§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Stallard.]
§ 11.25 p.m.
§ Mr. Greville Janner (Leicester, West)I am pleased to have the opportunity to raise the problems of sufferers from that most unfortunate illness which is called agoraphobia, an illness which afflicts an unknown number of people—unknown because very few of them are prepared to admit that they have it or to come forward to seek treatment. So many of them, indeed, are afraid or ashamed of admitting that they suffer from a disease which prevents them from going out, which gives them a morbid fear of public places, which makes them terrified of using public transport, and which often keeps them unnecessarily housebound.
196 Since raising the matter in the House and elsewhere, I have received a great number of letters from sufferers, most of them people who are unable to leave their homes, who are delighted that their problems are now being aired in the House so that there may be some prospect of their suffering being understood by others and of more help being given to them. But this morning I received an anguished telephone call from a psychologist in Leicester who said that we should not described agoraphobia as a disease. I received also a letter from a voluntary society saying that people should not be encouraged to think of agoraphobia as an illness which requires constant treatment and which might in any circumstances be incurable.
I have formed the view that, alas, agoraphobia is certainly an illuess and that those who suffer from it do indeed regard themselves as ill. It is a most disabling illness if we define disablement as a condition which prevents people from following their normal lives and careers. It is a disabling illness for an estimated 70,000 to 90,000 of our fellow citizens, many of whom suffer from other phobias at the same time.
I shall quote from two or three of the letters I have received. A gentleman writes that he could not go out, and he started a business at home. He says:
I still remain an agoraphobic, but I know from long experience that the symptoms sometimes disappear for years at a time until some unfortunate incident stirs it up, even subconsciously, and we are off again. I have always kept this illness secret even from my wife and sons, and when today I mentioned that I was agoraphobic she jeered. Perhaps the lack of being able to discuss our plight does retard recovery.People are ashamed. They are afraid of it. They do not even like to tell their own family.A lady writes:
I have been a victim for years, and I have known many others, some of them very young, whose lives are wasted. Drugs do not help. Many of us are of the opinion that it has something to do with the acids in the body, but I have good reason to think that even research is unable to help us. May God speed this effort. May you be successful in getting some help for this hellish illness.I have received many sad letters, mainly from people in my constituency. As a result of the interest aroused, and of the efforts of a remarkable lady, Geraldine 197 Onions, who lives in Loughborough, a society has been formed, called Link-up, which held a meeting in Leicester a few weeks ago, where over 40 agoraphobics and their families came together. It was an immense achievement. Many of these people find great difficulty in going out. All of them had to fight the fear which they knew would come or could come. Most of them coped because they have loving relatives prepared to help them, but there were also people there, husbands and wives, representing those who could not get out of the house.What help is it possible for us to provide for these people? First, through this House, I beg all who know sufferers from this illness and other phobias to look after their unfortunate neighbours over Christmas. Those who suffer mental or psychiatric illness suffer torment just as those who suffer physical illness do. At least one can say of a physical ailment that it can be seen and it may attract a measure of sympathy for that reason.
The sufferers of agoraphobia and other similar ailments receive little sympathy and understanding. Even their own families torture them by telling them to snap out of it in a way that is impossible. Over the Christmas period I beg people to assist those who cannot go out of their homes.
I ask that all possible support be given to voluntary organisations such as the Phobic Society, Open Door and Link-up. There are similar organisations in various parts of the country that are doing voluntary work and helping those who suffer from these ailments to help each other and themselves. I ask the Government, through my hon. Friend the Under-Secretary of State, to give support to the voluntary societies so that as many as possible of those who suffer from agoraphobia may be assisted to look after themselves and may avoid the totally unnecessary unhappiness and expense of institutionalisation.
Secondly, I ask my hon. Friend to pass on to my hon. Friend the Under-Secretary of State who has responsibilty for the disabled, my hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris), that great campaigner for the suffering, the wish of the members of Link-up in my constituency and the feelings of the vast majority of sufferers from agora- 198 phobia that they should qualify for a mobility allowance in the same way as those who are immobile as a result of physical ailments.
I know that within the organisations of those who seek to help the agoraphobics there is the feeling that money should not be spent on paying mobility allowance. However, from the people whom I have visited when on constituency rounds, who are unable to get out, who cannot use public transport, who cannot get to work and who cannot make a useful and happy living because they are unable to be mobile, I know that even a little help would enable them to have some form of conveyance so that they could get out into society and out to work
It is to be hoped that such people would recover. It is to be hoped that they would get better or even have a remission. It would be possible and reasonable for them to be required to state that and to renounce their allowance in the same way as sufferers from other illnesses are able to obtain help but cease to receive an allowance when they recover from their illnesses. I ask that special consideration be given to the granting of a mobility allowance to sufferers from agoraphobia and other psychiatric illnesses who are rendered immobile.
Thirdly, the Chronically Sick and Disabled Persons Act 1970, of which my hon. Friend the Minister with responsibility for the disabled was the father, has not been applied throughout the country with nearly the vigour, enthusiasm, care and thoroughness that was required. I ask my hon. Friend the Under-Secretary of State to give the House a categorical assurance that the Act applies as much to the mentally handicapped as it does to the physically handicapped. I am sure that he is aware of the widespread misunderstandings in that area throughout the country. Failure to apply the Act means that avoidable suffering among the mentally handicapped is prolonged. Once again, it results in entirely preventable institutionalising.
Finally, I ask for more funds for research into the baffling illness of agoraphobia. I was told today that there is a gentleman who says that he can cure it. I hope that he can, and I am sure that 199 for some people the cure is possible. Alas, for others it is not. We do not know the nature, origin, cause, methods of cure and diagnosis even of the illness of agoraphobia. Either the Government should provide funds for research or they should encourage others to undertake research. Priority should be given to such research.
The priority given to the mentally handicapped generally should be high on our scale of priorities. I appreciate that there arc problems of resources but the case of help for the mentally handicapped is strong. A person who is a serious sufferer from agoraphobia suffers from a most unpleasant, debilitating and unhappy illness.
Mrs. Onions and her colleagues in Linkup are proposing to organise the first-ever lobby of agoraphobics to come to this House. I hope that before the spring many agoraphobics all over the country will pluck up their strength and courage, join their comrades, come to this House and seek help for themselves and for others like them in a way that requires quite as much courage as the efforts of a physically handicapped person to get up and walk on legs that are immobilised.
When the agoraphobics come to the House they will seek to see my hon. Friend the Minister with responsibility for the disabled, and I ask my hon. Friend to convey to the Minister the respect and admiration of my constituents and their request that he should receive them when they make their way to this House. They will be symbolic of suffering. They will be symbolic of courage. They will be symbolic of the determination of people who are suffering from a disabling illness to help themselves. I hope that the Government and this House, all hon. Members and all our good citizens, will this Christmas give thought to those who are truly immobile and unable to leave their homes freely or at all because they suffer from the problems of the illness of agoraphobia.
§ 11.37 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)I am grateful to my hon. and learned Friend the Member for Leicester, West (Mr. Janner) for bringing to the attention of the House tonight the problems faced 200 by those people unfortunate enough to suffer from agoraphobia. May I say I am deeply conscious of the very considerable distress which this condition can cause and have every sympathy, as has my hon. Friend the Minister with responsibility for the disabled, for sufferers and their families.
Perhaps I could just place this disease in the context of our general programmes for the mentally ill and the mentally handicapped.
The Government attach high priority to developing services for mentally ill and handicapped people, and in March 1978 national guidelines for forward planning were issued to health and local authorities, suggesting rates of growth to 1982 and indicating the major priority areas where service development and increased expenditure are needed. It is the Government's policy that the balance of care in these two fields should shift from the health services towards the personal social services.
It is envisaged that, in England as a whole, NHS capital and revenue expenditure on mentally ill and mentally handicapped hospital patients should increase in real terms by about 2 per cent. a year over the period 1976–77 to 1981–82. During this time the number of beds is expected to reduce so that the amount spent per bed would increase by over 44 per cent. a year. Expenditure on personal social services for the mentally ill and the mentally handicapped over these years is planned to increase by almost 9 per cent. a year. Over the same period a growth rate of 1.7 per cent. a year is projected for the NHS as a whole, and 2.1 per cent. for the health and social services as a whole.
Authorities were asked to spend about £9 million of the English share of the £50 million injection announced by my right hon. Friend the Chancellor of the Exchequer in his April Budget on psychiatric and geriatric hospital care, and, as my right hon. Friend the Secretary of State said in the debate on the Gracious Speech, he hopes to be able to announce further resources for the health and personal social services over and above the increases already planned.
