at London zoo while mentally disturbed. It is also worth remembering that the incidence of suicide, particularly in prison, is far higher than the number of cases in which mentally ill patients harm someone else. Sadly, about 1,000 schizophrenic patients in this country commit suicide every year. That is a figure that we should focus much more on.

It will always be the duty of the Government to protect the public from harm, if necessary by detention or compulsory treatment, but politicians must take care to adopt a balanced approach that does not stigmatise, and thereby worsen the plight of, those who pose no risk to anyone—except, possibly, themselves. I look forward to the Secretary of State outlining some of the measures that the Government are introducing in their draft Bill today. I hope that they will be dramatically different from some of the proposals in the White Paper.

In a joint statement, the Royal College of Psychiatrists and the Law Society have warned that they would find proposals too closely based on the White Paper unacceptable:

"We call upon the Government to halt any further attempt at legislation based on the White Paper 'Reforming the Mental Health Act' and to begin meaningful consultation on a statutory scheme that takes account of mental incapacity on the successful Scottish model."

The Secretary of State needs to address those reservations.

The statement goes on to say that the question of resources needs to be considered and that an Act based on the framework of the White Paper

"would collapse under the weight of its own regulatory framework . . . The proposals would be . . . costly to implement . . . The new Mental Health Review Tribunals alone would require the time of 600 (extra) psychiatrists. It would be impossible to recruit such numbers. Those in post would be diverted from . . . patient care."

It is well known that reservations were expressed about proposals relating to those with dangerous and severe personality disorders. The statement said:

"In order to accommodate such a risk, the criteria for compulsion have been so widened that large numbers of patients would find themselves inappropriately placed under . . . the Mental Health Act . . . increased numbers would overwhelm already over-stretched acute ward and community teams. Patient care would suffer and the level of risk would be increased rather than reduced."

I should be grateful if the Secretary of State would deal with three issues, the first of which relates to compulsory treatment in the community. In what circumstances will a patient receive enforced treatment, particularly medication, in the community? Secondly, if the Government intend to remove the criterion of treatability under the draft legislation, how will patients with personality disorders who are detained be affected? Who will decide which patients can be detained and for how long, and how do we get round the fact that there is no suitable definition of severe personality disorder? Experiments to determine whether patient behaviour can be predicted through case studies have produced extremely poor results, yet predictability of behaviour will be central to the Government's proposals. Thirdly, when is the proposal likely to become law?

Hugh Bayley referred to private sector provision. I have been extremely impressed by the way in which other countries that I have visited deal with mental illness. I was especially impressed by a psychiatric hospital in Denmark, which stood in stark contrast to those in the UK that I have visited. I noted the sense of calm, and the profound sense that patients were treated as individuals, and with great dignity.

Hon. Members may be aware of examples such as the Hotel Magnus Stenbock, in Helsingborg, which is well known in mental health circles. It is a good example of what might be termed a halfway house for those moving between an institutionalised setting and the community. It has 21 single rooms and offers a balance between private and social space. It offers not just structure and crisis accommodation but a place of safety, and develops a sense of community and acceptance. It is run by the RSMH, a multi-million pound organisation of mental health care users that sustains and nurtures self-help care models throughout Sweden.

Perhaps the most striking comment on that hotel was made by a shopkeeper who runs a nearby store. One might have expected the local population to object to the proximity of such an hotel, but on the contrary. The shopkeeper said:

"The proximity of the hotel has not had any adverse effects on business, sometimes the general public are a little wary of users, but they see the staff in the shop are not afraid and are treating the hotel residents the same as all the other customers. It makes them more comfortable. We believe everyone has the right to be treated as a human being and at some point in everyone's life we all encounter problems, some more severe than others."

That is symptomatic of the way in which Scandinavian countries deal with mental illness. They regard it as an illness that is no more to be afraid of than cardiac or respiratory illness; they do not attach to it the stigma that the United Kingdom does. As it involves a private sector organisation, that example shows that such services do not have to be provided by the state.

Photo of Andrew Miller Andrew Miller Labour, Ellesmere Port and Neston

I apologise to the hon. Gentleman for missing the first couple of minutes of his speech. The facility that he has just described sounds remarkably similar to the Countess of Chester site, launched by the Secretary of State a couple of months ago, in which £14 million has been invested. Does he recognise that such provision can be made within the framework of the NHS, and is it not a pity that we have had to wait for so long for the end of buildings that were condemned in the 1980s?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

Sadly, we have not seen the end of enough such buildings. The updating of facilities is to be commended, but that is not just a question of changing the bricks and mortar. A cultural problem exists in this country and we need to overcome it, but the stigma attached to mental illness makes it difficult to achieve progress.

I shall now turn to another hidden scandal in the UK—the situation that pertains in our prisons. Enoch Powell may have lit a funeral pyre beneath mental asylums when his Mental Health Act 1959 began the process of shutting them, but today some 70 per cent. of the prison population have a mental health or substance abuse problem, or both. We once hid our mentally ill in asylums, but we now unwittingly locate far too many of them in our prisons.

The incidence of mental disorders among the prison population far exceeds that in the population as a whole. It is a troubling thought that, at the beginning of the 21st century, anyone who is mentally ill and has a brush with the law could be subject to inadequate treatment in Dickensian settings in our prisons. Facilities for patients often amount to little more than sick bays with limited primary care cover. The assessment of a prisoner arriving at a prison typically takes five to seven minutes, and is often conducted by a retired GP or a locum with no specialist knowledge of mental health.

The level of training of staff often does not match the complexity of the conditions with which prisoners present. Prisoners are therefore less likely to have their mental health needs recognised or to receive psychiatric help or treatment, and are at an increased risk of suicide. The number of suicides in 1999 was twice the figure in 1990.

A report by John Reed, the medical inspector for the inspectorate of prisons, has stated:

"A period in prison should present an opportunity to detect, diagnose and treat mental illness in a population hard to engage with NHS services. This could bring benefits not only to patients but to the wider community by ensuring continuity of care and reducing the risk of reoffending on release."

John Reed has also said of prisoners:

"Many are quietly mad behind their cell door and are not getting any treatment. Care for mentally disordered offenders in prison is a disgrace."

As a matter of urgency, therefore, the Prison Service needs to consider how to address the mental health needs of the people in its charge. In particular, research is required to determine how much the prison environment impacts on mental health. That may include issues such as overcrowding, confinement in cells and the range of activities available in prison.

A second problem is that prisoners with mental health problems remain in the Prison Service and are not diverted to the NHS as the Reed report, among others, recommended. It is inappropriate for prisoners with severe mental health illness to be in prison. Sir David Ramsbotham has said:

"In my view mentally ill prisoners requiring 24-hour nursing care should be in the NHS, not prison."

Photo of Julian Brazier Julian Brazier Shadow Minister (Work and Pensions)

My hon. Friend is making a powerful point. Does he agree that part of the solution lies at the beginning of the process? The police should be trained—they have a good record on the issue in Kent—to pick up early, before a case even goes to court, the fact that a prisoner might be suitable for mental health assessment and sectioning, instead of putting him into the criminal justice system.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

That is greatly preferable, but it is also essential that people who go to prison with an undiagnosed mental illness are not under-treated and then return to the community with a much greater chance of reoffending. That is part of caring for the vulnerable, but it also involves enlightened self-interest for the wider society. Whether patients are in the criminal justice system or not, it is in everybody's interest to ensure that they are properly treated in the right setting, so that they are not released from custody with a treatable condition.

I have read the draft Bill, and we will examine closely the Government's proposals for a shift from prison to NHS treatment. If my cursory reading is any guide, those proposals will certainly command the support of the Opposition.

Photo of John Battle John Battle Labour, Leeds West

I remind hon. Members that Armley prison is in my constituency. I do not want to rehash history, but I remember that in 1996 some hon. Members pleaded with the then Government to halt the bed closure programme because it would mean a shift from care in the community to care in custody. That is what has happened. Without going over the past, will the hon. Gentleman be generous enough to acknowledge that for some months we have had 10 pilot mental health in-reach programmes in prisons to address that problem? Is he aware of that fact?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I am aware of it and I welcome it, but we should treat the matter as one of even greater urgency. I hope that the Secretary of State will outline the proposals in the Bill to do just that; it is something that we have been urging the Government to do. If that is what the Secretary of State confirms this afternoon, he will have our support.

The Wanless report looked at the costs of mental illness and the potential savings that a better system might bring. Derek Wanless pointed out that MIND had estimated the total cost of mental illness at £37 billion a year, of which £11.8 billion was accounted for by lost employment. In 1995, more than 91 million working days were lost as a result of mental illness. The Home Office estimates that the overall cost of crime is £58 billion a year, and a significant proportion of crime is carried out by those with a mental illness.

When asked about the cost benefits of better mental health care, Wanless said:

"It is difficult to estimate the exact value of potential savings, but it does not seem unreasonable to assume that there might be a 5 per cent. reduction in the costs of mental illness and a 2 per cent. reduction in the costs of crime . . . giving a net saving across government as a whole of some £3.1 billion a year."

The House would do well to take a wider view of costs and benefits.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

The hon. Gentleman is making a thoughtful speech, much of which I agree with. In respect of prisoners, he referred to the Reed report, which recommended strongly—as have a number of individual inquiries—the break-up of the special hospital system and the development of more regional secure units. Would it be his policy to follow those lines and develop further regional secure provision, with a view to moving prisoners who are wrongly in prison into more appropriate places?

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I could not honestly say that I have come to a fixed view on the best way to provide more appropriate care. There is a need for further research as to how best to manage the transition from the prison setting to a more appropriate setting for the treatment of mental illness. Perhaps the pilots referred to by Mr. Battle might give us some valuable information.

We accept that health policies cannot hope to eradicate the problems of an entire society—that vision was shattered after 1948—but what health policies can do is to seek to support those who suffer in what can at times be an atomised and alienating society. That is why the Conservative party has decided to make mental health a central part of our health policy agenda. The issue must become a matter of public concern, not just private misfortune. An enlightened society is one that realises—as they have in many Scandinavian countries—that it is to the benefit of everyone for mental illness to be treated adequately, and, if possible, prevented.

I give the House this final thought: perhaps we need to bring back one other concept that we seem largely to have forgotten—the concept of sanctuary. We started out with Bedlam, then we had madhouses; Lord Shaftesbury gave us asylums, then we looked to the community. Now we must speak of what all the differing environments ought to provide—a sense of sanctuary.

Recently I visited a mental health counselling service in Aylesbury, where those involved described their office—particularly movingly, I thought—as a place where patients came to feel safe. That is a good guiding principle.

Last week I visited the Hillside clubhouse in Holloway. I am ashamed to say that I did not know about the clubhouse network, but I was struck from the moment I went through the door by the fact that those with mental health problems looked on the clubhouse as somewhere they could go to feel safe. It offered them companionship, constructive activity and the chance to go and get a paid job in the community. It supported them without compelling them. Everyone found their own level and progressed at their own pace. It was not somewhere they were forced to go but, equally, it was somewhere that would keep in touch if they stopped coming along. In short, it offered genuine care in a real community, and it was a sanctuary within an ever more complex society.

Concern about the social welfare of those in society who have no one to speak up for them and often cannot speak for themselves is an essential part of any programme for a truly national party. There can be few groups more vulnerable than those with mental illness. We have decided to make mental health central to our policy not because it is fashionable, and not because we have identified some interest group or section of the population whom we can make politically beholden to us as a consequence. We are not doing it because we see some short-term gain to be had by pretending to interest ourselves in so-called soft social issues for a few months. We are doing it because we believe that it is the right thing to do, and that is what politics ought to be about.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health 4:35 pm, 25th June 2002

I beg to move, in line 3, to leave out from "illness" to end and insert:

"notes the decades of under-investment which led to crumbling buildings, demoralised staff and inadequate treatment under the Conservative Government which left many of the most vulnerable in society without the care they need;
supports this Government's investment in NHS mental health services to ensure better and faster care for people with mental health problems, including new community teams, more staff, improved acute care and new services for children;
supports the full implementation of the Mental Health National Service Framework to ensure national standards are in place for the care and treatment of mental illness;
recognises the massive contribution of carers and the Government's action to support them, and commends the Government's 'mind out for mental health' campaign to tackle stigma;
and believes that improving mental health services should remain a key Government priority."

When I became Secretary of State, I said that our top clinical priorities in the national health service should be threefold—to secure improvements in cancer and cardiac services and also in mental health services. These are the clinical priorities set out in the NHS plan. Why? Because all three had suffered from decades of neglect and, in all three cases, large numbers of patients were affected.

