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Schizophrenia (Constituency Case)

Volume 164: debated on Monday 8 January 1990

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10.18 pm

I am grateful to you, Mr. Speaker, for allowing me this opportunity to raise briefly a serious issue on behalf of my Fylde constituents. I want to raise with my hon. Friend the Under-Secretary of State for Health one of the most difficult constituency cases that I have had to deal with since I became a Member of Parliament. It concerns a young man who, for the sake of the debate, I shall call David, a schizohphrenic, and the problems that his mother faces in looking after him.

I shall never forget, when I first met David's mother, her asking, "What will he do when I am gone? Who will look after David?" She was referring to facilities in the community available to look after her son. He is schizophrenic, irrational, sometimes subject to the influence of alcohol and drugs and imagines that people will murder him. He finds it difficult to live in the community. He tries hard, but his condition is serious. He repels some of the help available to him such as day care, and even the community psychiatric nurse has had difficulty.

When I first encountered the case, I felt that I was in some sort of game of pass-the-parcel. I raised the matter with the district health authority which referred me to social services; I raised it with social services which referred me to the district health authority. I found it a most difficult case to make progress with. I am raising it tonight because I know that my hon. Friend the Under-Secretary takes a keen interest in mental health matters. I have letters from David's mother, one of which reads:
"I have nightmares about what the future holds for both David and myself—I love him dearly and have sorely tried from the beginning to be 'a prop' to him, but … at my age which is 68, I wonder what happens when I die."
This Christmas she went to his flat. He had had some surplus milk bottles which he had flung all over the place. She walked in on a carpet of glass. He had had a bad schizophrenic attack and had crushed his collection of records and cassettes.

David's mother is 68 and tries her best. She has commented favourably on the efforts that have been made since I intervened and asked Lancashire social services to help. It has provided a home help with whom he has formed some kind of relationship, but much of the help is somewhat tenuous. I asked the district health authority what might be done to help, but was confronted with a picture almost of despair. When I asked what it could do to help the seriously mentally ill or people with serious behavioural difficulties, I was told, "I am afraid that we do not have a facility to help a young man such as this. The best we can do is send him to a facility in Northampton. We have three people on whom we are spending some hundreds of thousands of pounds in providing care. Could there not be some funds for a supra-regional unit to look after people who suffer from this kind of condition?"

The White Paper on caring for people might be a blueprint for hope for mentally ill people in the community. I showed it to the local social services department for comment and was told, "We have ideas. We would like respite care, one-to-one care in the community and the opportunity to put a social worker or community worker at the young man's disposal, but where are the resources? Can we be sure that in future the Government will give us the resources necessary to provide the intensive care which this type of person requires?"

The example that I have given, albeit briefly, is not unique. Schizophrenia is a widespread problem. Only today the Daily Mail wrote about it in human terms. It is a condition that many people find difficult to face. Margaret Wallace, a champion of schizophrenics and a journalist of note, recently presented an excellent television programme which showed that, to deal with schizophrenics in New York, warehouses with 750 iron beds in them are available to "look after" such people. That is a nightmare which haunts the mother of this young man.

I should like to hear from my hon. Friend the Under-Secretary what hope he can offer David's mother and many others that the future will not be so bleak for those who suffer from this terrible condition.

10.24 pm

My hon. Friend the Member for Fylde (Mr. Jack) has done the House a great service by raising this subject. I very much hope that the House will have the opportunity to return to it at greater length and in greater depth than is possible tonight. In the time available I shall make five brief and simple points.

First, I do not believe that there is as deep an understanding of the affliction of schizophrenia as there should be in society and in the medical profession, particularly among general practitioners and primary care services. Early diagnosis means that early help is available to the family and the individual suffering. There should be a far greater understanding of how individuals can relapse throughout their lives. Schizophrenia can arise in the late teens. I have met a number of families who, to their great despair and amazement, have seen their children lapse into schizophrenia, sometimes diagnosed too late. The children then spend time in and out of psychiatric hospitals and then perhaps relapse into a chronic condition later in life, sometimes physically assaulting their parents, which is incredibly distressing.

I share with my hon. Friend a desire to bring out into the open this terrible disease so that, whether we are politicians, consultants or GPs, we are aware of the scale of the problem.

Secondly, the Government have continued the long-standing policy of seeking to care for those with mental illness as far as possible in the community. That is a humanitarian policy, but there are limits to the degree to which we can care for those with a mental illness, in their own homes, with their parents, sharing flats or in hostels. In my judgment, there will always be a need for state provision for asylum care which can be short and long term. There will always be a need for some provision of institutional care for those with a mental illness. I do not think that it is fair to portray our policy as moving entirely away from an institutional setting to a community setting. Therefore, for my hon. Friend's constituent there will always be a need for some hospital care.

Thirdly, from 1 April 1991 the Government will be introducing a new grant payable through regional health authorities to social services departments to help them to improve facilities available in the community for the mentally ill. We recognise that social services departments do not spend enough of their resources on the care of the mentally ill in the community. It is 3 per cent. of their budgets. That is not sufficient. Therefore, the new grant will help in pump-priming—in the construction of new facilities, and in hiring additional social workers to care for those in the community. I frankly admit that in certain parts of the country the service is less than adequate. It is a function of historic policies and decision taken in good faith in the past.

Fourthly, from 1 April 1991 we shall be requiring all district health authorities, before they discharge any schizophrenic patient, to ensure that there is a proper plan for caring for that individual so that the health authority, the hospital and the consultant may know where the patient is going, how he can be contacted, who his friends are and what is his method of medical and social support in the community. That is most important, and I commend the Royal College of Psychiatrists for producing a code of practice broadly similar to our discharge policy for hospitals.

Finally, it is most important that the Government facilitate the construction of more community care facilities. I am very pleased to repeat the announcement which my right hon. and learned Friend the Secretary of State for Health made a few weeks ago about the creation of a capital loan fund. It is a major new initiative, and £50 million will be available to district health authorities to borrow from the loan fund to construct facilities in the community now and repay the money when the facilities which they replace are sold when they become empty and are no longer used. I hope that that will bring to fruition a much earlier construction of facilities in the community. I hope that that will help my hon. Friend and all those who suffer from mental illness.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.