Perhaps I may say a little about the nature of the condition. Agoraphobia means literally "fear of the market 201 place ", and an irrational fear of "going out" is the most frequent symptom from which others may develop; many anxieties may be present in patients said to be suffering from this condition. I understand that many people believe that the fear is more of separation from the home, based on the original separation of child from parent, than of open spaces. It is the most common of the non-specific phobias and varies from mild anxiety when away from home to patients who are completely housebound.
Studies show that women agoraphobics far outnumber men, and the stage of onset is usually between 18 and 35 years. Precise evidence on which to base an estimate of the number of sufferers from agoraphobia is not available, but in a recent study in this country it was found that about 3 per cent. of all people consulting a clinician about psychological problems suffered from a phobia as a main complaint. However, it is recognised that many people suffering from phobias do not seek psychiatric help, and voluntary bodies working in this field have estimated that there are as many as 300,000 people suffering to at least a minor degree from agoraphobia in this country.
Facilities for treatment are available under the National Health Service, and I understand that many agoraphobics do in fact receive considerable help from them. Some patients can be treated at home by their general practitioner; others may need to be referred to hospital for specialist psychiatric and psychological help, and in recent years considerable progress has been made in a number of centres in this country in developing treatments for phobic conditions, notably by using behavioural methods. The treatment of phobias has been transformed by the advent of such methods, which are now widely available. They were pioneered largely by psychologists and are mainly carried out by them. Such treatment is at present usually obtained through the hospital out-patient services, though in some places a system enabling the general practitioner to arrange for patients' treatment has been tried. The more specific the phobia, the better the prognosis with treatment, but even diffuse states have, I am advised, been treated successfully, particularly by such methods as, for example, taking the sufferer into the actual 202 situation that produces fear and either desensitising him gradually or, occasionally, over-exposing him. This sort of thing has been done on a domiciliary basis and this gives the opportunity to look at the family situation, which is often of particular importance. Special facilities for people suffering from agoraphobia separate from the general psychiatric services are not thought to be either desirable or required.
Apart from the treatment services provided as part of the health services, local authority social services departments are responsible under the National Health Service Act 1977 for providing care and after-care facilities for people suffering from mental illness. This, of course, includes people suffering from phobic states. Local authorities can provide day care services ranging from large day centres to small neighbourhood groups, clubs and so on which appear to be particularly helpful in many cases, social work help to the sufferers and their families, including therapeutic programmes and support, domiciliary care, and also residential care should this be required.
In addition—here I take up one of my hon. and learned Friend's main points —the powers which local authorities have under the Chronically Sick and Disabled Persons Act 1970 to assist different classes of disabled persons apply to people suffering from agoraphobia as to other mentally ill people. I think it is true to say that many people are not aware of the help that is available to them through local authorities under this Act. Hon Members, as my hon. and learned Friend emphasised, can play an important part in making sure that their own constituents who need such assistance are aware of the help which their own local authorities can give them. Under the Act, help can be provided in a number of ways—for example, help with telephone and television, adaptations to the house, and so on—some of which may on occasion be of benefit to agoraphobics, though, of course, it is for the local authority to determine what assistance should be provided in any individual case in the light of the particular needs and circumstances.
Jobs that can be done at home are hard to find, but, in addition to help 203 that local authorities can sometimes provide, the disablement resettlement officer at the Employment Service Agency is able to give advice about work aspects. I should emphasise that there are differing schools of thought about providing special facilities, such as a telephone, in the home for agoraphobics. Some hold to the view that such assistance only reinforces the phobia.
Voluntary organisations—another point emphasised by my hon. and learned Friend—also have a valuable role to play in influencing public opinion and encouraging a more understanding attitude towards the problems faced by people such as phobic sufferers. I know that sometimes local voluntary organisations can be very effective by forming self-help groups and support systems where members arc brought together and sustained by sharing a common problem. These help maintain self-respect and morale through a difficult period and combat loneliness and isolation. Individual volunteers can also be of great use in accompanying people suffering from agoraphobia when they go out and in providing transport to get someone to a therapeutic facility to take advantage of what is available.