For years, mental health services were the Cinderella of the NHS, despite the fact that, as Dr. Fox said, millions of people—perhaps as many as one in four of the population—face a problem at some point in their lives. Each year, 600,000 adults with serious mental health problems are cared for by specialist mental health services. Thousands more young people and tens of thousands of elderly people also receive care. For every individual with a serious mental illness, many others such as families, carers, friends and, indeed, members of the wider public are affected, sometimes—sadly—with tragic consequences.

The hon. Gentleman was right to stress that mental illness takes many forms. It is worth saying at the outset that despite public perceptions to the contrary, the overwhelming majority of people with mental illness are a threat to no one. Indeed, many mentally ill patients are among the most vulnerable in our community. Reducing the stigma of mental illness should, in my view, be a priority for any caring, civilised society. That is why I was pleased last year that my Department launched the mind out for mental health campaign. It is the first time that the Government have backed a public information campaign specifically designed to tackle such discrimination.

At the other end of the spectrum, however, there will always be some people with a serious mental disorder. Sometimes they do not recognise how ill they are; sometimes they are so disabled by their mental illness that they are not able to seek help, and sometimes they choose not to seek help. In a small minority of cases, people with a serious mental disorder will pose a significant risk to others but, more particularly, to themselves. In those circumstances, the Government's priority must be to protect patients, their families and the wider public both under the law and through the provision of appropriate services.

This much, then, is common ground between the Opposition and the Government and probably all parties. The difference lies in what various parties have been prepared to do about these problems and are now prepared to do about them. My right hon. and hon. Friends are more than happy to debate these issues with the Conservative party, because they know the difference between the warm words of the Conservatives in opposition and the grim reality of the Conservatives in power.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

For a serious debate, the hon. Member for Woodspring skated pretty lightly over 18 years in office. I think that he was a Minister for at least part of that time. I know that the hon. Gentleman wants to forget what happened then, but what happened then informs what goes on now, and the standards of care and services that people with mental health problems receive.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

Is the Secretary of State really suggesting that the whole concept of care in the community as it was initially rolled out was not part of a consensus? If he believes that, he is quite wrong.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

I will be coming to care in the community in a moment. I think that it was a spectacular failure, for reasons that I will give, and I think that the hon. Gentleman is gradually coming to that view too.

It is worth reminding the House about the state of mental health services that we found when we came to power in 1997. The view not only among carer and patient groups but in the wider health service is that mental health services had been allowed to become the poor relation in the NHS. There were no national standards of care—not a single one.

Mental health law had been allowed to be overtaken by both developments in services and in the wider society. Care in the community had been a failure, not least because the policy was both indiscriminate and underfunded. Years of under-investment had left dedicated, hard-working staff in our mental health services with more than their fair share of run-down buildings, continual cuts in the number of beds and, of course, shortages of staff. Indeed, in 1997, two-thirds of health authorities did not even provide round-the-clock access to community mental health services. The simple truth is that mental health was not a priority then—but it is now.

Photo of David Heath David Heath Shadow Spokesperson (Trade and Industry), Shadow Spokesperson (Home Affairs)

I do not for a moment doubt the right hon. Gentleman's commitment to this policy area, but the reality in my constituency is that we have seen the contraction of psycho-geriatric wards and acute mental wards into a centralised general hospital rather than the provision of such support across the community. That affects links between patients and their general practitioners and between patients and their own community and family. Is that part of the right hon. Gentleman's policy or is something still wrong with the funding arrangements for mental health trusts?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

On the provision of mental health services for older people—the point that the hon. Gentleman raised—as for provision elsewhere in the mental health service, the answer is not that one particular model of care is required. We need a spectrum of services to cope with the spectrum of needs; an elderly lady with severe dementia will have a different set of needs from those of a young child with depression. Our problem is that there are gaping loopholes and gaps in provision across the piece—whether in the acute sector, the community sector, crisis intervention or intermediate care. We need to plug all those gaps.

I do not advocate a single model of care as the answer to the problems in our mental health services—a range of provision is needed. The truth is that—as we set out in the national service framework that we published about three years ago—it will take some time to get there, so it is better to be straight and honest with people about that. We have started a 10-year programme and we are making progress, and I shall come to some of the details in a moment.

Photo of Michael Fallon Michael Fallon Chair, Treasury Sub-Committee

The right hon. Gentleman talked about warm words and he says that he is making progress, but surely he must admit that it has taken two years since the end of the consultation process to produce a Bill and even that is only a draft. What is the framework for putting his warm words into action?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

I shall come to that in a moment. Not even the most devout proponents of the Mental Health Act 1983 would claim that it was a radical overhaul of the 1950s provision. Fundamentally, mental health legislation in the 21st century is based on a model that dates back to the 1950s, so it would be just as well, as we have this once in a generation opportunity to get it right, that we do precisely that—through consultation, Green Papers, White Papers and a draft Bill. I should have thought that the hon. Gentleman would welcome that, because it provides a wider opportunity both in the House and outside to ensure that the provisions in the new Act are right and that we learn from some of the deficiencies in current mental health law.

Photo of Joan Humble Joan Humble Labour, Blackpool North and Fleetwood

Does my right hon. Friend agree that the rapid closure of large mental institutions in the 1980s and the ejection of tens of thousands of people on to an unsuspecting community which was ill prepared to accept them has made his and the Government's job in building up new mental health services much more difficult? Does that not justify careful thought in order to ensure that the community is properly prepared for a genuine programme of care in the community?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

It is as true for mentally ill patients as for most patients that nobody actually likes being in hospital; nobody wants to be in hospital and people try to avoid it wherever possible. Sadly, for some people it will always be necessary, so we must get the range of provision right. Despite all the efforts in the 1980s and 1990s to make community care work, that one telling statistic, which I gave earlier, that in 1997 two-thirds of health authorities did not provide 24-hour access to community services, is a real indictment of the failure to implement what were undoubtedly good intentions. They were good intentions, but I am afraid that the world is paved with good intentions; deeds, rather than words, count in the end.

To get the range of services and provision right, three changes are necessary: first, changes in the law; secondly, reform to services, particularly with new national standards; and, thirdly, the right level of investment in mental health services. I should like to deal with each of those changes in turn.

First, on the changes to the law, I am publishing today a new draft mental health Bill and consultation paper, copies of which are available in the Vote Office. As I said in response to Mr. Fallon, our proposals have already been subject to fairly detailed consultation during the past couple of years, but I hope that the publication of a draft Bill will allow further detailed scrutiny to take place. I would certainly urge all right hon. and hon. Members who have an interest in mental health issues to engage in that process and, more particularly, those outside the House, too.

The current mental health provisions date back to the 1950s. They are, quite simply, out of date. They have failed properly to protect the public, patients or, indeed, the staff who work in our mental health services. For example, under existing mental health law, the powers to treat patients compulsorily are available only if patients are in hospital. However, the majority of patients today are treated in the community. Public confidence in care in the community was undermined therefore by failures not just in the services, but in the law, too. The policy lost public confidence because, in too many cases, neither the services nor the law properly protected either patients or the public.

Services have too often worked in isolation from one another. Too often, severely ill patients have been allowed to drift out of contact with mental health services altogether. Many patients have failed to comply with treatment. That is, I am afraid, a recurring theme in all the inquiries into the tragic toll of homicides and suicides that have taken place in recent years. Doctors have often been in the absurd position of having to wait until patients in the community become ill enough to require admission to hospital. That prevents earlier intervention to reduce the risks to the patients and, of course, the wider public.

In particular, existing legislation has failed to provide adequate public protection from those whose propensity to be a risk to others stems from a severe personality disorder. As a result, patients and the public alike have been put at risk; they have been denied the protection that they need. Every year, there are more than 1,000 suicides and 50 homicides involving patients who have been in touch with mental health services in the previous 12 months. That graphically illustrates the failure of the old legal framework, which is in desperate need of reform. Our proposals, which are the most far-reaching for decades, are designed to enhance the safety of patients and the public.

It may be of benefit to the House if I briefly outline the proposals in the draft Bill and the accompanying consultation paper. At the heart of the draft Bill is the need to ensure that there is a new focus on the individual patient. Under the current law, patients are defined and treated not on the basis of their individual needs, but depending on which category of mental disorder they have. That has led to a loophole in the Mental Health Act 1983, so that a small minority of dangerous mentally disordered people have been able to argue that they will not personally benefit from treatment. In some cases, they argue that their illness makes them refuse to take part in appropriate therapy sessions or to co-operate with treatment that could be provided for them.

Under the 1983 Act, patients in those circumstances would be discharged from treatment and even detention, although people in official positions—whether prison officers or police officers—know full well that they could pose a risk to others as well as themselves.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

Let me continue this point. I shall let the hon. Gentleman intervene in a moment or two.

The current system does nothing to protect those patients and it certainly fails to protect the public if a small minority of dangerous people with mental disorders in those circumstances go on to harm or even kill others or themselves. In the draft Bill, we shall introduce one broad definition of mental disorder and one set of tight conditions to govern the use of compulsory powers. If those conditions are met and treatment is available, compulsory powers may be used. That will close the loophole and ensure better treatment for dangerous mentally disordered patients and provide better protection for the public.

Similarly, my right hon. Friend the Home Secretary will have powers to direct those who are already serving prison sentences to be assessed and treated. Subject to the new mental health tribunal process, which I will describe shortly, it will be possible to detain dangerous people with severe personality disorders for as long as they continue to present a high risk to others. New services are currently being developed for that small but high-risk group of patients, and my Department and the Home Office are committed to providing more than £120 million to make them available to all who need them.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

There is clearly a great debate to be had about the Secretary of State's definitions of mental disorder and mental illness, but I want to ask about his view of treatment. He seemed to imply that there was treatment for severe personality disorders. Does he accept that there is at least controversy about whether effective treatment exists, and that, notwithstanding good intentions, defining treatment as including the general term "habilitation"—which means, to an extent, teaching people how to behave—does not solve the problem, which is that he wants to detain people who cannot be treated?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

The hon. Gentleman is right: there is controversy. There is certainly not a set view in clinical circles.

Some interesting experimental therapeutic interventions have been made in the United States and Holland, for example, involving precisely the small cohort of patients whom we are discussing. We are trying to learn from the impact of those interventions. As I think the hon. Gentleman knows, we have already provided funds for pilot programmes at Broadmoor prison, and we plan other tests at Rampton and Broadmoor to try to ensure that the right range of treatments is available.

The hon. Gentleman could put his question in a different way, and ask what else we should do. Should we throw up our hands and say that there is nothing we can do? People in the system know fine well that although this is a very small minority of potential patients, they pose a substantial risk to themselves, their families and the wider public. Given those circumstances, what are those of us in decision-making positions to do? Are we to say there is nothing we can do, or try to close a patent loophole in the law?

I think it right for us to publish our Bill in draft: White Papers are one thing, but seeing legal, statutory proposals in black and white is quite another. I know that there is concern, and that there will be controversy, but I say in all candour that unless we do something we shall see more of the problems in our constituencies of which we are only too painfully aware.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

What the Secretary of State is saying is important. He has rightly drawn a distinction between the draft Bill and the current legislation, pointing out that there is now a single definition of mental disorder and that the treatability criterion is being abolished. He says that he is doing this because a proportion of patients with severe personality disorders would otherwise pose a risk to the public. According to the Government's own research, what proportion of those patients might expect to be detained under new legalisation?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

That depends on the process, which I will describe in a moment.

As the hon. Gentleman probably recalls from earlier debates—I think my last statement to the House on the subject was made at the time of the White Paper's publication—we currently estimate that between 2,100 and 2,400 people make up the small cohort of potential patients whom we are discussing. Most are in contact with the criminal justice system, and the overwhelming majority are already in prison. We are revising the estimate, however, and it is likely to be revised upwards rather than downwards. Although the number is small, unless appropriate treatment and management are available there is a grave danger of precisely the problems that the hon. Gentleman mentioned in his speech.

Other changes in mental health law are needed. In the past, too many people with mental health problems were rightly removed from crumbling acute hospitals, but wrongly placed in the community with little support and poor treatment.

Some lost touch with services, with tragic results for them and their families. Some started on a cycle of detention in hospital and discharge to the community, only to be forced back into hospital when a crisis hit. That revolving door is bad for patients and their families, and we intend to tackle it in the Bill.

We will do so by allowing compulsory treatment to be provided in the community, as well as in a hospital. That will allow earlier intervention to prevent a patient's condition deteriorating and so help to reduce the risks that patients may pose to themselves or to others. New orders will mean that patients subject to compulsory treatment, whether in the hospital or in the community, will have to comply with the terms of their treatment programme.

