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Mentally Ill Patients

Volume 131: debated on Thursday 14 April 1988

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To ask the Secretary of State for Social Services what information he has as to the main difficulties experienced by other countries as a result of reducing hospital accommodation for the mentally ill and encouraging a shift to care in the community for these patients.

There are four main lessons to be learnt from the experience of other countries in reducing hospital accommodation for mentally ill people and encouraging a shift to care in the community.Major changes take time to implement effectively. Present changes are evolutionary and not revolutionary. A change towards less in-patient care and more care in other settings has been under way for many years in this country; some signs of this change can be traced back to the 1930s. The steady reduction in the number of patients resident in mental illness hospitals and units reflects that change and the development of new treatments and styles of care. The closure of some hospitals consequent to this changed pattern of care requires careful assessment of existing and likely future needs and reprovision of necessary services locally prior to closure. This is a process that should not normally be hurried.Changes are brought about most effectively when planned jointly by all care agencies concerned, whether statutory or not, and should take account of the views of mental illness sufferers and their families. Changes are most effective when there is strong local commitment to making the change work.Measures need to be taken to ensure that, as secondary mental health care staff move into the community, their main focus of activity continues to be those people who are severely disabled by mental illness. Some countries have reported an undue movement of staff-time towards dealing with people who, although suffering from mental distress, are not severely disabled at the expense of the more severely disabled. Ministers are very conscious of this potential problem and are keeping closely in touch with research on the subject.Particular attention needs to be paid to ensuring that patients with longer-term disabilities who are being treated in the community are regularly reviewed and continuity of care ensured so far as possible.