Perhaps I should at this point say something about social security benefits as they concern agoraphobics. In so far as agoraphobics are considered to be incapacitated for work, they can, on production of medical evidence to this effect, usually qualify for sickness benefit, followed by invalidity benefit if the incapacity continues beyond 28 weeks, if their contribution record shows a recent history of employment or self-employment. Those who are unable to satisfy the contribution conditions for sickness or contributory invalidity benefit may be eligible for non-contributory invalidity pension, but married women have to show that they are also incapable of performing their normal household tasks because of their disablement. Alternatively, or additionally, the Supplementary Benefits Commission exists to help all those not in work whose resources are insufficient to meet their needs as assessed for supplementary benefit purposes. A few people suffering from agoraphobia are so severely disabled by other resultant 204 symptoms that they need the constant care of another person and may qualify for attendance allowance.
Some have suggested that agoraphobics should be entitled to mobility allowance —my hon. and learned Friend stressed that point—and I should like to clarify the situation. As I am sure my hon. and learned Friend will know, very careful thought was given to the scope of the mobility allowance scheme, more particularly in view of the limited financial resources available. The Government's main aim in introducing mobility allowance was to extend equal mobility help to those who are unable or virtually unable to walk, whether they can drive a vehicle or not. The scheme was therefore limited to people who could not get about at all through being unable or virtually unable to walk because of physical disablement. I very much appreciate that the scheme does not include all the people who have problems in getting about, but severe financial stringency made it essential to limit it.
Apart from agoraphobics, eloquent pleas have since been put to us on behalf of many groups of disabled people, including the blind and mentally handicapped. In reviewing their public expenditure programme, the Government will keep in mind claims for extending the scope of the allowance, but any proposals for change in the present schemes will have to be weighed against proposals put forward to the Government for extending the present level of help to the disabled and all other proposals for increases in public expenditure.
Turning now to the question of research which my hon. and learned Friend stressed, my Department has not funded and is not currently supporting research into the specific problem of agoraphobia, but we are able and prepared to consider proposals for research related to the provision of services for psychiatric disorders, including phobias, within my Department's research programme.
It might at this point be worth outlining the operation of that programme and how it relates to non-departmental research programmes, including that of the Medical Research Council, in this area. My Department has a system of research liaison groups to make decisions about departmental research. These bring 205 together senior administrative and professional staff concerned with the development of policy along with my chief scientist's advisers—mostly themselves distinguished researchers—and departmental research management staff, to consider applications for the funding of research. The criteria for the research liaison groups in commissioning research include, as one might expect, the scientific validity of any research proposal, its relevance to the policy needs of the Department and judgment of priorities in the allocation of funds.
There is a fruitful overlap of responsibilities between my Department, which has an important role in identifying problems regarding the causes, prevention and treatment of mental illness as they affect the provision of health and personal social services, and the Medical Research Council, whose principal role is to fund biomedical research to solve such problems. The research funded by the research liaison group is mainly related to the provision of services. Responsibilities for funding research are not, however, rigidly defined because the research liaison group, the Medical Research Council and the universities all share an interest in research into the prevalence and distribution of the different kinds of psychiatric disorder, the assessment of numbers in particular diagnostic categories, and the disabling effects of mental illness.
More specifically, I understand from my right hon. Friend the Secretary of State for Education and Science that the Medical Research Council has no research grants exclusively concerning agoraphobia, but two of its programme grants, with a total value in the last financial year of £97,000, include studies on phobia. These include research on the psychological treatment of psychoneurosis at the university of Oxford and therapeutic studies 206 of resistant neuroses at the Institute of Psychiatry in London. My hon. and learned Friend will also be interested to know that some years ago the Medical Research Council's unit for epidemiological studies in psychiatry at Edinburgh carried out some research into the clinical, familial, psychological and social aspects of agoraphobia in housewives. I should also mention that one study recently accepted for funding on the Department's side—that is, by the mental illness research liaison group—,on which we are likely to spend about £50,000 in the next two to three years, its concerned with methods of giving behavioural treatments. It is therefore hoped that it will be of direct benefit to sufferers from agoraphobia among other comparable disorders.
My lion and learned Friend mentioned a lobby of constituents and others suffering from this problem. I know that my hon. Friend the Minister responsible for the disabled is well aware of the problems of people suffering from agoraphobia and other phobias. I am sure that he will give sympathetic consideration to any request for him to meet my hon. and learned Friend's constituents on their lobby.
In conclusion, may I emphasise the concern and sympathy which the Government have for sufferers of agoraphobia and their families. Although no doubt there is much more which could be done to help them, given both unlimited resources and greater knowledge of the condition, I hope the House will agree that considerable help is presently available.
§ Question put and agreed to.
§ Adjourned accordingly at twelve minutes to Twelve o'clock.