Postponed Proceeding resumed on Question,
That this House takes note of the Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency.
§ 9.18 p.m.
§ Sir K. Joseph
When I was interrupted I was making the cryptic statement to the House, "Not only is there Percy but there is Piercy," and I feel that I should go back and explain what that succinct remark was intended to mean.
On mental health we have had a debate which was enlivened, just before the last interruption, by a speech of great practical humanity by my right hon. Friend the Home Secretary, and I am sure, judging from the references of all hon. Members who have spoken to the Royal Commission Report, that the whole House must have been delighted by the wide-ranging sympathy and the adventurous and enterprising approach that my right hon. Friend, on behalf of the Government, brought to this problem of mental illness.
I was very sorry indeed to miss the opening speech of my hon. Friend the Parliamentary Secretary, but I gather both from him and from the Home Secretary that the House has had the assurance that the Government is already in consultation with local authorities, and we can wish for no further token of their earnest intent to take this Royal Commission Report extremely seriously.
Each Member who has spoken in this debate today has concentrated, so as to enable other Members to speak, on one facet and I propose to do the same. The subject on which I wish to concentrate is that of the local authorities. The Royal Commission Report wishes there to be an enormous expansion in the responsibilities of local authorities. So much of the local authorities' functions and powers are under discussion today—the discussion of boundaries and of finance—that one should try to draw the implications of this Report in ample time for them to be considered before consultations with the local authority representatives are in full swing.
There was a time when local authorities were responsible not only for social but 148 for medical services in connection with mental health. Since 1948, the hospitals have been separated from the local authorities. The local authorities have had power but not obligation to carry out mental health community services. Some of them have done a great deal of work in the mental field but most of them have been chary even of admitting mentally ill people into Part III accommodation so that not only have the hospitals and mental institutions been left with all the medical care, but they have had even more social care than one might have expected because of the lack, in most cases, of Part III help from the local authorities.
As a result, the hospitals have had to provide beds for people who, had they had reasonable homes to go to, would have been sent out of hospital to their homes, and the hospitals have as a result not been able to concentrate upon the cure of people who are mentally ill, with all those rapidly expanding weapons of treatment of which many hon. Members on both sides of the House have spoken today.
One of the results of this is the strong recommendation by the Royal Commission that local authorities should play a full part in community care. Some Members, including my right hon. Friend the Member for Kelvingrove (Mr. Walter Elliot) and the hon. Member for St. Pancras, North (Mr. K. Robinson), have expressed doubts whether local authorities are sufficiently equipped for this mammoth job of providing the community care that is necessary. It was at this point that I tried to remind the House that there is not only a mammoth job of dealing with mental disability but that we have recently heard in this House the Parliamentary Secretary to the Ministry of Labour announcing the Government's acceptance in principle of the Piercy Report on the rehabilitation of the disabled. That Report recommends an enormous expansion of community care by the local authorities for all aspects of non-mental disability as well. The local authorities, therefore, really are facing a revolutionary expansion of their activities.
It may be of interest to hon. Members to realise that in the Percy and the Piercy Reports local authorities are recommended to run clubs, workshops— 149 diversionary, occupational and sheltered—hostels for all sorts of disabled people—mental and physical—homes, domiciliary services for all disabled people, whether mental or physical; and they are recommended to provide community care for mildly mentally ill, whether those mildly mentally ill have never been to a mental hospital because they are not ill enough, or whether they have been to a mental hospital and have recovered from their acute phases.
The local authorities are recommended to provide community care for the stabilised severely sub-normal, that is, the mentally defective, who are now to be called the severely sub-normal. One must remember that local authorities have, for many years, carried a great burden of looking after mental defectives; and in fact there are at this moment no fewer than 75,000 mental defectives under the supervision of local authorities—more than 50 per cent. of the total mental defective population of the country.
Local authorities are also to look after mild psychopathic cases. They are to look after the community care for the senile, and the elderly eccentrics who have no homes of their own, and a whole range of others whose disability is not in the least mental, who are covered in the very long and detailed Report of the Percy Commission.
No one doubts the good will of local authorities. No one doubts the skill of their officers and the interest of their citizens, but this is a mammoth task, and we should ask ourselves whether this revolutionary increase of local responsibility and power can be satisfactorily managed quickly, or whether we must be content to move slowly and securely, building up the staff and buildings and the co-operation which will be so essential.