In his speech, the hon. Member for Woodspring asked about medication. I know that concerns have been expressed about that matter. I can assure the hon. Gentleman that it will never be appropriate, under the terms of the draft Bill, to provide compulsory medication in a person's home. Instead, orders will set out the form of treatment that should apply. For example, if a patient in a clinic refused to comply with the order, he or she could be readmitted compulsorily to hospital.

Mental health legislation, by necessity, must tread a delicate path between protecting those who are most vulnerable and ensuring public safety. In the draft Bill, the new powers that I have just described are balanced with additional safeguards for patients. Each patient will have an individualised care plan, on which any compulsory treatment will be based. Unlike now, those making decisions about compulsion will also have to consider the patient's wishes and feelings about his or her treatment and the views of his or her carers.

There will be proper safeguards, and patients will be helped to make use of them. Most significantly, all orders for compulsory assessment and treatment for more than 28 days will have to be authorised by an independent judicial body—the new mental health tribunal—and its decisions will be regularly reviewed. For offenders, of course, the initial decision to apply compulsory assessment and treatment will be a matter not for the tribunal, but for the courts.

Photo of Tom Clarke Tom Clarke Labour, Coatbridge and Chryston

I am grateful to my right hon. Friend for giving way, and for his approach to these matters. In 1986, some of us managed to steer an Act through the House dealing with some of the issues touched on today. I remind my right hon. Friend of two things. First, that legislation provided that patients leaving long-term care would receive a proper assessment and a response to their needs. Secondly, and more importantly, it provided that advocacy would be crucial to a patient's rights. Will my right hon. Friend assure me that those factors have not been forgotten?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

They certainly have not been forgotten. I commend the work that my right hon. Friend did in 1986, and still does today, on many of the issues to do with the very difficult problems associated with long-term care for some of the most vulnerable in society, and with the role of carers. He is right about what must be included in the barrage of safeguards that we must put in place.

Removing a person's liberty is an extremely serious step to take. That might be the right thing to do in some circumstances, both for the individual and society, but the power must be balanced with new safeguards for the person involved. As is the case now, those safeguards will include the provision of free legal advice for those who need it. For the first time, people will also get the right to new independent advocacy services, which are intended to help them through what can be the rather byzantine maze of mental health legislation. Those free and independent advocacy services will be available to every patient who goes through the compulsory treatment process.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

I listened carefully to my right hon. Friend's detailed analysis of the draft Bill in respect of the role of tribunals. He made it clear that tribunal decisions will be subject to review. A constituent of mine received a mental health tribunal decision more than a year ago, but it has not been implemented yet. How would the circumstances of a person like that man be affected by the new arrangements proposed in the draft Bill?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

I am not familiar with that case, although if my hon. Friend writes to me about it, I shall be happy to consider it. Let me say two things. First, under the draft Bill, the decisions of the mental health tribunal are binding on the national health service, and we would expect the national health service to act quickly to implement them. Secondly, there are safeguards, too. Compulsory treatment will be allowable for the first 28 days without recourse to the mental health tribunal, although the right of appeal to the mental health tribunal exists even during that period. Thereafter, the tribunal can make compulsory treatment orders, for up to six months in the first instance, for a further six months in the second instance, and, finally, for periods of 12 months and so on. Rights of periodic review will exist within that if the person concerned wants to challenge it or their carer has a view about it. I want to assure my hon. Friend that, all along, we have tried to balance safeguards with proper protection for the public.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

I am not sure that I fully clarified my point. The patient to whom I referred was subject to a tribunal decision that he should be transferred from a particular hospital a year ago. He has still not been transferred. When the draft Bill becomes legislation, how will those circumstances differ? Who would ensure that that decision was implemented?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

First, that will be a decision for the tribunal. Secondly, however—this is an important further safeguard, too—as my hon. Friend is aware, we currently have the Mental Health Act Commission. The draft Bill proposes that we build on the work of the commission but give a new power to the new, independent health inspectorate that we envisage—the Commission for Health Care Audit and Inspection—which will have precisely the function of ensuring that the decisions of the mental health tribunal are carried out fairly, according to legislation. In law, the national health service will have to act following a tribunal decision. An additional failsafe exists, however, through the powers that will be accorded to the Commission for Health Care Audit and Inspection.

These are major changes to mental health laws. As I said, we are committed to consulting widely on them. We intend, however, to provide new safeguards for patients alongside better protection for the wider community. I believe that the changes are long overdue.

Photo of Peter Viggers Peter Viggers Conservative, Gosport

The Secretary of State stresses the breadth of the consultation procedure, which I am sure that we all welcome. A procedure exists, however, whereby the Committee dealing with a Bill can go into a Select Committee phase to take evidence before moving to a Standing Committee phase. Have the Government considered whether it might be appropriate to use that procedure for this Bill? [Interruption.]

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. Before the Secretary of State answers, may I say to Dr. Harris that I am not entirely happy about the device that he is using now, unless he can satisfy me that it is purely and simply for diary purposes?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

I hope that the hon. Member for Oxford, West and Abingdon is not taping me, Mr. Deputy Speaker.

Mr. Viggers is tempting me to take on powers that I do not really have. In the end, those are matters for the business managers. The Government would certainly look favourably on the idea of referring the draft Bill to a Special Standing Committee. That would be helpful not only in terms of being able to examine it in detail, as we did with the Adoption and Children Bill, for example, but of taking evidence from many parties, some of whom will be happy with the provisions, and some not. If that is the hon. Gentleman's suggestion, I have no problem with it. I have no doubt that it can be discussed through the usual channels.

Mental health legislation, however, is only for the small minority of patients with a mental health problem that poses the gravest risk to themselves or to others. It is really important to keep that in mind and in perspective when debating these issues. I have no doubt that tomorrow, almost inevitably, the newspapers will be full of stories about the compulsory powers in the mental health Bill that we are proposing. However, we are debating a range of issues here today, and mental health law inevitably only ever affects a small minority of those patients with a mental health problem. It is important to keep that in mind when we debate these issues.

In the end, good quality care and treatment are key to making sure that most people with mental health problems never need to fall within the scope of mental health legislation. That is why, for the first time, the Government have laid down national standards for mental health services. Not surprisingly, the national service framework that we published three years ago has been widely welcomed, not just by clinicians and managers, but even more importantly, by carers and users of the services.

Photo of Lynne Jones Lynne Jones Labour, Birmingham, Selly Oak

Will my right hon. Friend acknowledge that Government policy will have failed if the use of compulsion does not decrease in future?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

That is what we want. We must try, and are trying, to undertake two parallel processes. The first is to deal with the loopholes in the law that, admittedly, only ever affect a small minority of people and a small minority of patients, although with huge and sometimes tragic consequences. However, our effort overall must be to develop services that are capable, in an appropriate way, of dealing with people's problems without compulsion. That is why we are trying to build up services in hospitals as well as crisis intervention teams in the community, assertive outreach teams and some of the new services that are being made available for young people with the first onset of psychosis.

Normally such young people, who are among the most vulnerable in the community, are simply not dealt with at all. They often have to wait years to be seen. However, we now know that the model that is being rolled out in 18 local communities across the country works. It can provide quick interventional services and makes a real difference to those people. It prevents them from ever requiring hospitalisation.

As I tried to make clear earlier, the trick is to get the range of services right. Although the national service framework and the NHS plan are, by necessity, 10-year programmes—we must build up capacity and change the culture of the service—progress is under way. Last year was the first year in perhaps decades in which the overall number of mental health beds in the national health service rose rather than fell. There are more than 500 extra secure beds and 320 extra 24-hour staffed beds. Such services were never available in the past, but more of them are to come.

Clearly, everything cannot be done at once, because of staffing and capacity constraints. None the less, a range of services that gets early intervention into place and ensures that appropriate services for those who need them are available in primary and hospital care is in place across the country as a whole.

Photo of Julian Lewis Julian Lewis Opposition Whip (Commons)

The Secretary of State mentioned what he thought would be in the headlines tomorrow, but I am sure that he is aware that in the headlines today is the case of a 60-year-old mental patient who was raped on a mixed-sex ward. He will recall our exchanges in the past about mixed-sex wards, and that in 1997, the date for ending them was envisaged to be 1999. That went back to 2002, and then to the end of 2002. When will we see the elimination of mixed-sex wards in mental hospitals?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

If I were the hon. Gentleman, I would be cautious about drawing too much from an individual case in the national health service. I might be wrong, but my understanding is that the incident concerned happened to a patient who occupied a single room, not in a mixed-sex ward. I may be wrong about that, but if the hon. Gentleman is getting his information from the Daily Mail, he should be cautious.

Wherever the incident took place, it was appalling and almost indescribable. It raises profound questions for the NHS. It is worth remembering that there are some evil people out there and we must ensure that the right form of protection is available for patients without—this is something we want to avoid—turning all our hospitals into prisons. I am sure that the hon. Gentleman wants to avoid that too.

Photo of Julian Lewis Julian Lewis Opposition Whip (Commons)

The Secretary of State is partly correct. According to BBC news online, the incident occurred in a patient's room, but it is believed that a male went through a mixed-sex ward before reaching that room. If it had not been a mixed-sex ward, that person would have been spotted. In any case, the Government have stated for years that they would abolish mixed-sex wards, but they have not done so. When will they do that?

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

In all candour, the hon. Gentleman is trying to draw too many wrong conclusions from one isolated terrible case. Let us examine carefully whether the incident involved a mixed-sex ward or not. It is my understanding that a member of the public came into the hospital and entered the lady's individual, single room.

We are making progress on mixed-sex wards. I think the hon. Gentleman is aware that we have targets to meet by the end of the year. I have no doubt that he will be the first to raise it if we do not meet them. However, I can assure him that we are well on target. If he wants to have a word with me after 31 December, we will contrast the progress that this Government have made in eliminating mixed-sex accommodation with the absolute failure to do anything about it when his Government were in power.

Providing the right range of services—whether in community services or acute services—requires investment. Until the Government came to office, no special funding was available for mental health services. When I hear the hon. Member for Woodspring railing against diverting mental health funding into other clinical areas, I am afraid that I also hear the sound of opportunism resonating with hypocrisy. He usually never misses an opportunity to argue the case against what he calls political priorities for funding certain services in the NHS—priorities set by Ministers. Mental health is such a service. I say that unashamedly. Under this Government, it is receiving special funding—I say that unashamedly, too—because it has a special need. Far from not producing results, the resources that it is getting are indeed producing results.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

I did a bit of research before the debate. In the hon. Gentleman's area of North-East Hertfordshire, an assertive outreach team has recently been established to cover that region and a new rehabilitation project is providing high-level support to 12 people and lesser support to eight others. In addition, a new community mental health centre was established last year which offers day care and outreach facilities. A new assertive outreach team and a crisis resolution team are operating in area represented by the hon. Member for Woodspring.

I am sure that Mr. Burns is well aware of the opening of the Christopher unit in Chelmsford; it is a seven-bedded psychiatric intensive care unit. Older people's services in his area include a liaison nurse and a third consultant post. There is 24-hour access to those services for the first time. We have also provided drug and alcohol services and more appropriate premises.

The Conservatives ask where the money is going: it is going into front-line mental health services, which is precisely where we want it to go. Staff numbers are growing, too. There are 450 more psychiatrists, 1,700 more psychologists and more than 2,000 extra nurses working in mental health services. Services for patients with the most severe mental illness have been the first priority for investment, and rightly so.

The hon. Member for Woodspring rightly raised concerns about the standard of prison care, but as he heard from my hon. Friend Mr. Battle, progress is also under way in that sector. We can make further progress in the years to come, provided that—this is the crucial consideration—we are prepared as a society, as a Government and in this House to commit the necessary resources to correct the historical underfunding that has been all too prevalent in our mental health services.

It is certainly true that there is a long way to go to secure the world-class mental health services that our country should aspire to provide, but progress is under way, and as the NHS plan set out, there is more to come. I was pleased that the hon. Member for Woodspring quoted approvingly from the Wanless review, which refers to mental health. I am pleased that the Conservatives now acknowledge the importance of Derek Wanless's work, especially as the hon. Gentleman dismissed the report when it was published by saying that it had "completely missed the point."

The hon. Gentleman may find the odd paragraph here and there in the Wanless review with which he can agree, but he cannot—perhaps he will not—make the single commitment for which it calls: a commitment to a growing NHS with rising levels of investment not just for one or two years, but over a period of years.

