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Care In The Community

Volume 576: debated on Friday 25 October 1996

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What measures they intend to take in response to the concerns expressed by the Royal College of Psychiatrists in August 1996 that "the Government's policy in England and Wales on care in the community is in a state of deep crisis".

The Parliamentary Under-Secretary of State, Department of Health
(Baroness Cumberlege)

My Lords, many of the concerns raised by the Royal College of Psychiatrists were addressed by the Secretary of State in February 1996, when he announced the allocation of extra resources and the publication of The Spectrum of Care, a report setting out the range of components required for a comprehensive mental health service.

My Lords, I thank my noble friend for that encouraging reply. What steps are being taken by the Government to meet the concerns expressed by the college over the large numbers of severely mentally ill patients who are being transferred into the community? Is my noble friend aware that they are transferred into hostels, where very often they are cared for by untrained volunteers who are inadequately prepared for the realities of mental illness or for caring for severely mentally ill patients? Will she give a positive response to the college's request for an inspectorate to ensure that all people working in community based homes or hostels are adequately trained?

My Lords, I do not in any way want to decry the work that is done by volunteers, as I am sure my noble friend would agree. However, I support her point that volunteers who work in this very difficult field should have enough support from professionals and should have training that is relevant to the jobs that they do.

We do not feel that an inspectorate is the solution. We look to health authorities, which commission services, to ensure that they are up to standard.

My Lords, is the Minister aware that, in addition to the concerns expressed by the Royal College of Psychiatrists and despite the welcome initiative in February, the college is anxious about the diminishing number of admission beds for acute psychiatric cases and, as a result, many patients having to be transferred to hospital beds a long distance from their homes? Is the Minister satisfied with the operation of the amended mental health Act which requires patients released into the community with serious psychiatric illness to receive compulsory treatment under supervision?

My Lords, I understand the noble Lord's point. Our first duty is to try to prevent patients entering hospital if it is at all possible and, through very comprehensive community services, to keep them at home. However, we recognise that there are occasions when they need to be admitted, and indeed in some cases detained for the rest of their lives in secure accommodation. We are increasing the number of medium-secure beds: £47 million has been invested. That means an addition of 1,250 purpose-built beds by 1998 and some very secure accommodation. The noble Lord's point concerning admissions is a matter that I shall need to consider further.

My Lords, is my noble friend aware that, although the Question refers to England and Wales, perfection in these matters does not prevail in Scotland? On one particular matter applicable both north and south of the Border, will the Government make very clear that care in the community cannot apply to one very small category; namely, the known, dangerous paranoid schizophrenics, who must be treated institutionally?

My Lords, I was always under the illusion that Scotland was perfection. I assure my noble friend that when patients are discharged into the community there is real determination now to see that they are ready to leave hospital; that there is a care programme attached to them so that when they enter the community they are well looked after; and that they receive the support and supervision that they need. I agree with my noble friend that there will always be a minority who need to be detained. In such cases an assessment must be made between their civil liberties and the protection of the public. Increasingly, we look towards the protection of the public.

My Lords, is the Minister seriously claiming that the measures taken so far by the Government have tackled what the Royal College terms a "deep crisis" in community care and the demoralisation in the field of psychiatry? If we couple the Royal College's indictment with today's report from MIND which claims very authoritatively that mentally ill people are being subject to widespread harassment, discrimination and abuse, we have a very sorry picture which should be addressed urgently by the Government with adequate funding.

My Lords, we totally reject the allegations that the mental illness services are in deep crisis; they certainly are not. We are looking after a whole range of people now in much more compassionate ways than ever before. We accept, though, that there needs to be a balance between those who can be looked after in the community and those who need to be detained in long-stay institutions. Indeed, when the Secretary of State made his announcements, coupled with £95 million of extra resources, he majored on 24-hour nurse beds, where there was clearly a gap in the system. We are thus seeking to fill that gap.

MIND is a very effective voluntary organisation. We have looked with interest at its survey. It is extremely hard to eradicate discrimination among any groups of people, but we have certainly put a lot of work into looking at mental health in the workplace. We understand that one of MIND's major concerns was that people who sought employment were being discriminated against.

My Lords, most of us recognise the difficulty of dealing with people with mental health problems. Is the Minister also aware of the increasing concern within the police service about the number of seriously mentally ill patients who have been discharged into the community, in their view wrongly, whom the police then have the responsibility of trying to help in conditions of great difficulty?

My Lords, yes, we are aware of that, and that is why in courts now we often have a social worker or community psychiatric nurse to try to follow a diversion scheme so that people who should not be in the penal system are looked after earlier in the process.

We also recognise that pressure is increasingly put on the health service by those who should not be in hospital but who need secure accommodation. This relates to my earlier answer to my noble friend concerning the number of places available.

We also increasingly seek to establish crisis intervention teams in the community, which should help the police with their difficult task.

My Lords, is my noble friend aware of the growing demand for village communities for the mentally ill? Such communities can very often supply a far more appropriate and cheaper service than community care. Since they are in such demand from families, especially for the more severely mentally ill, will the Government look into the case for their promotion?

My Lords, I am very aware that parents of children with learning disabilities—the mentally handicapped group of people—are concerned to build village communities for their care. I think that the case for such communities for those who are mentally ill is not as strong.

My Lords, will the Minister give us an estimate of the number of beds in the new residential nurse units—which we all applaud—that are likely to be available in the next two years?

My Lords, a lot of work is being done in this area. I presume the noble Lord is referring to the 24-hour nurse beds. We are working very hard with health authorities and trusts to ensure that these are established as soon as possible because we recognise that new long-stay patients are coming into the service who need this form of care. This is a new initiative which started in February and clearly there are not many such beds yet, though I believe some have been established through the Challenge Fund which we set up. Perhaps I could write to the noble Lord, with forecast figures as well as actual figures.

My Lords, there is plenty of time for both questions. I think it would be appropriate for us to hear from the Front Bench opposite.

My Lords, if the Minister rejects the description that there is deep crisis in the mental health services in our inner cities, how would she designate the situation as regards acute beds where there are bed occupancy rates of up to 150 per cent. in the acute mental health units in many inner cities? Does she not agree that those units are under severe pressure because of the lack of a range of services such as long-term beds and crisis intervention services? What action are the Government taking to ensure that initiatives such as the diversion of mentally disordered offenders from the criminal justice system into the National Health Service is properly resourced? Does the Minister accept the need for a thorough review of the workings of the mental health Act?

My Lords, we recognise that there is pressure on the mental health services in some of the inner city areas but it is not universal, even in those inner city areas. We know that bed occupancy rates relate not just to resources but also to the way that managers choose to manage. Indeed, on Thursday this week there will be a seminar in London to look at how beds can be better managed. This issue has to be seen in the full context of the building-up of the mental health community teams, many of which have yet to become established. They perhaps need to use volunteers and to find new skills. We are recruiting very heavily for those. It is totally wrong to say that mental health services are in crisis, because clearly they are not.

My Lords, is the Minister aware that in Northern Ireland health and social services systems have been integrated for some time and that psychiatrists, social workers, nurses and others find themselves working together on the same themes? They are not employed by definite authorities and do not have the same kind of problems with budget difficulties across different departments. Would she be prepared to look seriously at those experiences in Northern Ireland over the past 20 years, since they might be usefully applied, whereas one would hope that other experiences in Northern Ireland would not be applied?

My Lords, we are always willing to look at good experiences or forms of practice across the whole world.