Mental Health Wards

Part of the debate – in the House of Lords at 8:01 pm on 12th June 2006.

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Photo of Lord Carlile of Berriew Lord Carlile of Berriew Liberal Democrat 8:01 pm, 12th June 2006

My Lords, my noble friend Lady Neuberger brings to all the subjects on which she speaks and writes intellectual rigour, energy and compassion, and this is no exception. The House should be very grateful to my noble friend for raising the subject for debate tonight.

Unlike the previous two speakers, I am not an expert in this field, but I have had experience very close to a service user. Like those speakers, I have some interests to declare. I was chairman of the scrutiny committee on the draft Mental Health Bill, which has been kicked into the long grass, as the House knows. I have been involved with a number of mental health charities and I am the president of the Howard League for Penal Reform, which, unfortunately, has a very large clientele of 77,000 people in prison at present, of whom approximately one half suffer from a mental illness.

The subject that we are debating tonight is unfashionable but, in my view, it is the most important subject in the health service today. The popular newspapers, the red tops, are not given to running campaigns for improvements in mental health services. I was very sorry indeed to see that that great boxer, Frank Bruno, was suffering from severe mental illness, but that gave us an opportunity to see the red tops engaging in the subject. They were very good at it when they were dealing with Mr Bruno. I wish that they did it more often. I wish that we could see campaigns for child and adolescent mental health services from the popular newspapers in this country, just as we see campaigns for cancer care and heart care.

Everyone in this House will have had the experience of visiting a very sick or dying relative in hospital—someone with a physical illness. It is all very definable, is it not? The relative has an illness that has a name. The symptoms can readily be looked up on the internet or in a dictionary. The doctors can usually give a pretty clear prognosis. Above all, the patient knows from what he or she is suffering. When they go to visit, the relatives can acquire that understanding. They can take advice and follow it relatively easily.

With mental health, it is quite different. Most—certainly many; I should not say most—people in acute mental health wards do not necessarily accept that they are ill at all. They sometimes feel that they are being unfairly incarcerated by the law. They sometimes suffer from delusions and severe psychotic episodes. It is very difficult to explain to some, for they will not be able to understand the nature of their illness. It is just as hard for their nearest and dearest. People who visit patients in acute mental health wards often feel angry with their relations because they are not being reasonable or behaving like other members of the family. Our health services do very little really to explain not only to the patient, for whom it may be difficult, but to their friends and relations exactly what is happening to them. It really is time that we treated mental illness like every other illness—like measles, mumps, leukaemia, or any other definable diagnosis—but I suspect that we are still decades away from being able to treat mental illness in that way. I regard this kind of debate as a catalyst in that process and as an opportunity for non-experts such as me to make a plea for better services.

Many studies have been done on mortality from mental illness, and they are very shocking. Lawrence, Holman and Jablensky found that mortality among the mentally ill in Western Australia is two and a half times that of the general population. Similar studies have been done in the United Kingdom, Michigan and elsewhere. The messages that they send to us all is that mental illness is as potentially fatal as almost any other illness, and more fatal than most. Of course, the tragedy is that, in many cases, people who are mentally ill do not die because their bodies give up working; they die at their own hands, all too often.

When so many people are dying at their own hands when they are not suffering from a physical illness, surely it must be logical that there are better ways of preventing them from losing their lives in that way. My plea is for services to be provided in acute care to plan better outcomes. The noble Baroness, Lady Murphy, for whom I have great admiration, spoke of services in London as being, frankly, very poor. I think I heard her say that she would be hard put to think of a real exemplar of good practice. I will give her one that we saw on a visit of the scrutiny committee on the Mental Health Bill. It was the adolescent unit at the Bethlem Hospital, which is part of the Maudsley. It is, however, very small. It has a very small number of patients, and a school where they can take all their examinations. But you will be very hard put to find services like that if you go out of the Bethlem and out of London.

The committee visited the equivalent facility in Cardiff, but frankly it was in appalling buildings and depended entirely on the angelic efforts of one middle-aged man who was in charge of the teaching in that school. Adolescents who are acutely mentally ill may lose two, three or four years of education, but if they come out of hospital, as we hope they will in due course, having lost that education, it is almost impossible for them to recover any kind of normal life unless they are very resilient and acquire a deep understanding of their illness.

My plea is that services should be provided to enable young people to return to normal life. I have been involved in a particular small charity in Wales that seeks to provide—it is doing quite well—aftercare services for young people coming out of mental health wards. It does such things as teach them to cook again and to write a CV and obtain a job. But an organisation such as that—it is called Rekindle—has no public money because the public sector is so unimaginative in what it does with the money going to mental health services. Far too much is lost in bureaucracy, and a ludicrous amount is lost in maintaining buildings that should have been destroyed 20 years ago and reduced to smaller units. There are also terrible staff shortages.

I want to say one thing about the Mental Health Bill. We know that the Government intend to introduce a new Bill, which is merely an amendment of the Mental Health Act 1983. I plead with them that we should not find ourselves getting bogged down in the Michael Stone question all over again. Mental health is not about a small number of people who unfortunately are not cured, are released from hospital, possibly by mistake or maybe by negligence, and commit terrible acts. It is tough to say so, but we can say it in this place because we are not elected: those kinds of accidents happen from time to time. We must talk about the real questions in mental health and not the headline questions, such as Michael Stone.

I should also like to make a plea for better CAMHS—child and adolescent mental health services—provision. I have three short points to make. First, no child or adolescent should go into a mental health ward that is not completely age appropriate, wherever he or she is in the country. That is not yet the case. Secondly, there should be universal quality of care for mentally ill children and adolescents. It should not matter that they live in Birmingham or Berriew. In Berriew, there will be very little provision. In Birmingham, there will be rather more. It is not universal at the moment. Thirdly, the quality of mental health care for children and adolescents should be consistent. It is not. One of the reasons for that is therapists are being asked to give therapies for which they are not qualified. It is not satisfactory. A huge amount needs to be done, but we should never lose sight of the fact that this is an area of acute care and extreme suffering. I hope that this debate will help towards better standards.