The matter is complicated by the fact that not all local authorities necessarily agree with the recommendations of the Percy Commission. The County Councils' Association, for instance, thinks that the hostels recommended by the Commission should be run by hospitals, not by the local authorities at all. It seems to me that the hospital's job is one of cure and not of care, that is, unless the care involves constant nursing and individual treatment, and that the Royal Commission 150 was right in recommending that the hostels should be run by the local authorities. But it will be all the harder to get local authorities to carry the Commission's recommendations into effect if some representatives do not even agree with what is recommended.
Once again, we come back to the basic necessity for close co-operation between all the bodies concerned. The education, child care, welfare and health departments of local authorities and the hospitals must all co-operate to a degree to be found only in very few, very progressive, local authorities. Experiment will be absolutely vital, but it is no good experimenting, however successfully, if other local authorities do not copy. I fully accept the recommendation of the Royal Commission that a system should be developed, possibly under the aegis of the Minister of Health, to disseminate the experience gained as a result of experiment.
Here, once again, I mention the suggestion that this country today may very well need, with so much expansion in the social services, a social service staff college or a local authority staff college, at any rate a staff college of some sort which could not only run courses and introduce the best ideas for wide publication, but could also produce an authoritative series of journals and bulletins which will compare—not as one sees done superficially in the Press, but really compare—the achievements, the problems and the statistics of one authority with those of another. Of course, I am not forgetting that the Minister of Health will retain power of inspection, but the only security and safeguard to ensure a high, and rising standard in the local authority service will be provided by the interest of the public, and the interest of the public must depend upon thorough and systematic information.
I suggest that there are several things which the public and the local authorities have the right to know now. I take my examples from the Royal Commission's Report. First, the Minister of Health should make it clear, by an Amendment or authoritative interpretation of Section 28 of the National Health Act and Section 21 (8) of the National Assistance Act, that the local authorities have power to provide residential accommodation and that they have power 151 to admit the mentally ill into Part III accommodation.
Next, I hope that, in the discussions with the local authorities which are going on, consideration will be given to correlating local authority boundaries with those of regional hospital authorities, so that the teams which will have to cooperate in this great, new expanding experiment will be more or less the same, and not an ever-changing permutation of different individuals dealing with different small sections of each region.
First, and most important, however, is finance. The Percy Commission involves very heavy new financial cost but I believe that in the long run, there will be a commensurate financial saving. It may well be—and I really believe this—that once those who can be released from hospital to homes can go there and be looked after by local authorities, the mental hospitals and institutions will be able to shrink to a size determined by what one might call the acute mental case load level. It will, in addition, be possible for the mental hospitals to give a far better service to the country, concentrating upon preventive medicine, which we all desire, and working upon the cure and treatment of their patients with the modern methods which, as we all know, are becoming ever more available. It cannot be concealed that before this is possible, much money must be found for expanding the staff and the buildings of local authorities.
I particularly ask my hon. Friend to bear in mind the importance of drawing to the attention of the Committee in his Department which is now considering the question of social workers the importance of covering the requirements of social workers involved in both the Percy and the Piercy Reports. I very much hope that with the long-term savings in mind, neither the taxpayer nor the ratepayer will grudge the temporary burden which is involved in building up the community services which will be necessary before the hospitals and, therefore, the central Budget can be relieved.
There is no doubt whatever that the Percy Report has shown an indubitable way to bring great benefit to large numbers of the population. It seems to me, and, I am sure, to all hon. Members, that we must find the money for the research, 152 The staff, the buildings and the services so that we can achieve the long-term saving, not only in money, but also in human lives, that will be represented by this revolutionary expansion in the sphere of mental health.
§ 9.32 p.m.
§ Mr. Norman Dodds (Erith and Crayford)
I begin by echoing the feelings of my hon. Friend the Member for Woolwich, East (Mr. Mayhew), who deplored the fact that during twenty-seven years there had been only two debates on this important subject and that the debate this evening was interrupted by a Private Bill, which meant that those hon. Members who spoke before seven o'clock had to curtail their remarks. I believe, however, that there will be many more opportunities in future to deal with this subject.
We have had a very good speech from the Leader of the House, in which he said that this matter is being treated seriously. The Parliamentary Secretary began his speech by saying that there was need for consultation and that the various people were being consulted before measures of the kind we are considering could be brought into force. Everybody agrees with that. I join, also, those who have congratulated the members of the Royal Commission for the excellent job that it has done.
I share the view of my right hon. Friend the Member for Warrington (Dr. Summerskill) that there is need to exercise special care concerning the recommendations for psychopathic patients. There is no doubt—I wish I had time to dwell on this at length—that since 1929, without any change in legislation, there has been a tendency to bring into mental deficiency and to certify more people, including those who, by reason of their intelligence quotients, should never have been sent to mental institutions.