It was that commitment to a growing and improving NHS that we made at the time of the last Budget, and it was precisely that which the Conservatives voted against. We chose to make the necessary investment in the NHS; they chose otherwise. This week they will the ends, with today's demand for an improvement in mental health services; next week, no doubt, it will be something else; and almost daily, Conservative Back Benchers demand more health spending in their own constituencies. It is worth reminding the hon. Member for Woodspring—and the House—that only a few weeks ago he led those same Conservative Members into the No Lobby to vote against the Budget that provides the means to achieve the ends that they claim to want.

Unless and until the Conservatives have the courage to support the investment that the national health service needs, their claims of conversion to a new form of compassionate, caring conservatism will count for nothing. I say in all candour to the hon. Gentleman that until then they will be judged not on their rhetoric, but on their record—their record of underinvestment when in office, and of opposing investment when in opposition. They can talk about caring until they are blue in the face, but talk is cheap; making the necessary investment in public services is not.

It is the Labour Government who have begun the process of transforming our mental health services. Taken together with the reforms and investment that we are making in mental health services throughout the country, the proposals that I have outlined today for new mental health laws will enhance the safety of both patients and the wider public. I commend those proposals to the House and urge my right hon. and hon. Friends to back the amendment in the Lobby tonight.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon 5:16 pm, 25th June 2002

There is clearly much with which to agree in both the Front-Bench speeches that we have heard so far and in the Conservatives' motion. Indeed, it is tempting to support everything in the motion. The only point of disagreement might be what is lacking from the motion—an even more candid analysis of the record of many previous Governments. None the less, I think that the motion on the Order Paper is one that my party can support.

The Government have made things difficult by proposing to remove some of the words in the motion and replace them with other equally important statements. That puts those of us who did not table an amendment for fear that it might not be selected, in the difficult position of wanting to support some of the thoughts expressed both in the motion and in the Government amendment.

The debate has ranged wider than the words of the motion. The change to the title of the debate is interesting. Kali Mountford claimed that it was illegitimate for the Conservatives to change the subject of their debate, but I think that it is legitimate for them to have done so. They clearly thought that mental health was an important issue this week, perhaps because they knew that the Government were about to publish a draft mental health Bill.

The change on the Order Paper makes it appear that the Government advanced the publication of the Bill to today to allow us to have a debate on the Bill as well as on the Conservatives' motion. There are good and bad aspects to that proposition. It seems to me that the House has witnessed a reverse statement: questions were asked by Conservative Front Benchers before the statement was made, and parts of the Secretary of State's speech resembled the sort of prepared statement that he would give on the publication of a draft Bill.

I hope that we will be able to return in good time to the draft Bill and its provisions. I welcome the fact that the Bill is in draft form, but not that the whole process has been somewhat delayed. None the less, the Government ought to be commended on the fact that the process has been deliberative—deliberation is a separate issue from delay. I am pleased that the Bill is in draft form because we have significant concerns about its current provisions, to some of which we take exception.

In his speech and in an article in The Independent today, Dr. Fox analysed care in the community, describing it as correct in principle. I agree with him. I would go further and say that care in the community was a good policy. For many people—not only those who were in institutions and were released as a result of that policy change, but those who would have become new patients facing life, or at least long-term, incarceration in institutions—the policy of care in the community introduced by the Conservatives was a boon.

Is it correct to say that because there have been problems with care in the community, it has failed? I would argue that that is an unfair statement, because care in the community was never properly tried and it never had the required funding and resources. Clearly, in mental health more than any other area, the therapeutic environment is staff-rich. Many other conditions can be treated at arm's length from professional staff, with drugs alone or with surgery and little follow-up, but mental health needs a high ratio of professional staff to patients, not only to monitor drug therapy, but to offer the talking treatments and counselling that are becoming popular with patients and whose effectiveness is increasingly becoming evident.

That is why care in the community, which loses the economies of scale achieved by gathering people in institutions, should not be seen simply as a cash-releasing exercise allowing old hospitals to be closed and sold off and the overheads saved, and why it required not just existing funding, but additional investment, which was never made available. Despite progress in their thinking, the Conservatives have not accepted that analysis of care in the community.

In his article in The Independent and in his speech, the hon. Member for Woodspring said that he thought care in the community

"was implemented too quickly, often with inappropriate patient selection, and in too many places there was too little investment".

If he had ended with those words, we could have said, "And so say all of us," but he qualified them by referring to

"too little investment in training, finance and related areas."

I assume that "related areas" refers to the staff, psychiatrists, community psychiatric nurses, community care managers, and the organisation and services to support patients in the community.

I would not say that care in the community failed because of poor implementation. That appears to blame the staff or civil servants for what was a political decision to underfund the sector. I say that it was in large part due to a failure of funding and—these arguments have been well rehearsed before—the difficulty of communication between social services and health departments, particularly when both are short of money. I have made the point before that to describe the barrier between them as a Berlin wall is wrong—it would be more accurate to say a Berlin trench, with both digging for the resources. That applies not only to the Conservative Government, but to the previous Parliament.

I pay tribute to the work of the Zito Trust in drawing attention to the needs of patients in the community and the dangers that they pose to themselves and the public. Mike Howlett of the Zito Trust was quoted as complaining that part of the problem with the way in which some patients in the community have been managed is that dangers were not spotted. That is no excuse for detention of those with personality disorder, or for compulsory treatment, but it is an argument for better follow-up, more support for those patients and ensuring that they remain in touch.

I had a homicide in my constituency which occurred nine years after the patient was last in touch with mental health services of either kind, so it was not a problem of poor follow-up of a treated patient who was in the system. The patient was not in the system at all. There is not enough evidence to suggest that we need to go further than improving support. We should not be considering indefinite detention and other such policies.

The hon. Member for Woodspring also spoke—and I believe that others will speak—about the stigma attaching to people with mental health problems. We must recognise that, and regret stigma where we see it—in films and on television—in the portrayal of people with mental illness in stereotypical or caricatured forms. We must regret irresponsible newspaper coverage of events in the community and seek to persuade newspapers to look at the problem from both points of view, and not just to represent, as they see it, the views of the outraged public.

We in the House have a responsibility for the language that we use. I have often been embarrassed by language used in the House—including, no doubt, some of the language used by my hon. Friends. The hon. Member for Woodspring was provoked into describing, without justification, an intervention from a Labour Member as "imbecilic". The use of such words is part of the problem. The Secretary of State's predecessor sometimes became carried away and used heightened language about which I have expressed concerns to him. He did so, for example, in describing Opposition politicians as loony. That may have been worth a laugh at the time, and such language might sometimes have been merited—I am not speaking about those on my Benches—in terms of what he was trying to say. None the less, the use of such terms is part of the problem of increasing stigma. I hope that the Government guide themselves in line with their campaign to ensure that we are responsible in our use of language.

Mental health services have been described in this debate as Cinderella services. We need to analyse in a little more detail the reasons why they can be so described. It has always been difficult to argue for more funding for mental health at local and indeed national level, because it is not glamorous and the latest technologies are not found in this specialty. The status of professionals working in mental health has not traditionally equalled that of those working in acute medicine, emergency medicine and elective surgery, and in what is seen as life-saving surgery in general. That makes it is almost more important for Governments and more incumbent upon them to redress the balance and ensure that adequate funds are made available. We start from a position of gross underfunding of the mental health specialty. It was most prevalent in the Conservative years, but also existed in the first two—if not four or five—years of the current Administration.

We have a further problem in that there are no easy outcome measures. When the Government link funding or prioritisation to the measurement of outcomes, as they do in elective surgery and accident and emergency medicine in terms of trolley waits or general waiting times, the danger is that specialties such as mental health and care of the elderly, which are not easily outcome-measured, suffer because of a lack of political prioritisation, despite the words of the Secretary of State and despite the national service framework. If targets are based on those outcomes and health service managers know that their jobs are dependent on their meeting Government targets that have been raised to a level of political risk, such as those for waiting times and, even worse, waiting lists, there is a danger of diversion of resources from mental health to those other fields.

That is why I have argued—and I have done so consistently, in contrast with the Conservatives—against such central priority setting. I believe that funding should generally not be earmarked; that priorities should be set locally; and that when politicians, even under pressure from the Opposition or the newspapers, seek to set targets in certain areas, they must recognise that there will be a tyranny over the outcome measured in terms of time and resource allocation and prioritisation.

That is a problem. The Secretary of State will recognise that some of the resources that he meant to go into his priority of mental health were diverted into dealing with the here and now of deficits and waiting list targets, and that that funding was, and still is, being poached from mental health. It would be better to ensure that local priorities are set with input on public health and guidance from the Government, but not strict targets. There is a need to allow the bottom-up approach to ensure that resources are provided.

Within this particular Cinderella specialty—there are two such specialties: elderly care and mental illness—the elderly mentally ill are the Cinderella of Cinderellas.

Photo of Oliver Heald Oliver Heald Shadow Cabinet Minister (Work and Pensions)

The hon. Gentleman talks about money that the Government have earmarked not going into mental health services, which is a particular concern. However, is it not the case that he does not even believe in the earmarking in the first place, so the idea that the money would go into mental health is not correct?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

The difficulty with earmarking is that there will always be something that is not earmarked, unless one centrally earmarks funding for every service. That is why I do not believe that the earmarking of funding is the right way forward. I hope that I have answered the hon. Gentleman's question. I believe that I have been consistent in holding the position that earmarking for the pleasure of allowing the Secretary of State to make announcements about his priorities does a disservice to neglected areas. However, I pay tribute to the hon. Gentleman's interest in mental health, which has been even longer held than that of his hon. Friend the Member for Woodspring, if I may put it that way.

The elderly mentally ill are affected by shortages not only in acute beds, but in residential care and community care services, owing to the impact of the huge funding gap in social care. It is well recognised that social services departments now spend £1 billion more on social care than the standard spending assessment. The Government's failure to meet that gap means that other services are having to be cut. Until the Government put some of the new resources—more than they plan to—into social services, the false economy of beds being blocked will remain. As the Secretary of State knows, bed blocking is a phenomenon not only for acute hospitals, but for acute mental hospitals.

Photo of Alan Milburn Alan Milburn Secretary of State, Department of Health

On the £1 billion gap, is it Liberal Democrat policy to eradicate it?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

Yes, it is. We were clear about that in our alternative Budget. If the Secretary of State looks at the detail, he will see that putting £1 billion of new money into the gap would prevent the inexorable rise in regressive council tax and facilitate the local development of services for growth areas instead of propping up the service. I do not want to be distracted too much into social care, but I assure the Secretary of State that my comments are not inconsistent with what we have said before.

A survey that we carried out in the past year showed that 72 per cent. of social services departments were unable to meet the demand for nursing elderly mental illness beds and that 68 per cent. were unable to meet the demand for residential elderly mental illness beds. Fifty-eight per cent. reported shortfalls in the provision of specialised dementia care and 62 per cent. reported shortfalls in provision for older people with challenging behaviour. In dealing with mental illness, we must recognise that we are also dealing with illness that presents as dementia, especially among the elderly. They are affected by underfunding in every budget on which they rely; they are the Cinderella of Cinderellas.

We have had a brief opportunity to look at the draft Bill. I hope that the Secretary of State accepts that we need to spend more time on the detail and that we can do so in Government time, perhaps in Westminster Hall. The Bill has two main flaws. It provides for too much detention without proper treatment, and for inappropriate treatment in the community without enabling people to get back into hospital when they need to.

Photo of Tom Clarke Tom Clarke Labour, Coatbridge and Chryston

Before the hon. Gentleman develops his argument, which he is doing very well, I ask him to focus on those people who, whether they like it or not, remain in the community, and who were the subject of the Donaldson report on chronic fatigue syndrome and ME. Does he agree that in so far as there is a psychiatric input—which is debatable—no time should be lost in referring GPs to the findings of that report, and that it would be a great mistake if the National Institute for Clinical Excellence was asked to spend too much time on it?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

Not enough information on those difficult conditions is available to or absorbed by those in primary care, on whom the burden most falls. There have been reports in recent days about the amount of unnecessary paperwork that GPs have to get through, and I hesitate to say that they should do even more reading without some being taken away from them. The right hon. Gentleman's remarks are on the record. All hon. Members have constituents with chronic fatigue syndrome or ME, and we know what an ordeal they have to go through to get recognition of their condition, let alone the treatment and care that they and their families need.

Returning to the draft Bill, it is going too far to detain people who should not be detained for intervention that cannot in all cases be described as treatment. Again, we need more time to develop that, but the Secretary of State knows the arguments against the provisions.

