My Lords, the noble Baroness, Lady Neuberger, has done us a service in tabling this Question today. I pay tribute to the way in which she so ably articulated many of the serious and widely held concerns about in-patient mental health care. I listened to her with a considerable measure of agreement, as I did to all other noble Lords who have spoken.
We have heard a lot of worries and criticism, one way and another, but I shall begin with a brief reassurance to the Minister. I am the first to recognise—as, I am sure, are we all—that the resources directed by the NHS towards mental health in general have risen considerably in recent years. I am also the first to recognise that, as a result of this investment, we are seeing gradual improvements in the service. Nevertheless, measuring the quality of mental health care, like any other sort of healthcare, is about not inputs but outcomes. That was why the noble Baroness was so right to focus our minds on the patient experience. In this field of care, almost par excellence, the patient experience defines the standard.
In preparing for this debate, I have been looking at a number of recent surveys: the 2004 survey published by the Sainsbury Centre for Mental Health, the Mind Ward Watch survey of the same year, the National Audit of Violence in 2005 and the Sainsbury Centre report, The Search for Acute Solutions. There is an awful lot of information out there, almost a bewildering amount, and it is quite easy, if we are not careful, to get bogged down in the detail. What we need to do, as shapers of policy in the broadest sense, is take a step back and look at the direction of travel, define our objectives and try to identify the key trigger points that are likely to lead to the attainment of those objectives.
For a start, we need to do exactly what the noble Baroness, Lady Barker, suggested: take a long hard look at what we want in-patient mental health care to look like, and what we want it to do at a time when we are seeking to deliver greater amounts of healthcare in the community. In other areas of the NHS we are seeing health policy develop in a way that reflects modern values: no longer the pervading assumption of "doctor knows best", but rather professional attitudes that credit patients with being individuals who know their own minds, and who may actually have personal preferences. Autonomy and choice should be just as much a part of mental health care as of any other sort of care.
If we truly believe that, a number of things have to follow. We need to improve the commissioning of in-patient care. We need to create opportunities for people to make genuine choices about where they get acute care, and what sort of care they receive when they come to need it. Flowing from that, we must make in-patient care responsive to the wants and expectations of patients who elect to receive it.
I am sure most noble Lords here have seen the inside of an in-patient mental health ward. I have visited a number—not, I may add, as a patient—and I cannot say that I found it an uplifting experience. There were good, sometimes excellent, staff, but the prevailing mood in those places could be summed up as a mixture of intimidating, institutional and crashingly dull. Where we find, as we did in the Mind Ward Watch survey, 53 per cent of in-patients saying that the ward environment did not help their recovery, a quarter of patients saying that they felt unsafe and half saying they had been abused in some fashion, we know there is a huge amount left to do.
Too often cognitive behavioural therapy is recommended but not available. Too often we have children being treated for mental health problems on adult wards because children's facilities are not there. Nearly 3,000 bed days every month are accounted for in that way. With the recent tightening in PCT funding, we are seeing in some places not an elimination but a reintroduction of mixed-sex wards—the very opposite of what is desirable.
If we look at the trends over the past few years, the number of in-patient beds has gone down, yet the demand for beds has stayed the same; hence the bed occupancy figures rightly mentioned by the noble Baroness, Lady Neuberger. In some areas of the country, particularly London, staff shortages are acute. Very often, the worst shortages are where the need is greatest; London again being the prime example. Part of the difficulty of in-patient care—a major part—is that many staff prefer to work in a community setting, and they vote with their feet. Some staff migration of this kind is needed to form up the new crisis resolution teams and for treating patients at home; but too much of it leaves the acute wards depleted, and it is very difficult in those circumstances for the staff who are left behind, however good and caring they are, to deliver an optimal service.
It is against that background that I say to the Government that should a new Mental Health Bill be introduced which sanctioned in-patient treatment even where there was no illness to treat, or which resulted in significantly more people being detained compulsorily, that would be a recipe for huge problems. The audit of violence contains all the warnings we need on that score. We all know that investment needs to be channelled into community services. But as Anna Walker said recently, more attention must be given to in-patients. Something has to be done to recruit and retain good staff in those acute settings, and to make them feel that it is a job that is really valued and worth while. Most of the experts agree that part of the solution lies in new ways of working, so as to create more face-to-face time between staff and patients. There are models of good practice out there from which we can draw.
Allocating the health budget is all about fixing priorities. So let us never forget the cost of mental illness in terms of social exclusion and the drain it represents on the economy, amounting to many tens of billions. It is an area of ever growing importance in our nation's health, on which we look to the Government to give a lead.