There must, therefore, be alarm at the statement in paragraph 17 of the Royal Commission's Report:… Psychopathic patients, or patients with psychopathic personality. We use the term 'psychopathic personality' in a wider sense than that in which it is often used at present …In that respect, we need to have a great deal more information about what is proposed, because many people can be brought into the net, which means that the liberty of the individual is endangered as a consequence.
153 One of my hon. Friends disagreed with the hon. Member for Carlisle (Dr. D. Johnson) about the recommendations being revolutionary. They are so revolutionary that they really say, "Scrap the present Jaws and start again." In the debate today, I have found very much complacency about what is now going on under the mental laws. I wonder whether hon. Members who have spoken would have made different speeches if they had read all the evidence which was submitted to the Royal Commission by some of the most reputable organisations in this country, evidence which cannot be thrust aside as being irresponsible.
I took the trouble to read through the 31 booklets containing Minutes of Evidence. That evidence, as anyone who reads them can see, is of dark blots on our national life, blots caused by what is happening in the mental hospitals and mental institutions. I do not think that the Parliamentary Secretary can deny that the organisations which gave testimony before the Commission included some of the finest authorities in the country.
While I acknowledge that much has been done, and is being done, and that in many respects progress has been made, I still think that the public conscience would be really aroused by this evidence, and that, if it were to be published, so that the public could judge of the conditions, it might well be that, in consequence, the necessary co-operation between the local authorities and the public would be forthcoming.
There is, for instance, the evidence of the Fountain Hospital Management Committee, which shows that children were certified as mental deficients although they were not mental deficients, and that they were so certified simply so that they might get necessary care. There was the evidence of Dr. Hilliard, who mentioned a baby only two weeks old, and stated that authorities would rather the children were not certified. There is the evidence of the National Spastics Society:There are rather a frightening number of cases all over the country where that has happened.Further evidence the Society gave was:We do know, for example, that in one mental hospital there are 300 spastics, about a quarter of them children and only about a third of them are really certifiable; the rest are in need of institutional care.154 There are children who were certified as mental deficients, and then it was found that they were suffering from deafness and ought not to have been certified at all.
It is an impossible task, in the few minutes one has in this debate, to go through all the evidence, but there is much to show that it is necessary to certify people in order that they may have necessary attention for other ills—people who are not mentally deficient and are not insane.
Among the Royal Commission's recommendations there is a recommendation that I should have thought could have been introduced without legislation, and one which should be introduced immediately. In page 11 of its Report the Commission says:Except in emergency, there should always be two medical recommendations at the time of admission to hospital or guardianship, at least one of which should be given by a doctor experienced in the diagnosis or treatment of medical disorders, and one if possible by a doctor who already knows the patient.What a contrast that would be to what happens today. There are about 2,000 patients who, under the mental illness laws, are certified by one doctor, to one who is certified by two doctors. A justice of the peace will sign a certificate who has not any special knowledge of mental illness, who has not seen the patient before, or who has seen him perhaps only once and then for only three or four minutes. Had I time I would read the evidence which shows that they go round certifying them and then picking them up a few days later.
Then there is the case of the old people. What a scandal that is. Document after document as well as the evidence before the Royal Commission shows that there is a large number of old people who ought not to have been certified at all. One of my hon. Friends—the only pyschiatrist in the House—cited the case of a person aged 84. The testimony before the Royal Commission shows that persons of 89, 90 and, in one case 100 years old have been certified and taken into mental hospitals as insane. There are cases of those who are being detained unnecessarily in mental hospitals.
There is also testimony by the Federation of Hospital Employees that 20 per cent. of the people in mental institutions today could be allowed out at once if 155 There were places to which they could go. [An HON. MEMBER: "Oh."] That is the point I am making, that there are people in mental institutions and hospitals today who are certified either as mental deficients or insane solely because we have not provided other places to which they could go. It is a shame that that should happen, and it is essential that, at the earliest possible moment, we should get down to this problem with a view to really awakening public conscience so that this sort of thing may be remedied.