It is important to hold a debate on compulsory treatment orders. There are arguments in favour of compulsory treatment and the Select Committee on Health made important points about it in its report in July 2000. We look forward to hearing the Chairman's views on the matter. The Health Committee was ambivalent and raised anxieties about it, but did not automatically rule out such a provision. The Government must show even greater recognition of the anxieties than the Secretary of State did.

It is feared that expanding the definition of mental disorder to include those with personality disorder, and expanding the definition of treatment to include habilitation—teaching people how to live independently—will mean that the definitions are too broad to reassure those of us who are worried that too many civil liberties will be lost in the name of public protection. It is worrying that the Secretary of State uses language such as, "If people refuse treatment, they will be compulsorily detained." If those people are deemed capable of refusing treatment, it means that although they may be mentally disordered, they may also be competent to decline treatment. If they do that, the Secretary of State will add an extra group of people to those who can currently be compulsorily detained.

The principles of non-discrimination and autonomy for people who are capable of giving and, importantly, refusing consent for treatment must be respected. Otherwise we enter new territory that is dangerous for Governments without greater support from key organisations such as the Royal College of Psychiatrists.

Photo of Joan Humble Joan Humble Labour, Blackpool North and Fleetwood

Does the hon. Gentleman acknowledge that the anger and bewilderment of people in the community who are assaulted by neighbours must be weighed in the balance? The police will not act because doctors advise them that the person is not fit to plead, and the health service will not act because it claims that the person has an untreatable mental illness. The problem persists, and there is anger in the community.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I understand the hon. Lady's point. The Secretary of State dealt with the matter when he asked, with an expansive shrug of shoulders, what Governments can do when faced with the problem that she outlined, and talked about the difficulties in the current law of ensuring that such people are treated. I acknowledge that the difficulty needs wider debate. However, I believe that steps must be taken before we go down the path that the Secretary of State suggests.

First, we must provide greater community support and early intervention, which is not currently available. Many tragedies could be prevented not simply by detention, but by early detection and intervention, and greater support.

Secondly, we must understand the principle of reciprocity. I do not believe that people who are subject to greater powers under the draft Bill will recognise that they are being fairly treated until the Government provide enhanced treatment facilities. I hope that they will do that with the extra funding for the NHS so that there is no delay in getting a hospital bed, or, as Mr. Hinchliffe said, in getting out of a hospital bed into other treatment. There should not be a delay before allocation to a community health team. There should not be such a shortage of professionals that oversight is inadequate.

We have an additional duty to ensure that patients who are capable but threatened with compulsory treatment are not rationed out of health care. I am conscious of the time, and the debate could continue, but I wanted to draw attention, before Second Reading of the Bill that is now in draft form—I hope that it will be amended—to the fact we could hold significant debates on this issue.

Dr. Fox made an important point about mental health in prisons. There are significant difficulties in prison, where all the problems in the community are writ large because there is a concentration of people many of whom have mental health problems. Despite the best efforts of those who work under siege in prisons, the health service facilities there are not adequate. The Government must pay greater attention to those concerns.

The problem of dual diagnosis has not yet been raised, although I am sure that all hon. Members will know that it is a major issue, involving mental illness coexisting with drug dependency. It is prevalent particularly among the prison population, but also in the population of drug users outside. Whatever resources are needed for each of those groups, the problem requires a combination of behaviour that is mediated not primarily through the judicial system but through enhanced treatment.

The Secretary of State felt that many of the people who had caused problems in the community through horrific and tragic incidents had not been in touch with mental health services at the time, even if they had previously been. I would suggest that that is an argument in favour of increasing the responsiveness of existing mental health services, and that that has to be done before the Government pursue other options. Otherwise, in the words of a civil servant to a conference in 2000, we shall be dealing not with a

"health act for vulnerable people in need", but with a public safety Act.

I shall not repeat the points that I made in an earlier intervention about treatability, but I am concerned that the number of people subject to detention on the basis of personality disorder will be dictated not by medical evidence—particularly if the pilot schemes and trials do not give the results that the Government want—but by the treatment of those people by the tabloids.

In their joint statement, the Royal College of Psychiatrists and the Law Society have raised a number of concerns about the draft mental health Bill founded on the White Paper, some of which were mentioned by the hon. Member for Woodspring but others of which were not. Until now, I have not read a briefing by a royal college so critical of Government policy and couched in such strong terms, and I hope that the Secretary of State will have an opportunity to read it. The statement says:

"The proposals"— based on the White Paper

"would be costly and complex to implement. Government funds would be better spent in the provision of more effective clinical services for patients.

The new Mental Health Review Tribunals alone would require the time of 600 (extra) psychiatrists. It would be impossible to recruit such numbers. Those in post would be diverted from direct patient care."

Many feel that they are now; the shortage of mental health professionals is severe. [Interruption.] I think that the Secretary of State just said, from a sedentary position, that he considered those views to be "drivel". That is an argument that needs to take place, with the Royal College of Psychiatrists and the Law Society on one side, and the Secretary of State's wishful thinking on the other.

The statement goes on:

"It is right that new legislation should reflect the move from hospital to community care. But the proposals as they stand would introduce powers that are ethically dubious and practically unworkable. They take no account of alternatives such as the use of leave and discharge with treatment conditions."

That is an alternative that was proposed by the Royal College of Psychiatrists.

It is damaging and disappointing that the Government stand poised to implement the much needed updating of the Mental Health Act 1983 with what could be considered repressive legislation, and to lock up people with untreatable personality disorders indefinitely. The public must be protected from the risk of attack, but the best way to achieve that is to ensure that there are adequate resources in terms of psychiatrists, community psychiatric nurses, community care managers, drug therapies and talking treatments. The public, and, to a much greater extent, the mentally ill themselves, are at much greater risk from under-resourcing than from the absence of detention powers or compulsory treatment orders.

The Conservatives have claimed that community care has failed, but it was never properly tried, because it has never been given the funding that it requires. I hope that all hon. Members will recognise the desperate need for resources and for improving the morale of people working in the mental health service, and for those things to be done before powers that are too draconian are taken in legislation.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield 5:44 pm, 25th June 2002

I welcome this debate, and I would like to say that there has been much in all the three previous speeches with which I genuinely agree. I welcome the fact that the Government have introduced their draft Bill, and I look forward to the debates on it. It will form the basis for important, long overdue changes in mental health legislation.

The background to today's debate is interesting. My right hon. Friend Mr. Dobson, the previous Secretary of State for Health, made the interesting comment, while he was still Secretary of State, that community care had failed, and today we have heard a possible confession from the Conservatives that their policies in the 1980s and 1990s on community care had failed.

In debates such as this, I find myself thinking about what went before. Dr. Harris referred briefly to lunatic asylums—the system of long-stay institutions that was in place not long ago. Community care is not a recent development; I had the interesting experience of working in community care in the 1970s, when it was getting under way. Reference has been made to Enoch Powell, and moves towards community care were being made as long ago as the early part of the 20th century.

I have a vivid memory of what I saw in those long-stay institutions. The implication of debates such as this—that there was a golden age of lunacy, in which all such people were happily looked after in nice places—is absolute nonsense. Frankly, those places, some of which I knew well, were not nice. I was familiar with some of the highly questionable treatments that were used, and I witnessed the gross denigration of human rights. I remember training as a social worker in the early 1970s with former psychiatric nurses. They told me about a particular Yorkshire institution in which competitions were held to see who could throw patients furthest down a ward. My plea is that we do not forget that the previous situation was not positive but appalling for vast numbers of people.

I have personal experience of discharging from hospital people who were deemed moral defectives—women who had spent their lives locked up in institutional care for doing nothing other than, say, having a child out of wedlock. That was a disgraceful and scandalous situation, which we should never forget. I met many others who were totally sane, even though they had spent their lives in institutional care. Indeed, other than the consequences of being institutionalised, they were no more mad than anybody in this place. Having said that, I have probably met more mad people in the Palace of Westminster than in all the years that I worked in various lunatic asylums and long-stay institutions.

The hon. Member for Oxford, West and Abingdon mentioned the Health Committee's mental health inquiry of 2002. It was a cross-party report, in which we stated that it was "misleading and unhelpful" to argue that care in the community had failed, but that

"it has failed for some individuals".

I readily concede that it has indeed failed for some. Like most hon. Members, I meet such people and I am very conscious of the need to address their difficulties. My personal view is that the vast majority of mental health patients get a better deal than that offered 25 years ago, and we should not forget that improvements have been made.

I commend the previous Conservative Government on the work that they did. Although I opposed many of their measures and had some practical concerns, the principle behind their policy was correct. They were going in the right direction and secured many achievements in community care. I congratulate the current Government, too, on many of their mental health policies, particularly the national service framework—a commendable initiative that is delivering genuine and long overdue improvements. However, I concede that several important problems remain, and in the brief time available I want to spell them out.

The resources question has been touched on. Money has been made available nationally, but it has not fed through to actual improvements in local mental health services. All of us—including, I suspect, Ministers—are concerned about that. I reiterate the point about funding discrepancies between health and social services. Commendably, through the Budget the Government have done something about that problem, which the Wanless report recognised. We now realise that such discrepancies have held back the development of alternatives for patients leaving hospital and returning to the community.

I also want to repeat my concern—I have expressed it on many previous occasions—about fragmentation of services and the lack of co-ordination between health and social care. I shall not reiterate the solutions that I have described many times before, but I hope that they come to fruition at some point during my time in this place. It is taking a long time to implement them, but I remain hopeful. The Government are gradually moving towards an integrated health and social care system. Such a system is necessary because problems such as mental illness do not slot neatly into a medical model or a social care model, but overlap both.

The lack of planning and co-ordination of services is obvious in my constituency, which contains male and female prisons. There is also a regional secure unit near my constituency. I visit each establishment and some of the special hospitals, and I see people who should be somewhere else, but nobody seems to ensure that such people move to where they should be. I welcome the steps that the Government have taken in linking special hospitals to local trusts. That is an important move forward, but I would welcome the Government being more radical and acting on the many reports that have suggested that we need to leave behind the models of special hospitals that we have used for many years and have more localised regional secure units. That is a politically difficult step, because no one wants one in their backyard. I have one in my backyard and I understand the difficulties, but that is the way we must go. I welcome the steps that the Government have taken in that direction, but we must go even further.

When the Health Committee considered mental health, the rights of patients concerned me greatly. We visited Broadmoor hospital, where we were told that 60 per cent. of the women detained did not need to be there and could be cared for in an appropriate environment within the community. That was very worrying, and we must ensure that our new mental health laws do something about that. At Ashworth hospital, we were told that a quarter of the male patients could be cared for more appropriately in the community. I commend The Independent on Sunday, which is running a series of articles that look in detail at the circumstances of some of those patients, because we need to be reminded that they are human beings. We should be concerned to ensure that our legislation will address their circumstances.

I am concerned that insufficient rigour is used when deciding where in the system patients would be most appropriately placed. That is why I intervened in the Secretary of State's speech to ask who will ensure that the decisions of mental health tribunals are properly policed. At the moment—and I mean no disrespect to the Mental Health Act Commission—I see far too many examples of people being left in completely unsuitable placements. I welcome the proposals for the inspectorate to examine that issue, and I hope that it will be able to join up provision in a way that does not happen now.

When the Minister winds up, I hope that he will address how we can square the principles of the national service framework—such as non-discrimination and combating stigma—with legislation that will primarily be focused on compulsion. That will present certain difficulties. On the matter of DSPD—dangerous and severe personality disorder—I would also welcome some clarification on what is a health issue and what is a criminal justice matter. Like the hon. Member for Oxford, West and Abingdon, I have some concerns about that difficult area, and we need to get it right. I am aware that the Government's position differs somewhat from that of the expert group that advised the Government on proposals for change in mental health law. I would also welcome comments on the consistency of the diagnosis of DSPD—we are talking about 2,400 patients—because I know many psychiatrists and they do not all agree on the diagnosis. We need to be careful when labelling people, or possibly locking them up for good, that we know what we are talking about.

Coincidentally, today I had a meeting with Young Minds, which was arranged many weeks ago. The young people I met made the point that we need to consider how we can prevent increasing numbers of children and young people from developing mental disorders. Their concern was that we do not make sufficient links between our health services and our education system. They see, as I do, children under immense pressure from league tables, examinations—I have a son who completed his GCSEs today, so I know full well the pressures on youngsters and schools—depression and parental break-up. Many factors are forcing young people into mental illness and the current system does not sufficiently address the need for prevention.

One of the issues that the Health Committee considered was the need to encourage far more user involvement in mental health services. We were impressed by some of the user initiatives that we saw in various places, which offered community-based alternatives to in-patient care. We felt that those initiatives should receive more support.

We have seen many positive developments in the past 25 years, for which successive Governments may claim credit. Although I accept that many challenges lie ahead, in my time in social work and working on policy development in this place, I have seen profound changes and it saddens me that we tend to forget how bad things were before the introduction of community care.

Photo of Hugo Swire Hugo Swire Conservative, East Devon 5:56 pm, 25th June 2002

Just a fortnight ago tragedy came to east Devon with the triple suicide of Anne Harris, Shaun Sheppard and Jamie Hague, about which there has been much press speculation—not least in the papers today. Professor Rachel Jenkins, the director of the World Health Organisation collaboration centre at London's Institute of Psychiatry, commented that she had never heard of a triple suicide before.

I wish to set the record straight in the limited time available. None of the three was detained at the time under the Mental Health Act. They were informal patients at the Cedars unit of Wonford hospital in Exeter. That unit is an acute in-patient mental health facility for patients between the ages of 16 and 65, primarily from mid and east Devon, on short to medium-term admissions. People are generally admitted for a few days or weeks and on discharge, they are followed up by a care co-ordinator who is a member of the community mental health team. People are admitted with a range of mental health problems, including acute mental illnesses and longer term disorders.

The challenge for the staff is to provide quality care in a less restricted atmosphere. The situation can change from minute to minute, and the staff have to attempt a difficult balancing act. The staff are a multi-disciplinary team, including medical staff, mental health nurses, occupational therapists and psychologists. Patients all have an individual care plan that covers medication, individual therapy, activities and leave away from the unit.

I have spoken regularly to Valerie Howell, the chief executive of the Devon Partnership NHS Trust, and I am most grateful to her for keeping me informed. I was told today that the internal review will report by the end of July to the trust board and will be followed by an independent review, consisting of three independent people—probably a nurse, a doctor and a barrister. All the findings of both reviews will be made public and the families of the deceased, with whom, of course, our concerns lie, will be fully involved in them. The reviews will be open and, no doubt, provide lessons to be learned. I suspect that the main question will be whether the care and treatment package was correct and sufficient support available.

The two patients who were thought to have killed themselves a few days earlier were not in-patients of the Cedars unit, although they were out-patients from the same health authority. The police have to deal with the aftermath of these distressing cases, and in this instance, no blame should be apportioned to them. It turns out that the policeman who found the three at the top of the cliff had no training in negotiation, although it is doubtful whether he could have done anything at that stage had he had such training.

Professor Jenkins has pointed out that people with mental illness are at a greatly increased risk of suicide. One in six people with manic depression take their own lives. That is why I am pleased that the motion refers to

"the lack of early intervention with the young".

It also expresses

"concern at the rise in the suicide rate of those suffering from mental illness".

We have a responsibility to the most vulnerable in our society—those who sometimes, through no fault of their own, get left behind. I therefore welcome any measure that addresses that issue. It is with some enthusiasm, therefore, that I support the motion tabled by my right hon. and hon. Friends.

Photo of John Battle John Battle Labour, Leeds West 6:00 pm, 25th June 2002

I welcome the subject of the debate, because we should all work harder to ensure that the issue of mental health is brought out of the shadows and on to the Floor of the House more regularly. In past years, we heard statements on mental health in December 2000 and December 1998, and I welcome today's draft Bill.

I cannot help but recall that, in February 1996, when the Conservative Government made a statement, we were in opposition, pressing the then Secretary of State to halt further psychiatric bed closures until community services were in place. We were pressing for the implementation of a full care programme. We asked that Government to address staff shortages and to change the mental health funding allocation formula to ensure that cash ended up where it was needed. That went unheard at the time, which is why—despite the tone of the remarks from Dr. Fox—I have to say that the new so-called "compassionate conservatism" is a rather shallow plant that lacks historic roots.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

Does the hon. Gentleman share my concern at the closure of Elderly mentally infirm mental illness beds across the country, and particularly in my constituency, under this Government without a commensurate increase in hospital at-home provision?

Photo of John Battle John Battle Labour, Leeds West

The hon. Gentleman should go to the Library to study how we had care in the community by default because of the closure of beds under the previous Government.

Let us consider the future. There is still a deep fear of addressing the taboo of mental health and there is still a stigma attached to it. There is still a sense that although the brain is a wonderful organ, it is still not sufficiently understood, despite all our brilliant neuroscientists. We know little about its complex workings and connections as it integrates, at its best, the mind and the body.

We neglect mental health, and yet how often do we, as Members of Parliament, see people in our advice surgeries who are suffering from mental illness? People come to see us who literally may not have spoken to another person in the two weeks since they were last at our surgeries. People come to see us who are confused, worried about their medication or concerned about their treatment and records. With respect to the doctors in the House, none of us can deal with such problems, but we see that there is a real need in terms of mental health care, and it is increasing. In policy terms, we must not steer clear of the issue but, instead, move closer to it.

For centuries, people with mental health were locked away in Bedlam, in asylums and in institutions, and were forgotten. Now, according to Sane, the mental health charity, one in four of us will suffer some form of mental illness in our lifetimes. We should reflect on that.

We should welcome the more open interest in mental health issues in our society. There is an acceptance of the reality of mental handicap and mental illness that perhaps was not there 10 or 20 years ago. There is an increasing refusal to accept the traditional mind-body split, which implies that each could be treated separately. There is a greater contemporary emphasis on holistic approaches to mental and physical health.

The mental institutions to which my hon. Friend Mr. Hinchliffe referred were closed in an attempt to provide care in the community. I worked in one such institution, in Meanwood Park, and I concur with my hon. Friend; they were not the right places for most of the people who were there. The problem was that when care in the community was introduced, there was neither care, in terms of back-up support services, nor community, in the sense of welcoming someone or offering local neighbourhood support. That left sufferers more isolated, neglected and unsupported than anyone else in society. The funding did not follow the mental health patient, as we were told it would at the time.

I welcome what has happened since then—for example, the Government's plan to increase the priority and significance of mental health, and the increase in investment. I welcome the work to tackle the problem of homelessness. We have a public information campaign and we have heard the announcement of a draft Bill, which deserves full consideration and wider public debate.

In my constituency, the health authority informs me that the rate of schizophrenia in our inner-city area is significantly higher than in other communities in Leeds. That will include post-natal depression, elderly people with dementia and Alzheimer's, people with phobias and people with eating disorders. However, people suffering from mental illness tend to end up at the bottom end, in privately rented terraced housing, small single bedrooms, low quality council housing and miscellaneous properties. They get the worst deal of all and they are up against it in trying to survive from day to day.

I spent a day with the Leeds community mental health trust, visiting day centres and talking to mental health workers and specialists working with those suffering as a result of alcohol and drug abuse. I also talked to patients. I would recommend such a visit to other colleagues, as it was worth while. I recall a young mother at one of the centres who told me that the centre was the only place that she could go where nobody judged her. That was important. We have heard the word "sanctuary" used earlier. Sanctuary is not only a place, but an attitude of mind towards others who feel that they are often accused, blamed, marginalised, dismissed and then written off.

One of the great innovations of the Government has been the reform of the NHS through the introduction of primary care trusts. We have to make sure that the variety of preventive health and social services, designed as a dynamic, supportive local network, work in practice and that each primary care trust gets an adequate budget to follow plans through at a local level. We can get agreement on priorities and objectives, and we can assess the needs. But if we assess that the local surgeries need eight mental health staff, it is not enough to provide funding for two, as has happened in Leeds, West. There are recruitment problems, but that is not all. We need to ensure that resources get to the front line locally. I hope that Ministers and the Department will continue to monitor in detail the reform processes that they have set in train to ensure that that happens.

I want to refer to three policy matters that we must take much more seriously. Colleagues have referred to prisons, and Armley prison is in my constituency. Some 80 per cent. of people in that prison suffer from mental illness and/or drug dependency and alcohol problems. Ten prisoners there today out of 1,247 have been sectioned under the Mental Health Act. Care in the community has come to mean, for many, care in custody.

I welcome the fact that Armley prison is one of the 10 prisons piloting the Government's new mental health in-reach approach. However, the scheme has been going for three months and has a team of seven; it should be nine. We need to follow this through so that the work of the Home Office and the Department of Health are linked. I also wish to refer to outreach, because we must ensure that when a prisoner leaves prison with mental health needs, he is followed through and receives support within the community.

I was involved in the establishment of the all-party group on epilepsy, which is well supported across the House. Some 500,000 people in Britain suffer from epilepsy. There was a report recently on people who have suffered sudden and unexpected death as a result of epilepsy, and it revealed that they were usually young adults. I thank the Minister for the reply that I received to my parliamentary questions of 20 June, in which she welcomed the national central audit of epilepsy-related deaths. The Department has promised to consider the recommendations and to develop a strategy and plan by September of this year. It is important that we treat epilepsy in the same way as diabetes, for example, and not leave it as a Cinderella illness. In the past, people with epilepsy were locked away in mental institutions.

May I make a plea for more attention to be paid to a real crisis area—that of suicides among young men? I have recently come across three such cases—in two cases suicide was attempted, in the third, tragically, the suicide was carried through. Will the Department of Health use its research resources to look at that policy and take it forward? The mental health needs of young men in an increasingly pressured and high-speed world are paramount.

Finally, proper support, assistance and treatment needs to be followed through to help people help themselves. That implies that the wider community assists as well, which means that the care plans referred to in the draft Bill will be vital. With proper back-up and the involvement of patients, they could be the focus and centre of the Bill. As a result, we might not fear mental illness as we have in the past but, as a society and through our institutions, we could properly care for sufferers and at last treat them as equal citizens in our society, as we treat anyone else with health needs.

Photo of Peter Viggers Peter Viggers Conservative, Gosport 6:11 pm, 25th June 2002

Time is very limited, but I welcome the opportunity to make a brief contribution to the debate.

There is a wide range of mental health problems, including anxiety disorders, attention deficit disorder, dementia, depression, eating disorders, mood disorders, obsessive compulsive disorders, personality disorders, psychotic disorders—including schizophrenia—self-harm, sleep disorders, stress disorders and substance abuse. I am sure that all of us, at various times, have come across those problems in our constituencies. Mental handicap, of course, has its own special problems. One is aware of the love and affection that people with special needs engender in their carers and next of kin.

We must remember that mental illness does not affect a different category of person. As has already been pointed out, one in four of the population suffers from some form of mental illness—and that definition does not even take into account questions of mental fitness. All of us are less than mentally fit at various times. Like physical illness, mental illness should be regarded as a normal part of life. However, that does not mean that it is not stressful for all involved. We recognise that mental illness and lack of mental health impose immense stress and pressure on carers. I am sure that we all wish to pay tribute to those who help people suffering from a mental health problem.

In some cases, mental health problems can be extreme. It is extraordinary that one third of all young men between the ages of 16 and 18 who are sentenced in court are diagnosed with a primary mental disorder. It is even more extraordinary that 70 per cent. of prisoners have mental illness or suffer from drug abuse. That leads to two conclusions: first, there should be a major new initiative, involving the national health service, to care for the mental health of prisoners. The second conclusion, which is not directly related to this debate, is that we must reconsider the treatment of heroin abusers. Locking them up in prison cannot be the answer if they have access to heroin in prison, and leave prison with greater problems than they had when they entered it.

In 1999 the Government promised to introduce a mental health Bill. It took until December 2000 to produce a White Paper, and now we have a draft Bill, which I welcome. I also welcome the Secretary of State's response to my submission that when the Bill has had a Second Reading—I am sure that we all wish it well on that occasion—it should be sent to a Special Standing Committee, so that all the issues can be considered on a non-partisan basis. The Bill would effectively go before a Select Committee, during which members of the Committee could cross-examine experts and form a view before considering it in a Standing Committee. That would be entirely appropriate.

The problems in the national health service include a shortage of psychiatrists, an acute shortage of psychiatric beds, a shortage of social workers in psychiatry and a shortage of people who can treat the large number of people who suffer from dementia. About 5 per cent. of those over 65 suffer from dementia, as do 20 per cent. of those over 80. Those elderly people are unlikely to see a psychiatrist at all.

My greatest sympathy is reserved for the young. In some cases of acute mental illness, young people have to wait a long time to see a psychiatrist. The waiting time in my constituency is 18 months. This is a matter of resources; we need more resources for psychiatrists, and the latest modern drugs.

The time constraints are severe tonight, but I welcome the chance to have made this brief contribution. The debate will have served its purpose if it pushes the Government to give a higher priority to mental health services, and helps all of us to regard mental health care as an important part of the national health service that is worthy of debate and support.

Photo of Lynne Jones Lynne Jones Labour, Birmingham, Selly Oak 6:16 pm, 25th June 2002

Today's debate has been interesting and enlightening. I agree with many of the comments made by previous speakers, and congratulate the Conservative party on making mental health the subject of this Opposition day debate.

There is much consensus between Government and Opposition on this issue. It was, after all, a Conservative Secretary of State for Health who coined the term "spectrum of services", acknowledging that there had been a failure to put adequate services in place in the community. It is sad that Dr. Fox did not acknowledge the failures of the Conservative Government. I agree with much of the Opposition's motion, but I am sad about its failure to acknowledge the positive progress that the Government have made. They have made the vision of the spectrum of services a reality by increasing the number of assertive outreach teams, improving talking treatments and psychology services and investing in the physical infrastructure in our acute wards.

There will be considerable investment in new mental health services in Birmingham. An acute hospital that is not very old is to go. It was provided in the late 1980s, and when I went there, I was appalled at the lack of therapeutic atmosphere in the building. It was a very constrained building that had obviously been subject to a great deal of cost cutting. At last we will get new services; many will be for in-patients, provided locally rather than at the main hospital base. The Government are making that investment. The Conservatives are right to say that we have a long way to go, but it is churlish not to acknowledge that great progress is being made.

I have not yet had an opportunity to look at the draft Bill, but I welcome its publication. I agree with Mr. Viggers that it should be subject to Special Standing Committee procedure. It is now nearly 20 years since the last major piece of mental health legislation. The draft Bill represents the opportunity of a lifetime, and we must ensure that we get it right. We must ensure that we balance the emphasis on public protection—which I think is over-emphasised—with people's right to receive appropriate care. That right is not in place at present. Every time we use compulsion it is an indication less of failing in the individual than of failing in the services provided for people in need.

The Government are initiating a 10-year programme to build up capacity. Goodness knows, more money is needed, and we must be vigilant in ensuring that money allocated for mental health services is not diverted to deal with other pressures. However, no matter how much money we put into services, it is also essential that we have enough staff with the necessary skills.

We do not have enough staff at the moment. The Sainsbury Centre for Mental Health has pointed out that in the existing establishment, one in eight positions is vacant. If the ambitions of the Government, expressed in the national service framework and other plans, are to be realised, we shall need an additional 8,000 staff—a 12 per cent. increase.

Psychiatry is a Cinderella service in more ways than one. It is not attractive to newly qualified graduates, and we need to ensure that it becomes more attractive. One reason why people shy away from mental health services is the culture of blame in our society, which creates problems in many services, including social work. Because of the stresses and strains on a service, things go wrong—and it is too easy to blame individual clinicians or social workers for their mistakes. That is not to deny that bad mistakes are sometimes made, or that there is some culpability. In many cases, however, people are working against the odds and we should acknowledge that.

We must deal with the blame culture, and we should move away from too much emphasis on public protection. The only time there is any great publicity or press interest is when a tragic event, especially homicide, occurs. In that context, it is commendable that the Opposition have initiated a debate on mental health when that type of public interest is not current. It is also commendable that they have adopted mental health as one of their priorities; it is already a priority for the Government, so there is much consensus, on the basis of which we can move forward.

At the last meeting of the all-party mental health group, we discussed mental health appeal tribunals. We heard about patients who had to wait more than 20 weeks for their case to be reviewed by a tribunal. The Royal College of Psychiatrists has pointed out that the process is extremely staff-intensive. A mental health appeal tribunal chair told the all-party group about the constraints on the tribunal service, including the shortage of psychiatrists to serve on the panels and the fact that the psychiatrists who have to provide reports for the tribunal are over-stretched.

The White Paper proposed automatic referral to a mental health tribunal after 28 days of compulsory treatment; my right hon. Friend the Secretary of State suggested that the Bill would include such a provision. There is concern, however, that even more psychiatric time will be taken up in dealing with the process, so there is a danger that there will be even more delays in the system. The Government need to consider that point.

Although there is consensus among us, omitted from many contributions to the debate was the need to make the experiences of users of the service central to its provision. We should have respect for them and involve them in decisions about their care. A survey carried out by the National Schizophrenia Fellowship showed that a quarter of mental health service users did not even have the opportunity to discuss their medication, while 62 per cent. said that there was no discussion of any possible alternative.

I am pleased to acknowledge the report produced recently by NICE, which made it clear that the choice of anti-psychotic drugs should be made jointly by the patient and the clinician. The report also noted that the use of atypicals should be a primary consideration, and there should be an end to postcode prescribing of such drugs. Compliance with medication is an important issue, and the use of the more modern drugs must be more widespread. Those drugs are not new; they came out 10 years ago, and it is one of the great failures of our service that they were not taken up.

Advance directives should have higher status; they should be given statutory recognition. If treatment is to be compulsory, the people who make such decisions should take into account the wishes of patients, who should have had the opportunity to express those wishes when they had the capacity to do so. Consideration of such wishes should be a statutory obligation, and patients should be encouraged to carry crisis cards.

The social security system is important to the well-being of mental health service users. I urge Ministers in the Department of Health to ensure that they have input to the development of services by the Department for Work and Pensions. Compulsion causes great stress to people who are already suffering from mental ill health. I draw the attention of the House to early-day motion 1345, which notes the poor availability of benefits to long-term patients, who receive only about £15 a week. The chief executive of the mental health trust in my area has pointed out that she has to use valuable trust resources to subsidise patients who cannot afford such basic needs as haircuts and shoes.

Carers are important. Too often, confidentiality is given as an excuse for excluding them. Obviously, if a service user expressly wishes to exclude relatives, that wish should be respected—although questioned. However, family members are too often excluded by default, because clinicians and service providers do not discuss the needs of the whole family with the service user. We must give greater priority to the involvement of carers. People who suffer from mental ill health, as well as those who suffer from personality disorders—the distinction is sometimes blurred—have often experienced trauma in their lives, and family members can help to provide support and enlightenment.

We need joined-up services. We need good services that take into account the fact that many mentally ill people also suffer from alcohol or drug abuse. Too often, services are either not provided at all or are provided separately, without appropriate links.

More and more health and social services are being provided through partnership arrangements. However, that means that when people want to complain about a service, there is no single point of reference. The local government ombudsman deals with complaints about social services, while the health service ombudsman deals with complaints about the health service. Will the Government consider appointing an ombudsman specifically for mental health service users and their carers?

Much has been said about stigma. We will not be able to give priority to mental health services until we deal with the stigma. The hon. Member for Woodspring began by saying that in mental health we accepted services that would not be acceptable in any other aspect of health services, and he is right. Too often, people are afraid to speak out about their experiences; they hide their feelings under the carpet.

One day, the shame attached to visiting a psychiatrist will be no greater than the feelings that people have when they visit any other medical practitioner. People will seek help when they need it. They will be able to talk about their experiences. Indeed, they will be proud of their ability to do overcome all the problems associated with mental ill health in our society. Their family members will not suffer the stigma of having someone with a mental illness in their families. The Government are putting in place the policies to achieve that, and we all have a role to play in ensuring that the day when people can talk about their experiences comes sooner rather than later.

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Health) 6:31 pm, 25th June 2002

I, too, welcome this debate. I have a long-standing interest in this issue; I am a former social worker, approved under the Mental Health Act 1983. May I say immediately that I was disappointed to find that clause 9(4)(b) of the draft mental health Bill notes that the applicants will not be approved social workers, but approved mental health professionals? When I looked at the explanatory notes, I saw that those approved mental health professionals are

"to undergo training and have a set level of understanding of mental health legislation and in assessing the non-medical aspects of treatment."

However, I see no reference to civil liberties or to non-discriminatory or non-oppressive practices, and that is a disappointment.

I worked under the previous legislation—the Mental Health Act, which has already been mentioned—and I know very well the weaknesses of the mental welfare officer system applied under that Act. I also know very well the weakness in relation to the independence of mental welfare officers. We now have a once in a generation opportunity to reform mental health legislation. I welcome the draft mental health Bill and look forward to contributing to debates on it.

Care in the community has not been the failure that some people claim. Care in the community has been underfunded. It has not been afforded sufficient priority, and the particular difficulties and opportunities of providing services in rural areas, of which I have great experience, have certainly not been properly addressed. However, it would be ludicrous not to accept that there have been failures, and we need to learn lessons from those mistakes. It is right to pay tribute to people, such as Mrs. Zito, who have suffered and to those who have done so much to draw attention to those failings and to remedy them.

One can understand the Government's wish to consider the safety of the patient and others as a key factor. That is a key factor, but it is not the only one. Care in the community is, and will remain, the first choice most of the time for most of the people with mental health problems. That is a matter of practicality, as well as one of principle.

I hope that some of my concerns will be addressed in the legislation and the developments that flow from it. I am concerned about the quality and the quantity of services in rural areas. After all, we are seeking equality of service throughout the United Kingdom. There are particular costs and difficulties in rural areas—for example, in gaining access to day facilities and to proper assessments if and when compulsory measures are considered. Any new legislation must take account of those issues; it must not be framed only with the urban context in mind. Securing equity of service to rural dwellers requires substantial additional investment in rural services, and we will look for assurances about that specific extra investment from the Government.

Lastly—I should say that I have heavily edited my speech, but hon. Members will have the benefit of hearing my opinions at another time—I am particularly concerned about language issues. I share that concern with hon. Members from other parts of the United Kingdom where there is a measure of societal bilingualism, such as parts of Scotland, and with black and ethnic communities, where many people who could be subject to compulsory mental health treatment may not speak English as their first language, if they speak it at all.

Proper communication is essential to a proper assessment. In fact, the 1983 Act requires that social workers interview patients in a suitable manner. However, the code of practice under that Act clearly takes an ability to speak English as the given context. Other languages are seen as just that—they are other—despite the Welsh Language Act 1993, under which Welsh and English are treated equally. The code of practice apparently suggests that the answer to language problems is to find an interpreter.

Most Welsh or Scots Gaelic speakers can also speak English, but when dealing with highly personal problems, such as mental health issues, they would prefer to use their own chosen language. I am sure that that is the case for speakers of so-called ethnic languages. If I were suffering from a mental health problem, I would need an interpreter, although I think that I am perfectly capable of conducting myself in English. I would prefer to be interviewed in Welsh, and I am sure that that would be infinitely more productive.

Any new legislation and any new code of practice must respond to that issue and ensure that own-language provision becomes easily accessible, which involves rights to advocacy and assessment. Welsh should be used on the same basis as English in the mental health services without remark or hinderance, and I hope that the Minister will give an assurance on that in summing up.

Photo of Mrs Valerie Davey Mrs Valerie Davey Labour, Bristol West 6:36 pm, 25th June 2002

I will be brief and just make one main point. The basic premise on which I approach health matters is that prevention is better than cure. I want to refer to the work that the Government have started—I hope that it will continue—with young people. Taking up the theme that my hon. Friend Mr. Hinchliffe touched on, I contend that prevention work would be best applied to that issue. No one wants to label such children. I am thankful that relatively few children need acute treatment, but we must not ignore those who do, and the Channel 4 television programme, "Young Minds", has recently added to our awareness of the issue.

Last week, a small group of hon. Members from the Select Committee on Education and Skills visited a remarkable school in Moscow, where, among other things, we met a permanent member of staff—a psychiatrist. The work that she does with not only individual children but the parents, families and the community at large, as well as 200 other teachers, spoke to us of a very important role. She is working with other such people in Denmark and Belgium, but not in Britain. We could learn lessons from that preventive work.

Those with serious mental illness often say that their childhood experiences have led to their developing mental illness later in adulthood. So, in working with children, we should be more aware of the climate in schools, families and communities that leads to mental health, and I ask the Minister, given her previous work, to link up with the work on health that is being done in the Department for Education and Skills to ensure that, to echo the words of the Government amendment, there will indeed be "new services for children".

Photo of Oliver Heald Oliver Heald Shadow Cabinet Minister (Work and Pensions) 6:39 pm, 25th June 2002

We have had an excellent debate on what everyone has agreed is an important and topical subject. Let me first refer to what was said by Valerie Davey. It is true that concentration on children's services and early intervention are vital, which is one reason for the reference to early intervention in the motion.

The great frustration for the party in opposition is that all its members can do is talk about issues. Part of the privilege of standing at the other Dispatch Box is the ability to do something. I agree with the Secretary of State that deeds, not words, count. Nevertheless, choosing the subjects to be debated can enable us to make a difference. Nearly everyone who has spoken today has agreed that simply by raising the subject of mental illness the Opposition have done something worth while.

As Mr. Battle has said, as Mr. Hinchliffe—Chairman of the Select Committee—has said, as Lynne Jones has said, as my hon. Friend Mr. Viggers has said, and as so many others have said, the stigma attached to the issue of mental health is one of the biggest obstacles to changing the way in which mental health services are delivered.

I agree with the hon. Member for Wakefield that the old system of asylums was awful, and had to be changed. He defended care in the community, as did Hywel Williams. I do not believe, however, that anyone could accept that that policy was implemented adequately. I have talked to carers and others who experienced its implementation. It is impossible to justify the inappropriate placing and the turning away of so many people, and the fact that the facilities they needed were not available. I still defend the liberation of tens of thousands of people who did not need to be in long-stay mental institutions, but we must recognise the realities of what happened.

As the hon. Member for Birmingham, Selly Oak said, we must recognise progress where the Government have achieved it. Today, after five years, we have a draft Bill on mental health. I am pleased that we have it, but five years is quite some time for us to wait for a change in the law that was promised so long ago. I am also pleased that it has now been decided that atypical medicines will be available to schizophrenics, but that too has been a long time coming. It has taken two years for the National Institute for Clinical Excellence alone to act.

There has been progress. It is, however, the job of Oppositions to hold Governments to their word—which we are trying to do—and also to talk to those involved with mental health. It is our job to go and see what is best practice, what works and what does not, so that when the time comes for us to present our policies they are well informed and based on practice.

Photo of Oliver Heald Oliver Heald Shadow Cabinet Minister (Work and Pensions)

Unfortunately for us, we must wait three years, or possibly four, before we can sit on the other side of the House and present our policies; but I look forward to that day. I am determined that when it comes, our policy on mental health will be one of which we can be proud. The Secretary of State should not be complacent.

We have important questions about the Bill, and we want answers. We want to know whether the compulsory treatment in the community to which the Bill refers means that medication will be given only in a hospital setting. The Bill mentions a clinical setting. What exactly does that mean?

What is the effect of the changes made since the White Paper to treatability and the definition of mental disorder? Do they mean, as was suggested by Dr. Harris, that those with personality disorders will be detained indefinitely, or can the Minister promise us that reassuring new safeguards have been introduced? Will she also answer a question put by my hon. Friend Dr. Fox? What will the Bill do to improve arrangements for the transfer of those with mental illness from prison to more suitable settings? That is one of the major issues of the day.

Then there is the issue of sanctuary. Let us not forget the experiences described by my hon. Friend Mr. Swire. He told us of a tragedy in his constituency involving a triple suicide. Such incidents make us realise what a priority mental health is when vulnerable people are at risk. I welcome the Government's target of a 20 per cent. reduction in the number of suicides over 10 years, but the fact is that the number has risen by 1 per cent.

The Secretary of State is right to be pleased about movement on crisis resolution teams, but halfway through the period he identified—2000 to 2004—there are 52 of them. He promised that by 2004 there would be 335. He is nowhere near halfway there, at the halfway stage. He promised that there would be 77 more this year. Will there be? He promised that there would be 50 early intervention teams by 2004. So far there are 16. He is not halfway there, but he is halfway through the time. Only 4 per cent. of local teams have established complete services of the sort that was promised. The Audit Commission has complained that less than half the number of specialist teams for the elderly are present in the areas where they are needed.

We were promised 700 extra workers to give carers respite. As far as we know, none have been appointed. We were promised 1,000 new primary care workers; there is not even a system enabling those who are there to be counted. The Secretary of State laughs. The fact is that he promised that by 2004 every prisoner would be seen and given a care plan on leaving prison. Here we are in 2002, and what has the Secretary of State done? He has changed the target: he now says that that will happen by 2006. We were told that there would be such services in every prison. In fact the Government aim to provide them in only 70 prisons—70 out of 136—by 2004. That cannot mean "every prisoner".

There are gaps in provision. Where is the money going? Day by day, we hear that money is not reaching the front line—money that was promised. We know that last year £10 million promised for child mental health was simply reallocated for general expenditure. We heard in the Chamber recently from my hon. Friend Mr. Key that Wiltshire faces cuts. Some of us attended a recent event organised by the Zito Trust, where its latest report on prescribing was to be unveiled. A consultant from Shropshire said that he faced cuts there as well. We have been lobbied about cuts in Manchester, and we have heard evidence of cuts in Buckinghamshire, Hertfordshire and North Cumbria.

It is all very well for the Secretary of State to twit me and say that we have had some extra services in North Hertfordshire. I am grateful for that and so are my constituents, but we are still two consultants short. Whatever area the Secretary of State mentions, he does not give the complete picture. He says that the constituency of my hon. Friend the Member for Woodspring has been given extra services, but the hospital is being closed. Right across the country the money is not getting through. It is no good having targets if they are not met.

It is the Opposition's job to do what I am doing now—to push the Government, and make them keep their promises on mental health. We have a duty to do that, because we are talking about trying to help the most vulnerable members of society. I want the new Bill to recognise that carers and other users of the system want conditions allowing them, as far as possible, to consent to treatment. We will read the Bill carefully, but the Secretary of State should be in no doubt about this: we want a Bill that will improve conditions for those who experience the tragedy of mental ill health, and that is not what the White Paper promised originally. If the Secretary of State has moved in our direction, we shall be pleased.

Above all, the issue is about human rights as well as money. When it comes to preferences for treatment, we want the Bill to ensure that patients and carers are at the centre of what is proposed and planned. We want the mental health sector to have the dignity that for so long it has not had. That means that when people suffering from mental health problems present themselves at hospital, they will not be turned away—as happens in one out of three cases at the moment.

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health 6:50 pm, 25th June 2002

Like other hon. Members who have spoken in this debate, I am grateful for the opportunity that it has afforded to focus the House's attention on this very important topic. As my right hon. Friend the Secretary of State for Health pointed out, it has been high on the Government's agenda since we first published the "Modernising Mental Health Services" White Paper in 1998.

I hope that it has been apparent in the debate that the Government share the concern expressed by Opposition Members and many other hon. Members about those in society who suffer from mental health problems. The concern is shared by hon. Members of all parties, but although I do not want to cast aspersions on the conversion of Opposition Members, my hon. Friend Mr. Battle described compassionate Conservatism as apparently having no roots. Given the numbers of Opposition Members present, it does not have many branches either.

Dr. Fox was right to express concern about homeless people who also have mental health problems. I remind him that it was not a Labour Minister who described the difficulty of stepping over the homeless to get into the opera. The Opposition's conversion to concern about the vulnerable and people with mental health problems is relatively recent.

We share the concerns of those who have expressed their anxiety about mental health problems. However, we do not share the analysis of the causes.

Photo of Michael Spicer Michael Spicer Chair, Conservative Party 1922 Committee

Will the Minister accept that a Labour Minister started the process of closing mental hospitals on a large scale in the 1970s? That happened to the detriment of my constituency, where two mental hospitals were closed in the 1970s.

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health

In fact, the hon. Member for Woodspring—in a rare mood of contrition—claimed that a Conservative Government were responsible for that, and apologised for it.

We share Opposition Members' concerns about mental health services, but we point the finger at the decades of underinvestment by the previous Administration. That led to crumbling buildings, demoralised staff and inadequate treatment. We inherited that legacy of neglect when we came to power, and we have been addressing it with vigour ever since.

We set out our agenda in 1998. Our aim was to modernise mental health care and social care, to provide new investment for reform and to ensure a modern legal framework to support effective treatment outside as well as inside hospital. We are delivering on that agenda.

All over the country, services are being reconfigured to meet the standards set out in the national service framework for mental health, to ensure better and faster care for people with mental health problems. New community teams have been established, and there are more staff and improved acute in-patient care. Of course, the scene will not be transformed overnight, and we would all like services to progress further and faster. However, across the nation, local implementation teams and front-line staff are working hard to improve mental health care. We do them a grave disservice if we fail to recognise how far they have come already, given the low base from which they had to start.

We are investing in mental health services, with £329 million set aside to support our NHS plan commitments. That money for the future was described by Opposition Members as "reckless" when we first allocated it, and they voted against it. With the draft mental health Bill that we published today, we have started the process that will lead to the 21st century legal framework that we need to underpin 21st century services.

Dr. Harris raised concern—

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health

No. [Interruption.] There is a limited amount of time left, and I want to make progress.

The hon. Member for Oxford, West and Abingdon rightly emphasised that mental health legislation needs to strike a careful balance between the protection necessary for patients and the public, and the safeguards that are in place. I can reassure him that we will continue to develop services in the community to ensure that the provision exists and is covered by modernised legislation.

I do not understand where the claims by the Royal College of Psychiatrists about the extra consultants needed for tribunals come from, but I am willing to work with the royal college to ensure that the tribunal plans work effectively.

My hon. Friend Mr. Hinchliffe rightly emphasised the need for closer integration of the NHS and social services departments. I am sure that, like me, he welcomes the fact that three out of four of the first care trusts in the country are focusing on mental health services.

My hon. Friend the Member for Wakefield also emphasised the need to move out patients who no longer need to be in high-security hospitals. We are making progress on our target to move 400 patients out of special high-security hospitals and into more appropriate care.

My hon. Friend also raised the important point about the tension between non-stigmatisation and the Bill's efforts to deal with the most severely ill. When hon. Members look at the Bill in more detail, they will see that it balances its broad definition of mental disorder with tight conditions, and that it massively increases the safeguards for patients. I believe that the Bill strikes the correct balance between the protection of patients and the need to safeguard their rights.

Several hon. Members spoke about the need for greater user involvement. I agree with them, and massive advances are taking place around the country in user involvement in the development of services.

Hywel Williams spoke about the principles underlying the Bill. The code of practice will set out the principles and their application.

Photo of Jacqui Smith Jacqui Smith Minister of State, Department of Health

No.

Those principles will be that patients will be involved in decisions about their care, that the decision maker will have to demonstrate the minimum level of intrusion, and that decisions need to be taken in a fair and open way. I can assure the hon. Member for Caernarfon also that the role of the approved mental health professional will be covered in the necessary training.

Mr. Swire and others raised the issue of suicide. My hon. Friend the Member for Leeds, West highlighted the high incidence of suicide among young men. The Government are undertaking consultation on a national suicide strategy, with active proposals to tackle the problem. I agree with my hon. Friend the Member for Leeds, West about the emphasis on primary care.

Mr. Viggers rightly emphasised the wide spectrum of mental disorders, and spoke about child and adolescent mental health services, which were also mentioned by my hon. Friend Valerie Davey. I agree that we need to ensure that the extra £105 million invested in child and adolescent mental health services develops those very specialist services. I can also assure my hon. Friend the Member for Bristol, West that the work that the Department is carrying out already with the Department for Education and Skills continues. We aim to ensure that the links between professionals to support young people are forged at school level and at local level. My hon. Friend Lynne Jones rightly recognised the progress made, and also emphasised the need for more staff. Users have a particularly important role to play, especially as support, time and recovery workers.

Mental health is at the heart of the Government's investment and reform in the health service. All of us will have been touched by mental health problems in ourselves, in our families and in our friends. As my hon. Friend the Member for Birmingham, Selly Oak pointed out, many will successfully recover and help to challenge the stigma and discrimination that have too often blighted patients' experience and service development.

Today, the Opposition have pledged plenty of sympathy and even some contrition, but no policy and no money. That is why they can never deliver better mental health services, and why they can never be trusted to support the ill and the excluded in our communities: only this Government can, and only this Government will. I commend our amendment to the House.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 187, Noes 317.

Division number 282 Mental Health

Aye: 187 MPs

No: 318 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Main Question, as amended, put and agreed to.

Resolved,

That this House expresses its deep concern at the plight of those who suffer mental ill-health and notes that almost every family will have experience of some form of mental illness; notes the decades of under-investment which led to crumbling buildings, demoralised staff and inadequate treatment under the Conservative Government which left many of the most vulnerable in society without the care they need; supports this Government's investment in NHS mental health services to ensure better and faster care for people with mental health problems, including new community teams, more staff, improved acute care and new services for children; supports the full implementation of the Mental Health National Service Framework to ensure national standards are in place for the care and treatment of mental illness; recognises the massive contribution of carers and the Government's action to support them, and commends the Government's 'mind out for mental health' campaign to tackle stigma; and believes that improving mental health services should remain a key Government priority.