I should like to quote in that respect the evidence of the National Association of Local Government, Health and Welfare Officers:In Kent, I have dealt with 450 cases in the last five years and 30 per cent. have been in the over-65 age group. There has been no alternative but the mental hospital for them with the consequence that the hospital which serves our area is overcrowded with senile dementia cases, many of whom could be adequately dealt with in other accommodation if it was available, and if there were statutory provision for it. We think it is dreadful having to certify people of 65, 70, 80, 90 and, as I did in one case, 100 years of age.It goes on to indicate that 75 per cent. could go to chronic sick hospitals, 20 per cent. to senile dementia hospitals with no certification and only 5 per cent. need to be certified as acute psychotic problems. It is clearly indicated in the Report of the Royal Commission that if the recommendations were carried out it would mean that thousands of people who are now deprived of their liberty in mental hospitals and mental institutions would not be deprived of it in that way.
When it is said that the statements that are made are sensational—and the two Front Benches get together and deplore what the Press has done about individual cases—I would remind them that in 1953 much of the impetus which resulted in the setting up of the Royal Commission was the result of the case of Janet Pritchard, and one only needs to look at HANSARD after the summer of 1953 to see that there were about 40 Questions on the Order Paper about that case.
It is true that the Royal Commission was set up because of the antiquity of the existing mental illness and mental deficiency regulations, and because of the contrast between the spirit which has permeated this legislation and that of other social service legislation. It is also a fact 156 that much impetus was given to it by the Press and others who were dissatisfied with what was going on.
In conclusion, I would quote what an hon. Member said earlier. Now that, at last, there is a blaze of light, I can only hope that that blaze will be kept going until the public conscience is aroused and that we will get down to dealing with this terrible and, I know, difficult problem and realise that many of these things need not happen. I am pleased that the Royal Commission has recommended that the number of people certified should be kept to the minimum, because many of us who have had experience of this know that once people have been certified it is an absolute nightmare to get any action taken. I hope that in future there will be many more occasions on which I shall be able to put my case very much better than I have been able to put it in the few minutes allowed to me tonight.
§ 9.45 p.m.
§ Mr. Percy Shurmer (Birmingham, Sparkbrook)
I am sorry that there is so little time left to make any observations on this subject, but I have been kindly allowed five minutes by my hon. Friend the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop). I was a member of three hospital committees from 1927 until the coming of the National Health Service. Since then I have been a member of one committee. Therefore, I have had thirty years experience. It should be stated in defence of the work done by the mental hospitals in difficult conditions that there has been a wonderful improvement in that time.
When I first became a member of a mental hospital committee the three hospitals were known as the Rubery, Hollymoor, and Winsor Green Asylums. Now one is called the All Saints' Hospital and the other two are named hospitals. People who have relatives in them no longer look upon them as mental asylums. We all know about the amenities provided in these hospitals and about the open doors. It is wrong for people to make rash statements and for the Press to report them, with the result that men and women are dissuaded from going to these hospitals as voluntary patients. We are getting a large percentage of voluntary patients in our hospitals today, and they are being cured.
157 I welcome the Commission's recommendations but, quite frankly. unless we act quickly the Report will be useless. There is a great deal to be done and a large amount of money must be spent. There was 38 per cent. overcrowding in All Saints' Hospital last year. The position is easier now, but the work of the doctors and nurses is still being made extremely difficult by the lack of accommodation. Mental hospitals have many patients who are no longer under active treatment Old people have been sent to mental hospitals and their homes have been broken up when they ought to have been sent to what are called "half-way homes."
There should be far more provision of that kind for these senile, infirm patients. This would relieve overcrowding in mental hospitals, but if the local authorities are to carry out the recommendations of the Royal Commission in providing half-way homes and more aftercare, some guarantee should be given of financial help from the Exchequer. The whole burden cannot be borne by the local ratepayers.
We must provide for the same amenities and care in mental hospitals as we provide in general hospitals. We should realise, also, the difference between the work of nurses in mental hospitals and that of nurses in general hospitals. I have just spent six weeks as a patient in Westminster Hospital. I know the wonderful work done by the staff there, but there the work is not as hard as that of the nurses in mental hospitals. It is brave of girls to volunteer to become nurses in mental hospitals and some adequate recompense should be given to them.
We should be quite honest about it and openly admit that many of our mental hospitals have been long out of date. The mental hospital on whose committee I serve celebrated its centenary recently. It was built by the architect who built the nearby prison. Many of our mental hospital buildings are very like prisons, but their committees and their staffs of doctors and nurses are doing their best to make them as decent as possible in the most difficult circumstances. The sooner we start to spend the money to build better hospitals and pull down the old ones and to provide accommodation for the aged and infirm, the sooner we 158 shall be better able to deal with matters of mental health.
I hope that, if not tonight, we shall soon be told that the Government will act on the Report of the Royal Commission and spend a little more money on mental instead of on general hospitals.
§ 9.50 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
We are all very glad to have heard the voice of my hon. Friend the Member for Sparkbrook (Mr. Shurmer) because of his very long experience in some of this work. We are all very sorry that the Minister has not been able to be present, but the Parliamentary Secretary can be happy that the Royal Commission Report has received such a very encouraging reception from both sides of the House. It is worth commenting that the debate is taking place because the Opposition made time available for it, not in order to prosecute any vendetta against the Government, but to see that feelings were ventilated and that every encouragement was given to the Government to move forward on the basis so well provided by the Royal Commission.
I am very glad indeed that so much attention has been paid by hon. Members on both sides of the House to the financial issue and to the responsibilities which we all hope will be undertaken in future by local authorities. Unless we can get local authorities to agree to take over some of these responsibilities for the welfare and care particularly of the elderly patients and also of some of the younger ones, it is impossible to see how we can make real progress towards the level of treatment which we know is possible today and which we are all eager to provide but which it is physically almost impossible to provide so long as nurses generally have to labour against crowded and difficult conditions.
We want to see a move towards a new provision for welfare and care by local authorities as a way of enabling hospitals to do the work which we are sure hospitals should do, in order that nurses can undertake the modern forms of care which are possible only if they are dealing with relatively small groups of patients.
I have seen all too often the difficulties in which a hospital has been placed when the authorities have been trying, as many 159 a hospital medical superintendent has said, to "dig a hole" in the hospital in which decent modern treatment can be provided. That inevitably means overcrowding even more seriously one part of the hospital in order to make modern treatment available in some corner.
Some mental hospitals and some institutions have been more fortunate than others in the space they have had available and in what they have been able to do; but in every one in the country, even in the most modern, the authorities have had to face difficulties which the community would not have tolerated in general hospitals. I remember saying, about three years ago in a general debate on the Health Service, that I thought that it was a sin and a shame that we should tolerate spending so little on the mental hospitals that the rate of expenditure per patient in the mental hospitals was so very much below that in the general hospitals. To me that was merely a general indication that the level of treatment in mental hospitals was relatively very low.
We are all glad to see the great developments now becoming possible. The Report suggests ways in which they should be not only possible, but actually take place. A great deal is left upon us in this House, whether we will approve and insist upon the expenditure on the local authority services which will be needed.
A point made by my right hon. Friend the Member for Warrington (Dr. Summerskill) was not taken up sufficiently, and I want to refer to it now. Some of us are sincerely anxious about the Government's position in regard to the financing of local government in relation to this specific issue. It will be very unfortunate if we are to start our encouragement of the local authorities to develop these services at the very moment of time when specific grants are to be discontinued and only general grants for all purposes are to be made available to the local authorities. I sincerely urge the Parliamentary Secretary to make that one of the early matters that he discusses with his right hon. Friend the Minister of Housing and Local Government, who will be responsible for financing local government affairs and for putting forward proposals very shortly in this House.
160 I am sure that we are all enormously eager to see the proposals which are being put forward take shape; but we recognise the expenditure involved. There is some truth in the point made by one hon. Member opposite that expenditure will be increased initially, though we can hope for real savings later on, but it is important that we should look clearly at this problem. In so far as we succeed in improving the scale of treatment in our mental hospitals, it is likely at any rate that expenditure per patient in these hospitals will go up. We must face that fact and welcome it as a sign that the work which we all want to see done is being done. It should not frighten us off.
The mere fact that we hope that we shall be able to move many of the more elderly and other patients out of our mental hospitals, and also out of our institutions as well, to which one of my hon. Friends quite rightly referred, does not automatically mean a reduction in expenditure in these institutions and hospitals if the improved care that we are eager to provide is made available at the same time.
This can only be an initial debate in what I hope will be a series of debates. I think it has been a valuable initial debate. It has shown that there is a very real unanimity in this House on the urgent need to seize this moment to move ahead. Although differences have very rightly and properly been expressed about the definitions and about the very important need to protect individual liberty, I think all of us are anxious that these very real differences that have been expressed shall not in any way hold back the work that can go ahead almost without delay.
What impressed me so much in reading this Report was to find how much could in fact be tackled even before the new legislation is available. It is upon that, I am sure, that we shall test the sincerity of the comments made by Ministers during this debate, and upon the administrative action that they are able to take in the field already open for administrative action. We hope very much indeed that the comments made by the Leader of the House and by the Parliamentary Secretary will bear fruit in the developments that we hope we shall be able to see in local government welfare services 161 and in the actual provision for the hospitals, which is so badly needed.
§ Question put and agreed to.
That this House takes note of the Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency.