§ Order for Third Reading read.
§ 3.39 p.m.
§ The Minister of Health (Mr. Derek Walker-Smith)
I beg to move, That the Bill be now read the Third time.
This is a long Bill, with 150 Clauses and eight Schedules. But, though the subject matter is often complex, it is drafted in a clear and intelligible form to give effect to provisions at once practical and progressive. It replaces the complex mosaic of the old law, which has grown up piecemeal and is in many respects out of date, with a single comprehensive design, simpler to understand and in keeping with contemporary social and medical advances. I believe that on its introduction this was a good Bill, but I am sure that it is now an even better one. It is better because of the constructive endeavours of hon. Members on both sides of the House, and I much appreciate the contributions which they have made to our discussions.
Though the Bill has been improved in many respects, it has not changed its basic design nor deviated from its fundamental principles. There are really two main principles in the Bill, first, that as much treatment as possible, both in the hospital and outside, should be given on a voluntary and informal basis, and secondly, that proper provision should be made for that residual category of case where compulsion is necessary either in the interests of the patient or the interests of society. These two main principles, and the Bill as a whole, should be seen against the background of the desirability of shifting the emphasis in mental cases so far as possible from institutional care to care within the community.
We have really been engaged in the Bill on a piece of delicate legislative engineering, animated by a high social purpose. We have sought to assemble a stable structure and to devise a viable system of checks and balances. We had, in particular, to balance three main considerations which can, of course, sometimes be in conflict—the therapy of the patient, the liberty of the subject, and the protection of the community.
Not unnaturally, a major part of our discussion has focused upon these vital 404 aspeots. The associated subjects of the definitions of mental disorder and the compulsory admission to hospital of some of those suffering from them have, in particular, been subjected to a close and careful scrutiny and to vigilant inquiry. The discussions on the definitions have not led to any basic amendment, although there have been two useful clarifying Amendments. But the discussion has, I think, served a useful purpose in that it has registered, after close examination, the approval of the great majority of hon. Members for these definitions.
There has been more alteration to Clauses 25, 26 and 29, which are the important Clauses prescribing the conditions requisite for compulsory admission. Several Amendments were accepted in Committee in respect of these Clauses and others have been moved on Report to meet most of the points which I then undertook to consider, Clauses 25 and 26 have been redrafted to improve the wording and to eliminate a number of expressions which seemed open to objection.
Clause 25, which deals with admission for observation, has been amended to make clear that observation may be accompanied by other forms of medical treatment. Clause 29 has been amended so as to limit the emergency procedure which, initially, of course, requires only one medical recommendation, to admission for observation; that is to say, a patient admitted on an emergency application cannot now be detained for more than 28 days unless an application for admission under Clause 26 is subsequently made.
Improvements have been made in the important matter of the renewal and discharge procedures. The intervals at which the authority for detention in hospital or guardianship lapses if not renewed, giving the patient a right to apply to the tribunal, has been reduced in respect of long term patients. The maximum period will be two years, as against three years in the Bill as originally drafted and as compared with five years under the present law. Patients will thus be able to apply to the tribunal within six months, and, if they remain so long, at the end of the first, second, fourth and sixth years and at subsequent intervals of two years.
405 Another Amendment which we have made allows patients to choose when to apply to the tribunal during these periods instead of being obliged to apply immediately after any renewal or else lose their right to apply.
Another important addition to the Bill is the insertion of a new provision in Clause 65. This permits patients who are subject to restriction on discharge under Part V of the Bill to require the Home Secretary to take the advice of the tribunal on their fitness for discharge at the end of the first year in hospital and subsequently at the intervals at which they would be entitled to apply to the tribunal if they were not subject to a restriction order.
Amendments have been made to the First Schedule to ensure that, in addition to a doctor and a lawyer, the tribunal which hears applications will, in any case, always include a lay member with suitable experience.
We have made a number of improvements in the difficult and delicate matter of who should exercise the rights of the nearest relative, the right to object to compulsory admission and the right to order the patient's discharge. While retaining the basic test of kinship, we have been able to give greater scope for applying, in addition, the tests of fitness for the function and affection for the patient.
We had some discussion at earlier stages about whether the Bill should put a mandatory duty on the local health authorities in respect of the mental health services. I yield to none in my desire that the local health authorities should work as quickly as possible in implementing the principle of the shift of emphasis to which I have referred. I have devised a method, as hon. Members who served on the Standing Committee know, whereby the local health authorities will be placed under a duty, but in a rather more flexible way, which will enable us to allow for local neeeds and differences of local circumstance.
I explained the mechanics of this in full in the Standing Committee, and I feel that I need now merely say that I propose to issue a direction under Section 28 of the National Health Service Act very soon after the Royal Assent is given to the Bill so as to impose a duty on local 406 health authorities to provide these mental health services. As soon as possible after that, I shall issue a direction under Section 20 of the Act requiring the submission within a period of, say, six months of revised proposals in the light of the Section 28 direction. The circular which contains this second direct ion will, in all probability contain detailed suggestions in the form of a model scheme, on which, of course, I should propose fully to consult the local authority associations before sending it out.
Not all action need await the Bill. On Monday, I sent out a circular to local health authorities and a hospital Memorandum. The main object of the circular is to draw the attention of local health authorities to the recommendation of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency that there should be this reorientation of the mental health services away from institutional care under the hospital service towards care in the community. The circula calls for greater expansion than heretofore in the service provided by local authorities and asks them to make a review of their mental health services and to decide upon the manner in which they should be developed.
Progress in mental health by local health authorities, in hospitals and generally depends, among other things, on skilled people and research. The Medical Research Council will continue, by appropriate means, to support promising work in all pants of the psychiatric field and encourage its development to the fullest possible extent. The Council has recently made arrangements far the setting up of two new units, one on the epidemiology of mental disorders and the other on psychiatric genetics.
The Council has also decided to set up two new committees, one on clinical psychiatry to advise it generally in this rapidly expanding field of research and the other on the epidemiology of mental disorders, the purpose of which will be to establish a more precise definition of the various mental disorders and to provide the basis for a realistic evaluation of methods of treatment. I am glad to say that two distinguished medical scientists, Sir George Pickering, Regius Professor of Medicine in the University of Oxford, and Professor Aubrey Lewis, of the Institute of Psychiatry, Maudsley 407 Hospital, have respectively accepted the chairmanship of these two committees. I should perhaps add that the Medical Research Council review is a continuing process. It is the Council's firm intention to seek every opportunity to advance knowledge in this field.
May I refer to one more special aspect before I conclude. I said yesterday in answer to the hon. Gentleman the Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) that I would say something on the question of the special hospitals at this stage. We had a good deal of discussion in Committee on this and hon. Members who served on that Committee will recall that suggestions were made for a Departmental committee of inquiry into their role. I listened sympathetically to those suggestions and I ventured to suggest that hon. Members who felt so inclined might care to select what they considered to be appropriate terms of reference for any inquiry or review.
The hon. Gentleman the Member for St. Pancras, North (Mr. K. Robinson) was good enough to respond to this invitation and he sent me his idea of the possible terms of reference and I am very grateful to him for that. I think—he may be disposed not to dissent from this—that his terms of reference go a little wide. In particular, I should say that the matter of conditions of service of the staff in the special hospitals are more a matter for staff negotiations through the appropriate established machinery than for independent inquiry. I agree, however, that it would be advantageous to think out afresh at this time the role of the special hospitals in the mental health service as a whole, and the classification of the patients to be treated in them.
I do not think that a formal Departmental committee is quite the right machinery for this purpose. I think that we should do better with an expert study of the problem by a small working party, which will include a number of outside experts. The working party will be able to get at the facts, and will, of course, he able to consider the views put to it from interested and informed people. The advice of this body would then be available to the Minister, in planning the future development of hospitals, both under the regional hospital boards and the particular Part VII hospitals of which I am speaking. I propose to embark 408 immediately on consideration of the appropriate composition of this working party.
Some action, such as that which I have just described, need not, of course, await the passage of the Bill; but, of course, it is the Bill itself which is the main gateway to that progress which we all desire in this human and challenging problem of mental health. In that knowledge, and in the belief that we have here something which will bring benefit to many and harm to none, I commend the Bill with confidence to the House.
§ 3.55 p.m.
§ Dr. Edith Summerskill (Warrington)
I believe that this is an occasion for mutual congratulations. May I say how happy I am to see the Chairman of the Standing Committee which considered the Bill, the hon. Member for Stretford (Mr. Storey), sitting on the Front Bench below the Gangway. During the many sittings of that Committee we examined this very long and highly technical Bill very closely.
I must confess that I had some apprehensions at the outcome, because I recalled that when I was a Minister, in two technical Departments, it was very comforting to have behind one a staff which contained a number of experts. Therefore, I should like to say at the outset—and I am sure that the Minister will agree with me—how grateful we are to those medical and allied organisations which gave us the benefit of their advice and offered us certain memoranda. I should like to make special reference to the Royal Medico-Psychological Association and its indefatigable secretary, Dr. Walk, whom, I am sure, the Minister and I both respect.
I agree with the Minister that this was a good Bill at the start and that it has been improved by the combined efforts of both sides of the House. We have done our best, and no one can do more, in trying to solve some very difficult human problems. We have been stimulated in our efforts by the knowledge that our discussions have been concerned with the lives and welfare of that utterly dependent section of society—those suffering from a mental disorder.
I think that that evoked serious and fruitful discussion and important Amendments, which I am glad that the Minister 409 has gone into in some detail this afternoon. I should like to say to him—and I am sure that my hon. Friends will support me in this—that we are very grateful to him for accepting such a large number of Amendments and for not only accepting Amendments, sometimes badly drafted, 'out for taking a hint and saying that he thought that some of the ideas might be embodied in the Bill. Yesterday, he came back with those ideas, beautifully set out in very tidy Amendments. Therefore, the Bill as it is now is the best that we can do. It may he that, as time goes on, we shall find in this difficult field of human endeavour that we have made a small mistake or a big mistake, but I think that we are all big enough to admit our mistakes and, should it be necessary, introduce some amendments to this legislation.
I should like to thank my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock), who was a member of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, for sitting almost silently during the whole proceedings and butting in only to keep us in order when she thought that we should be reminded of what the Royal Commission said. As the Royal Commission, following its four years' consideration, produced a very lengthy Report, some of us were very glad to have my hon. Friend kindly reminding us on some important point.
All new Measures of this kind which confer benefits on some, through the inevitable changes that must take place, call for the readjustment of the ideas of others. That is always a little difficult. The Ministry of National Insurance knows that, when each change in insurance is made, there are some who must be a little aggrieved; and even in this Bill there will be some who will look at our changes and feel that they have to readjust their ideas.
First, we have dissolved the Board of Control, but we are glad that its officers will be absorbed in the Ministry, where their experience and advice will be invaluable to the Minister, who assured us yesterday that this would be so. The mental health review tribunals will in some measure take their place and we shall watch with interest how they function. for they provide the new safeguards 410 for the rights and liberties of these rather pathetic patients.
The new classification of mental disorder will call for some reorientation on the part of psychiatrists. I am well aware that the disposal of the psychopath may present difficulties until the new attitude towards his problem is generally accepted. Indeed, the whole approach to mental disorder which is represented by the Bill will be achieved only by education and the careful indoctrination of the new conception of sickness of the mind.
Last night, I emphasised that it is not only the patient and the potential patient, but friends, relatives and the whole community who must readjust themselves to the new approach to the patient who suffers from mental disorder. It will not be easy. Deeply-rooted fears, superstitions and prejudices are not easily eradicated. The most important step in education and in the implementation of the Bill will be to explain whenever possible to the public, to large groups and to small, just what their new attitude should be.
I emphasise, however—and I attach tremendous importance to this—that the real implementation of the Bill will be found in the successful integration of community care, the hospital population, the general practitioner and the local authority service. I feel strongly that our whole new approach to medicine over the whole field in the National Health Service depends upon this integration of the various administrative parts of the Service.
While all of us, I am sure, recognise that this is the right approach, both therapeutically and socially, the local authorities may drag their feet, not through indifference, but because of lack of funds. The Minister has told us what he has done. I am very glad that he has responded to the appeal, not only from us, but also from local authorities and from other people concerned in this subject, that these powers should be mandatory.
The right hon. and learned Gentleman quite rightly says that to impose a Bill of this sort on a local authority without any flexibility may be a little difficult. Nevertheless, I remind him that some local authorities have done practically nothing, while others are in the van of progress. If the Minister is too kind, if he tells local authorities who have 411 failed to take action under Section 28 of the National Health Service Act that there is plenty of time and that they can adopt a flexible approach, I assure him that many of them will jump at that opportunity to evade their responsibilities.
The Minister has recommended the local authorities to introduce more residential care. He has brought to their notice the importance of training children under the age of 16. These proposals are excellent, but I remind the right hon. and learned Gentleman that all this is subject to the block grant. Those of us who have served on a local authority—and my apprenticeship to politics was seven years on a county and some years on an urban district council—are well aware that the person on the local authority who is most eloquent may finally get his way. It may be that these special provisions, which are of importance to the progress of a group in the community which has been rather neglected in the past, may depend upon the power, the eloquence and the persuasion of somebody on the local authority to press the majority to take a nice proportion of the block grant for that purpose.
The Royal Commission was a very practical Commission. Its members were idealists—they were starry-eyed, I am glad to say—and they made their recommendations, but they were well aware that those recommendations could not be implemented unless the local authorities had the money. The Royal Commission therefore recommended that a special grant should be made for this purpose. I hope that the Minister might reconsider this proposal at some future time.
I know, however, that funds have always been short at the beginning of most new social experiments. In fact, some of our most successful experiments have started literally on only a few pounds. That is not an exaggeration. I am thinking of our maternity and child welfare clinics, which started in a little shop with two women and an old-fashioned pair of scales. What happens generally is that the social service develops, the Treasury watches and then says, "This is worth while." The heart of the Treasury is softened and it then comes forward and provides more money. I hope that that will happen in this case.
412 I am very glad to hear that the Medical Research Council has set up the new committees. We in this House are all rather serious-minded. None of us laughs at the word "psychiatrist", but it is rather shocking in the twentieth century to hear people whom one would regard as quite intelligent giggle at the word "psychiatrist". We all know the person who does it—usually it is the person who is inadequate himself. There are deep psychological reasons why he or she should do it. Today, when I am glad to see a psychiatrist present on each side of the House, I am sure that psychiatrists will be delighted to learn that the Medical Research Council has now decided to set up most important committees, which will be of great use to the psychiatric world.
All of us will watch the developments which stem from the Bill and hope that they will do much to alleviate the sufferings, the fears and the loneliness of those who are sick in mind. In the twenty-one years that I have been in the House, I have had the honour to stand at the Dispatch Box, either on the Government side or on this side, and speak on great social reforms. Today, it gives me a feeling of great happiness and great content to see the House of Commons pass a Bill which, I am sure, will bring great happiness to many people.
§ 4.8 p.m.
§ Sir Hugh Lucas-Tooth (Hendon, South)
I am glad to be able to say that I find myself in complete agreement with every word that the right hon. Lady the Member for Warrington (Dr. Summer-skill) has spoken.
I should like to begin my speech by referring to a part of the Bill which has had little or no publicity. I refer to Part VIII, which deals with the management of property and affairs of the mentally disordered. The reason, I think, why this part has had no publicity is that the Bill is clearly drafted and there is no controversy whatever about the provisions relating to the property of the mentally disordered. In addition, the provisions are themselves extremely technical. There are, however, two points which could usefully be made on Third Reading. They were referred to in Committee, but they are worth underlining now.
Henceforward, the management of a person's own affairs can only be taken away from him if a High Court judge 413 finds him incapable of managing them himself. That is the effect of Clause 99 of the Bill. In future, there will be no automatic disqualification because of certification or something of that kind. That is a very important provision and one which should be widely understood.
The second point relates to the delays which have occurred and which have caused very great hardship to those affected by them. My right hon. and learned Friend the Attorney-General described in Committee what steps the Lord Chancellor was proposing to take to invoke the aid of the National Assistance Board, the citizens' advice bureaux, the hospital authorities and others to inform patients and their relatives of their rights and facilities under the law relating to their property.
It will be by the proper use of that information that the Bill can be made to work and that delays and consequent hardships will be avoided. I believe that at present there are 30,000 or more mental patients whose affairs are being administered by the courts. That means that about 100,000 people will be directly affected by these provisions, perhaps for the whole of their lives. I do not, therefore, apologise for referring to them.
It is not surprising that we had no discussion on the provisions of Part VIII on Report, but I think that it is most significant that we had no discussion on two other aspects of the Bill to which reference has been made by the right hon. Lady, namely, local authority services and the position of psychopaths. Both on Second Reading and in Committee we spent a great deal of time, possibly more than half of the time, in discussing these two problems, yet I think that they were completely absent from our discussion yesterday on Report. I believe that the reason for this is that there is a general feeling that we cannot now go further in the Bill in dealing with these subjects.
As regards psychopaths, experience alone will show whether we have got right the definition, the age limit and all the other provisions in the Bill dealing with this extremely difficult subject. I think that we are satisfied that, as far as can now be seen, the provisions in the Bill are right, but I confess that I believe that it will be necessary to alter some of the provisions, possibly quite soon. If my right hon. and learned Friend finds 414 it necessary to come back to the House with amending legislation, he certainly need not wear a white sheet. We shall all be behind him, as we are behind him in what he is doing here.
I agree with everything that the right hon. Lady said about the urgent need for vigorous action by the Minister in connection with local authority services and for local authority co-operation. Those things are essential. However, we must bear in mind that the Bill contains a most formidable sanction against inaction. For the first time, the Bill enables hospitals to refuse to accept patients, and that will create a pressure which will make it absolutely essential to develop the community services as quickly as possible. If we fail to do that, disaster will follow. For that reason, I think that the pressure on the Minister and on local authorities will be so great that there will be no possibility of our failing to go ahead to develop these services and so make the Bill a success.
These proposals are generally welcomed in the House and by those outside who are conversant with this problem or certain parts of it, but I am bound to say that, from my experience, the general public is apt to question this Measure. When talking to people, I have found a measure of anxiety. It has been asked, "Why do you want this Measure now? Do you think that it will work out right?" I believe that that anxiety is ill-founded, but, nevertheless, it exists and it is dangerous.
It is important that we should all make clear that a change in the law was essential, and not only because of changes in our thinking on these problems generally. The most obvious example is that I think no one will now deny that a life-long incarceration of a harmless person is a morally deplorable thing. A change in the law has been made essential also because of the advances in medicine and medical practice.
The changes that the Bill brings about are more liberal in many respects than the existing law. When the Bill becomes law, fewer harmless old people will he locked up for the rest of their lives. On the other hand, it seems to me that the Bill is firm and strict where it is necessary, and rightly so. For example, under the Bill, psychopaths can be detained and 415 treated, in certain circumstances, where they could not be detained and treated compulsorily under the law as it stands today. Under the existing law, a psychopath can be put under compulsion only after he has committed an offence. When the Bill becomes law, in certain circumstances he will be put under compulsion before he has committed an offence. In that respect, there will be a greater safeguard for the public when the Bill becomes law than at present.
In addition, the courts' power to deal with the dangerous and offensive types of mental disorder is maintained and, indeed, enlarged under Part V of the Bill. For example, the power to make a hospital order under Clause 59 where it is appropriate is a new and I think, effective piece of machinery. Again, the power to make orders restricting the discharge of mental patients for the protection of the public will be a useful piece of machinery. These are not altogether uncontroversial parts of the Bill, but it is right to underline them now to indicate to the public that this is not simply a Measure aimed at freedom and without regard to the public interest. It has the public interest very much in mind.
It seems to me that in the past our ideas of treatment, custody and punishment have tended to be confused and muddled. I do not believe that any of us has been able completely to disentangle them in our minds. The only criticism I have of the Bill is that even now I am not sure that we have them completely separated. We have failed because none of us could suggest better things, not even the hon. Member for St. Pancras, North (Mr. K. Robinson). The process of differentiation will be slow and difficult.
The Bill takes a step forward in what I am sure is the right direction. It will succeed if everybody concerned plays his part. The doctors and the Health Service personnel will, of course, play their part. They always do. I believe that the local authorities will play their part. Another group of people worth mentioning are the various voluntary bodies who are concerned with after-care, with children, with research, and other special aspects. If all these people play their part under the Minister's vigorous guidance I am sure that the Bill will be a great success, and I wish it well.
§ 4.21 p.m.
§ Dr. A. D. D. Broughton (Batley and Morley)
I was one of many who welcomed the Report of the Royal Commission on Mental Illness and Mental Deficiency and I stated that I looked forward to the new legislation which would be forthcoming and which would be based on the Commission's recommendations. I welcomed the Bill when it was introduced, and I am pleased to have had the privilege of serving on the Standing Committee which has been considering it.
I must confess to the Minister that towards the end of our proceedings in Committee I was almost in a state of despair, because he appeared to be so reluctant to accept Amendments which my hon. Friends and I had put forward. However, the right hon. and learned Gentleman certainly listened attentively to all that we had to suggest. He frequently gave us promises that he would consider these points, and I join with my right hon. Friend the Member for Warrington (Dr. Summerskill) in thanking him today for coming forward yesterday on Report with so many useful Amendments incorporating ideas which hon. Members on both sides of the Committee had suggested.
Now, again, on Third Reading I support the Bill, but not unreservedly. Cautiously, I give it my support, but with a few reservations. The Bill contains 150 Clauses and eight Schedules and, therefore, it is probable that no hon. Member will feel satisfied about every detail of a Measure of this size and complexity. At the outset of my criticism, I should like to reveal to the House my great bone of contention with the Bill. It relates to the compulsory detention of mentally-ill patients as now laid down it, the Bill.
I discovered recently that I was being quoted as one who advocated the abolition of the compulsory detention of patients suffering from mental illness. As far as I know, I have never said that. I have certainly never thought it. It is my opinion that many more patients are certified than there need be, but I accept as a fact that there is need to detain compulsorily some mental cases for their own protection and the protection of others. When we consider these cases we 417 have to look at the interests of the individual and at the interests of the community. When we are considering those interests, which often conflict, we find that it is necessary to detain some cases compulsorily.
Clause 25 speaks of admission for observation and Clause 26 of admission for treatment. These are harmless-sounding terms, but the truth is that all cases which are admitted, whether under Clause 25 or Clause 26, or, indeed, under Clause 29, which relates to admission in cases of urgent necessity, will be observed and will be treated, as is appropriate to their needs, within the limit of our knowledge and our skill. The real purpose of these Clauses is to give power for compulsory detention, and that great and heavy responsibility is given by the Bill to the medical profession.
I would remind the House that compulsory detention means loss of liberty and a serious restriction of civil rights. The Bill alters the existing law by removing the responsibility for the incarceration of mentally disordered patients from the hands of the civil authority, in the persons of the justices-of the peace, and thrusting it into the hands of the medical profession.
Under the Bill, compulsory detention is founded on the recommendations of two medical practitioners. I maintain that it is the duty of doctors to report and to make recommendations, I hold the opinion strongly that doctors are not qualified to take over administrative functions of such gravity as taking away a person's freedom and restricting civil rights. The doctors are the experts who advise, and it was said, I think by the then Mr. Lloyd George, that experts should be on tap and not on top.
I believe that there is insufficient safeguard in the Bill against wrongful detention and that there is likely to be a harmful effect on the doctor-patient relationship which is of first importance in the practice of psychiatry. These fears of mine have been expressed by other doctors, by patients and by many others.
I should like to refer to one or two opinions which have been expressed and which support my own. An interesting letter was published in The Times of 17th February this year from the General Secretary to the Medical Practitioners' Union, who said: 418There is a real danger that both parties, in their desire to promote the great objects of the Bill, may accept sections which are not in the public interest … The decision to detain compulsorily mentally ill, mentally defective and psychopathic patients will lie in the hands of the medical profession alone. The community accepts no responsibility. Many doctors feel that the basis of trust on which all psychiatric treatment must rest will suffer as a result of their having to assume administrative or executive functions.A leading article in the News Chronicle of 12th March stated:The doctors are, of course, best qualified to give an opinion on somebody's mental condition; but if they alone have the power to recommend that a mentally ill person be put under restraint, the doctor-patient relationship is endangered … To encourage people to submit voluntarily to treatment it is important that they should not feel that they are putting themselves at the mercy of doctors.Hon. Members who served on the Standing Committee which considered the Bill received from the National Council for Civil Liberties a manuscript giving the Council's opinion on certain aspects of the Bill. Under the heading "Detention without a Hearing" it stated:The sole requirement for detention as outlined in Part IV, is the receipt by the managers of the hospital of an application made either by the nearest relative or by a mental welfare officer with the consent of the nearest relative, if practicable, addressed together with two medical recommendations in the appropriate form.It went on to say:There is no provision for the patient to be heard or to be seen by anyone other than the doctors and the applicant. His sole right is that of appeal to the Mental Health Tribunal after the detention has commenced. This is the greatest weakness of the Bill and it is clear that the safeguards are quite inadequate.I have attempted to explain to the House why I feel unhappy about this part of the Bill, which deals with compulsory detention, and I am grateful to you, Sir, and to the House for bearing with me while I have expressed at such length my doubts and fears. I will now turn to other parts of the Bill.
As we have been reminded today in all the previous speeches, local authorities are to be made responsible for the care, in some respects, of some mentally disordered patients who need not be in hospital. I warmly welcome that policy for I know of mental patients who could be discharged from hospital if the necessary after-care and community services were 419 provided by local authorities and available for these patients. It is really too great and drastic a change from the security of a mental hospital to life in the outside world for many patients to be able to adjust themselves to the new environment without having a breakdown. In my opinion, one requirement is the provision of hostels which will provide accommodation for such patients on discharge from hospital. They would act, if I may so describe it, as a halfway-house between the hospital and a full life in the community.
In addition to the provision of accommodation, it is necessary that the local authorities should provide community services of a kind which would enable the patient to realise that there was someone who showed an interest in him. I believe that few local authorities have any idea of what will be required of them, and I was pleased to hear from the Minister that it is his intention to offer them advice on what they should do. I hope that when the Bill comes into operation the hospital authorities will not turn patients out of mental hospitals in large numbers to the care of local authorities. It will be some considerable time before the local authorities are ready to take over the care of these cases. If the patients are turned out too soon, and the local authorities are not ready to receive them, I feel sure that the community will not welcome them, because most of the patients are difficult people with whom to deal. That brings me to my next point.
Under the provisions of the Bill mental cases can be admitted to general hospitals, and I want to implore regional hospital boards to exercise care in deciding which hospitals, and in the case of general hospitals which wards, should be used for the admission of patients suffering from this type of illness. Surgical cases are not sent to hospitals where there are no surgeons and no nursing staff trained in operating room technique and the nursing of surgical cases. Similarly, mental cases should not be sent to hospitals where there is no psychiatrist or where there is no nursing staff fully trained in mental nursing.
Mental nursing is by no means easy. It requires a highly specialised training. I would like to take this opportunity of paying my tribute to the splendid work that is done by mental nurses. It is a 420 profession which calls for intelligence, knowledge, unlimited patience, sympathetic understanding and a kind nature. A woman who has acquired the status of a State registered nurse, after having undergone training in a general hospital, is, as a rule, quite incapable of nursing mental patients. Proficiency in nursing the mentally ill comes only after a lengthy and highly specialised training.
I will now say something about this training and where it should be undertaken. In my opinion, the place for training a mental nurse is in the large mental hospitals, and it will be necessary in the future, as at present, that there should be hospitals which can provide experience for the nurse under training in dealing with and caring for all types of mentally disordered patients. If, under the provisions of the Bill, the general hospitals take the acute cases—what might be regarded as the most interesting ones—then there will be a grave danger that the large mental hospitals will be used only as a dumping ground for the chronics. If that were to come about then the large mental hospitals would cease to attract many of the best nurses.
I would remind the Minister that trained mental nurses are required in large numbers. They are required for nursing patients in our large mental hospitals. They will be required as I have attempted to explain previously, for nursing mental cases in our general hospitals, and their services will also be required in the after-care and the community services of local authorities.
I hope that the passage of the Bill through Parliament has given added interest to the problem of dealing with the mentally disordered. I trust that teaching and training hospitals will in the future encourage more able men and women to undertake the nursing of the mentally disordered and that they will encourage more medical students to realise the importance of psychiatry and the enormous amount of interest that is to be found in the study of that subject. At present—I have said this previously in the House—psychiatry is the Cinderella of the National Health Service, but I hope that in the course of time, with the operation of this Bill, that state of affairs will be altered.
I would remind the House that almost 50 per cent. of the hospital beds in this country are occupied by patients who are 421 mentally ill. So we are dealing here with a problem of national importance. There is need for more research, and I was delighted to hear the Minister tell us that there is to be more research. I was very pleased to hear that two new important committees are to be set up by the Medical Research Council.
I believe that mental anguish is more to be pitied than physical deformity and pain. Mental illness is responsible for all enormous amount of human suffering. One of the most exciting adventures in the years to come will be exploring the hidden territory of the mind. New discoveries in human psychology and in psychiatry will be thrilling and of as much value in the realm of human relationships as nuclear development will be in the field of science.
In recent years psychiatry has taken great strides, and the advance against mental illness continues. I look forward to the day when medical students and probationer nurses will be encouraged to regard the conquest of mental illness as a first priority.
The Bill will, I believe, give encouragement to all those who work among the mentally disordered. It is an important milestone on the way to a better understanding of, and better treatment for, the mentally disordered and towards the prevention of this type of illness.
§ 4.42 p.m.
§ Dr. Reginald Bennett (Gosport and Fareham)
It is a very agreeable experience that the House should be speaking in unison on this subject today. I am sure that all of us welcome this harmony as probably one of the demonstrations of the best sort of thing that the House can do.
The Bill is a mammoth achievement, if only when seen in the scale to which the hon. Member for Batley and Morley (Dr. Broughton) has referred—that of approximately 50 per cent. of all hospital patients in the country. The problem has been enormous. Let us remind ourselves that it is no less now that the Bill is so well on its way. The problem is unchanged. What the Bill does is perhaps to arm us better in combating it. I think that we would all agree that the Bill will do an enormous amount.
It has been obvious for years that the procedure by which no mentally afflicted 422 patient could be treated unless through some cumbersome administrative organisation, of which the patient certainly was scarcely likely to be very conscious, was an utterly out-of-date conception and would have to be changed. As many of us know, there were very many ways already in which various bodies were instituting, on their own responsibility, methods of dealing with mentally afflicted patients outside the framework of the law. Obviously, this could not proceed very far without the law itself having to be changed, and changed it has been.
Something struck me very forcibly yesterday when I met the Bill again on Report, having been parted from it, unfortunately during the Committee phase. It was that in parallel with the facilitating of the administrative work there has been a remarkable cleaning up of the terminology, one which began by using words in common parlance rather than some of the polysyllabic monstrosities with which the Bill was previously encumbered. All that is to the good, and all that, apart from the content and presentation of the Bill, will help very greatly in administration.
There are undoubtedly provisions in the Bill which will contribute somewhat to treatment, but this, of course, is where we are not on such sure ground. With all the best knowledge in the House of Commons, the Bill cannot provide the actual treatment. However good the Bill is, it will not treat any patients.
I am reminded of the grasshopper which dashed, one cold winter's night, into a "pub" As the door slammed behind it and it ordered its drink it saw an owl sitting in the corner of the bar. The grasshopper said to the owl "It is cold, isn't it?". "Yes," said the owl, "very cold." The grasshopper said "For little chaps like me it is bitter weather. It is rotten for us, isn't it?" "Yes," said the owl, "I do not know what you can do about it." The grasshopper said "I wish I could do something about it." "Well," said the owl, "why do you not become a mouse?" The grasshopper said, "That is a bright idea. Why?" The owl said "The mouse has a lovely thick coat which is marvellously cosy during the winter. Is that not just what you want?" "Indeed it is," said the grasshopper. "How do I do that?" "I do not know," said the owl. "I merely advise on policy."
423 The Bill will make it easier to treat, but the treatment will still be done by the doctors. To some extent, there is a slight subtraction from what the doctors will be able to do, in that by the more frequent renewal of committal every two years the administrative work will be increased by 50 per cent. This paper work can only come out of the time which would otherwise be devoted to treatment. That, in a minor degree, is to be deplored. The problem can only be solved, I suppose, by larger staffs, and that is very improbable of attainment.
The Bill has done a brave thing which I think we all welcomed with admiration when it first cropped up. It has laid down a social definition of the psychopath. Hitherto, the psychopath has been defying all sorts of attempts at appraisal. The fact that the definition has come unscathed through all the critical discussions on the Bill undoubtedly shows that not merely hon. Members but those outside who wish to be heard, and are by way of being experts, are unable seriously to suggest any better form of definition. So much the better.
The problem comes, of course, in the operation of the Bill. Now that we have a working definition and can spot the psychopath, are we any better placed in doing anything to him? Very little, I am afraid. The psychopath can be diagnosed, and he can be presented to a hospital, but, as I have always maintained, hospitals will not welcome these people because of their genius for disorganisation. They are not unintelligent, and one of the great things of the Bill is that it has left behind that earlier concept of the psychopath. They are good at passing on disorderly activities to their neighbours in the ward—I have had an ample share of that.
The psychopath will not be acceptable to the ordinary hospital, even when put under compulsion. I do not know what will happen when such people turn up in numbers at a local hospital, in greater numbers than the hospital can stand without disruption. That is a problem which in the administration of the Bill will be one of the first and most serious responsibilities of my right hon. and learned Friend.
I hope that administratively he will find it possible to consider as early as possible 424 the institution of some sort of special arrangements for psychopaths where they cannot disorganise and vitiate the treatment of patients of another sort. In general, in mental hospitals segregation of patients under one diagnosis from partients under another is generally undesirable. The treatment of patients together generally seems to be one of the factors enabling patients to recover morale and to be able to hold up their heads among their fellow men. However, the psychopath is altogether different and although we cannot at this stage provide for it in the Bill, I hope that at the earliest opportunity my right hon. and learned Friend will give serious thought to establishing some sort of special accommodation.
Alas, for the psychopath aged over 25, nothing whatever is to be done and we are to continue to have the addicts and the violent, unstable adults breaking the place up and unable to be detained any more than they could be detained under the law which we are about to supersede. This is the loss of a genuine opportunity and the Bill has failed in that respect. Such psychopaths will still be bandied about from prison to hospital and from hospital to prison. Even when, in their more lucid moments, they ask to be detained for long enough to undergo a régime of treatment, which is always bound to be strict and usually rather harassing—and by definition the psychopath would be unable to stay such a course—within 24 or 48 hours the psychopath's wish to be treated and to stay will have evaporated and his endeavours will be directed to getting out again, something which the psychopath will be able to do. I hope that we shall do our best to improve the Bill by extending the provisions with which we have hopefully begun with one great triumph, providing a definition.
There is only one other point on which I wish to comment, which the hon. Member for Batley and Morley, as a medical colleague, was bound to mention. That is the unpleasant odium which is bound to attach to doctors, notably those who practise psychiatry. Everyone has known that it has been the doctors' reports which have been the basis for certification and the doctor has not been without odium in that respect hitherto. However, at least there has been somebody to sit in judgment on those reports. That will no 425 longer be the case and doctors will have to face the risk of an added burden of suspicion among a section of the population which, alas, is only too well filled with mistrust.
I ask the Minister to consider this very carefully and see whether, as time goes by, the misgivings—and I do not attempt to express myself dogmatically, but I share the misgivings, which are fairly widespread—felt by those who have to practise among these patients are not realised and to take action by amending this legislation if he finds that there is a growing resentment among the population towards doctors doing this work.
Those are matters which continue to give me a certain amount of anxiety for the future, even with this admirable Bill. In every other respect, as my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth) said, the Bill is the best we can produce and there is not much more which any of us can contribute towards its improvement. It is right that it should leave the House in this state, for the House cannot improve it further. We can feel, as I have felt throughout our deliberations, that we have done something together which we can unanimously agree will achieve a very great improvement in this enormous field of work.
§ 4.56 p.m.
§ Mr. W. A. Wilkins (Bristol, South)
It seems that the Bill will be received with general acclamation and approval in the House and, to judge from the proposals as a whole, that is quite justified. However, it would be unwise for the Minister to go away thinking that everything in the Bill has proved acceptable to everyone in the House and outside. I want to make some observations which will not be completely in tune with what has already been said, but which should be put on the record before we part with the Bill.
I want, first, to refer to the speech of the hon. Member for Hendon, South (Sir H. Lucas-Tooth), who said that the Bill was generally welcomed outside the House by people who understood the problem. I do not know his grounds for that judgment and I am sure that the Minister is aware that eminent people connected with mental health work do not entirely share that view.
Even as recently as this morning, representations were made to me by two 426 superintendents—one from a mental hospital in the South-West and the other from a mental deficiency institution—calling attention to what they considered to be some of the Bill's failings. One referred to the Clause which the hon. Member for Gosport and Fareham (Dr. Bennett) had in mind when he said that we could not provide actual treatment for some of these cases. He was referring to Clause 44 and, as a member of the medical profession, he knows that that still causes apprehension to people responsible for hospital administration.
This is the Clause which would make it possible for a subnormal or psycopathic patient who had been detained in hospital up to the age of 25 years to be released. They rightly pointed out that there was no magic cure for a person in that condition at the age of 25, and felt that the Bill weakened to some extent, or would do so, the authority which they could exercise over people of this age.
There were two letters in the Lancet of the 17th and 24th January which set out some of the apprehensions in the minds of medical men about certain provisions in the Bill. Reference was made to Clause 39, and it was contended that six months was a totally inadequate period in which to assess the suitability of a patient for independent community life. The writers of the letters also criticised Clause 26, and Clause 44, which refers to what the Minister calls the formative years.
I am not so anxious to stress the provisions of those Clauses which are causing some anxiety to superintendents of medical hospitals and mental deficiency hospitals. I am concerned about the arrangements which will have to be made, and which I take it this Bill is intended to provide, for the reception of patients who will be discharged to civil life when they come under the authority of the local authority. This will put a massive amount of additional work on our local authorities.
In common with my hon. Friend the Member for Batley and Morley (Dr. Broughton), I welcome the statement by the Minister. I did not get his exact words, but I believe that it was to the effect that two committees were to be set up, one to provide proper clinical psychiatry and the other to advance knowledge of this subject.
§ Mr. Walker-Smith
Both the committees to which I referred in that context are within the ambit of the Medical Research Council. As the hon. Gentleman will recall, I was speaking in the context of research.
§ Mr. Wilkins
I am concerned about one or two other matters. This morning I received a newspaper from Lady Eileen Goodenough Taylor, who is deeply interested in mental health work. She invited me to look at the rather violent attack that she had made on the Bill, especially on the functions which the mental health committees of regional hospital boards would have to perform.
The first major concern which she expressed was how we were to provide sufficient consultant or psychiatric services to deal with patients released from mental institutions of various kinds to community life. In the article she points out, and I give this merely as an example, that in the south-west region 360 consultant posts are authorised but only 31 are filled. How are we to obtain these people who, I believe, will be extremely necessary to perform these duties which, I presume, will be conducted or authorised through local authorities? I imagine that by the Bill this duty will be imposed on local authorities. If I am right in that assumption, as far as this evidence goes the psychiatrists are not available.
Will the regional hospital boards be responsible for the administration of the provisions of the Bill? If so, to what extent? Will it remain their sole responsibility to see that the provisions of the Bill are carried out and that the services are provided under their jurisdiction by the local authorities? If that is to be the case, is the Minister satisfied that he has sufficient power? Has he taken sufficient power under the Bill to enable him to carry through the proposals he has placed before us? I ask those questions because the provisions of the Bill will impose a far heavier burden on the services of psychiatrists than has hitherto been the case.
This is a great reform and I am not being critical about it because I want 428 to see any really serious opposition to the Bill. It is a great reform for what it seeks to achieve, and as such we are bound to welcome it, but all the proposals in the Bill—and here I only re-emphasise what the hon. Member for Gosport and Fare-ham said—will be of no avail unless they can be carried into practical effect. I believe, therefore, that we have a right to express concern about whether the Minister is satisfied that he can provide the additional professional services which the Bill will impose on regional hospital boards and local authorities.
Secondly, is the Minister satisfied that the Bill gives him the necessary power to strengthen both mental health committees of regional hospital boards and the management committees of mental deficiency hospitals?
The South-West Regional Hospital Board comprises 29 members of whom only seven, I believe, serve on the management committees of mental hospitals, and only three serve on the mental health committee of the regional hospital board. At the head of this organisation there are four medical officers responsible for the administration of the board. According to the information contained in the report of this knowledgeable interview given by Lady Eileen Goodenough Taylor, none of the four officers is a psychiatrist.
Yet the same applies in my region as in the region referred to by my hon. Friend the Member for Batley and Morley. From 49 per cent. to 50 percent.—
§ Dr. Bennett
Does the hon. Gentleman mean to say that there is no regional psychiatrist for that region?
§ Mr. Wilkins
I could not say whether there is a psychiatrist in the region. I am saying that on the regional staff—I am quoting from the interview given by a member of the regional hospital board and not apparently contradicted by the head of the board—there is not a psychiatrist among the four medical representatives at the head of the administrative staff.
This is a matter of concern, because in common with other parts of the country mental health presents a serious problem in the South-West. I am speaking from memory, but I believe that there are over 17,000 mental hospital patients in the 429 South-West. I regret to say that that is among the highest totals for various areas of the whole country. It emphasises the extent of the problem and one can understand the concern of anyone who is interested in the situation in the South-West, as is Lady Eileen Goodenough Taylor.
Perhaps the Minister can tell us whether he considers that he is able to meet the requirements imposed on local authorities and upon mental institutions in general by the provisions of the Bill. I share the view of my hon. Friends that mental illness is the worst of all afflictions. Therefore, anything that we as Members of Parliament can do, or anything which may be achieved through the local authorities to help those so afflicted, should be done. I wish the Bill well. I hope that it will achieve all the objectives which it is designed to achieve, but I believe that in the provision of suitable staff, particularly psychiatric staff, the Minister has to face a serious problem. It would be interesting to know whether the right hon. and learned Gentleman can say how he will be able to satisfy the need for professional staff which will arise when the proposals in the Bill are put into effect.
§ 5.15 p.m.
§ Mr. T. L. Iremonger (Ilford, North)
I must apologise to the House and to my right hon. and learned Friend that pressing duties outside this Chamber made it impossible for me to be present in time to hear the Minister's opening speech. I make that apology in case there was anything in what, I understand, was the important statement he made which covers any of the points I wish to raise.
Many hon. Members spent a long time during the Committee stage discussing this Bill, and I want to add to the almost intolerable burden of praise and gratitude which has been heaped on my right hon. and learned Friend for the extremely helpful and comprehensive way in which he dealt with all our questions upstairs.
In taking leave of this Bill, I want to refer to one aspect of mental health which we have now defined and brought within the scope of the Bill, namely, the psychopath; and to emphasise that the present definition includes those of normal intelligence. This opens up the most tempting and most challenging of the opportunities presented to us by the Bill. We must hope not only that we 430 have got the definition right, but that we shall get the treatment right and that we shall handle these people in the proper way. They have been referred to by my hon. Friend the Member for Gosport and Fareham (Dr. Bennett), and he and his medical colleagues in this House have far more experience of this matter than I have. But in the consideration we have given to the Bill, I have come to think that this has been the most important aspect of the whole question.
The treatment of the psychopath is a comparatively new field of endeavour in medicine, even in psychological medicine. It deals with problems which go to the root and foundation of the human soul and personality. Although this is a comparatively new endeavour, the problem is, of course, ancient and eternal. It is that of the changeling and the waif. They were no different from those who, in these days, pathetically and fantastically refer to themselves as the "beat generation" and "rebels" and all that sort of thing. There seems to be one thing which all these people have in common, they are incapable of forming real, lasting and valid relationships with the rest of society.
It is tempting to guess at what may be the origin of their trouble, and I think that could we define the origin more satisfactorily we might be able to get nearer to the proper treatment of such people. Anyone who has considered this Bill seriously must have been led into the realms of speculation. Dr. Bowlby has offered an explanation relating to the formative influences on the human personality in early life, but I cannot help feeling that there is possibly something more beyond that. There are human beings who have developed an admirable personality and character but who have suffered from all the deprivations which the worst Bowlby type could possibly have experienced.
I suggest there is some immutable and indefinable factor in the human make-up and in the fibre of an individual about which we cannot do anything. But all the same, I think the evidence which Dr. Bowlby gives us of the difference in the development between two kids, I think it was—I am referring to nanny goat kids and not human kids—brought up in different relationships to their mother must make us feel that there is a great deal within the depths of family relationship 431 in the early stages which may go to the root of this matter. But that is all speculation and does not directly help us towards a conception of treatment.
Today, we are also tempted to consider that there is some hope of treatment. There has always been treatment. Primarily, it has been the responsibility of the mother and father and of the priest and, in the olden times, of the witch. There was always the witch who could cure the small boy's warts, and it may well be that the witch was dealing with a manifestation of a psychosomatic disease in the same sphere in which the psychiatrist operates today. This is by no means an entirely new problem, but today it is being tackled by the probing of psychiatrists into the human mind and the responsibility has been assumed by the community. The Third Reading debate on this Bill therefore provides an appropriate opportunity to consider the scope and to take stock of this responsibility, and I hope that the Committees to which I believe my right hon. and learned Friend has referred, and which he proposes to set up, will deal with some of these questions which occur to me and which ought to be asked.
In the first place, the size of the problem of the psychopath of normal intelligence is quite unknown. Psychopaths of this kind come into our notice, some through the courts and some through psychiatric clinics. We have no idea how widespread they are and how many there are in society. We have very little way of assessing their effects, which are bound to be serious. They are a poison in society and a curse to their friends and to themselves. The worst thing of all is the pitiful waste of human life and of human happiness that they represent.
We ought to try to clear our minds about what the objects are of the treatment that should be provided for the intelligent psychopath. I am afraid that our objects must be very modest. I do not think that we can hope to turn these people into Wednesday's children, "loving and giving ". I am not sure that one can believe that that is within the bounds of possibility, but at any rate it should be possible for many of them to be able to attain at least a marginal adjustment to society so that they can keep themselves and other people out of 432 trouble and have some shadow of happiness brought into their lives. For some, even that will not be possible.
We have to reconcile ourselves to the fact that for many of them there will eventually have to be a cruel adjustment to society through the processes of the law. That is something that we cannot hope entirely to eliminate. Even with the most hopeful case, I do not think that the medical profession can rightly hold out to society the prospect of carrying out, in the case of the intelligent psychopath, in which there are deep difficulties of personality, the kind of adjustment and cure which can be carried out in very much more serious mental conditions, which possibly require compulsory detention of a patient for some time, but after which, eventually, the patient can be returned to society restored to his normal self and personality.
We have hardly begun to make a beginning with the treatment of the intelligent psychopath. I have been down quite recently to the Social Rehabilitation Unit run by Dr. Maxwell Jones at Belmont Hospital. It was a fascinating experience, which I know many other hon. Members have shared. Those who have not been there really should go. It is an eye-opener. No one who has been there could possibly look at this problem in the same light again. It suggested to me quite a number of things about which this House should be continually alert when the Bill gets to the Statute Book and to which we should give our attention, so that progress is made in the field which the Bill opens up to us.
Firstly, for example, I hope that my right hon. and learned Friend can tell us whether the research contemplated in his statement will be directed towards this difficult matter of the intelligent psychopath. Secondly, we have to face the fact that in the Bill we are possibly making a regressive step in this regard, because this kind of patient is extremely difficult, and we have made it possible for hospitals to refuse to take him in. We have to consider where he is to go and what is to be done with him. This is an excellent opportunity for expanding a little upon the developments that have been made, especially at Belmont, and to suggest the settling up of small pilot experimental units for treating the intelligent psychopath. The units should be small and we should go very carefully, 433 because we do not want to get it wrong. I do not think we should do other than build upon the experience that has already been gained, and we are therefore limited in what we do by the experience and skill that is available. I hope that when the Bill comes into effect we shall see an extension of experimental units for dealing with these people.
Thirdly, the question of staff must be considered very carefully. These people do not need trained nursing staff because they need no physical therapies. I am not sure that one might not go right outside the field of medicine and use, with mutual benefit, student probation officers or prison officers who are under training, and social workers and people like that. They could get nothing but benefit from contact with the peculiar difficulties of adjustment of this kind of mind and could very well make a most useful contribution. Thus we should not make demands upon trained medical staff, of whom there are all too few.
These are some of the very great problems which we have hardly begun to shape up to, and which the Bill presents to us in a most challenging form. In taking leave of the Bill, I hope that my right hon. and learned Friend and the House will regard it in this aspect, as above all not an achievement but a challenge.
§ 5.26 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
Experience may well show that the hon. Member for Ilford, North (Mr. Iremonger) was right in selecting the problem of the psychopath as the aspect of the Bill on which he wished to concentrate in the Third Reading debate. He was far from optimistic about the opportunities of treating intelligent psychopaths, but perhaps not quite so pessimistic as the hon. Member for Gosport and Fare-ham (Dr. Bennett), in whose speech I detected a slight contradiction. Having said that we could do nothing for the psychopaths, the hon. Member proceeded to regret that we have limited compulsory powers to psychopaths under the age of 21, If we can do nothing for them, it is just as well that we shall have only a limited number under compulsory detention.
§ Dr. Bennett
If the hon. Gentleman had understood me aright, he would have 434 gathered that I said that we could do nothing for the psychopath over 25 under the provisions of the Bill. I do not think I was so nihilistic as to say that nothing could be done. That was not in my mind.
§ Mr. Robinson
I must apologise to the hon. Gentleman. I understood him to say there is nothing we can do within the provisions of the Bill in the way of treatment. I say, with the hon. Member for Ilford, North, that we must experiment in this field. We must make small units throughout the country for this type of patient.
The significant thing is that at last the nettle has been grasped. The Bill makes a great stride forward, in that it enables these patients to be placed for the first time in a category. Hitherto, we have been thinking and talking of psychopaths as a kind of spectrum of behaviour-disorders, the word meaning different things to different psychiatrists. Now, at any rate, we have a definition of a kind which will enable a certain amount of isolation and categorisation to take place. That will facilitate and for the first time make possible social and clinical research into these cases.
The hon. Member for Ilford. North apologised for adding to the "intolerable burden of praise" that had been meted out to the Minister. I am sure that the Minister will agree with me that no burden of praise is intolerable. Whether it is or not, I prefer to add my contribution to it. The Minister, in meeting the points that were put to him in Committee, has proved himself what is called in racing parlance a "fast finisher". In the early part of the Committee stage I had doubts as to whether he wished to amend the Bill at all. But the right hon. and learned Gentleman seemed to me to become more flexible as the Committee stage progressed, and yesterday on Report he met very nearly all the points on which he had promised to give consideration in Committee. I think the whole House will agree that the Bill is the better for his so doing. It was certainly a good Bill when originally introduced, but I think without question that it is a distinctly better one now.
I cannot agree with what the hon. Member for Hendon, South (Sir H. Lucas-Tooth) said about the public attitude towards the Bill. The significant 435 thing is that there has been so little complaint against the basic principles of the Bill which, as the Minister rightly says, remain unchanged. I do not know whether people are peculiarly timid in Hendon, but I have not met any member of the public who is fearful of the results of the Bill, of the liberalisation which we hope to bring about. I think that if there were any general feeling on the matter that feeling would have been reflected in the popular Press which is always ready to follow up attitudes of this kind and—I do not want to use the word "exploit"—at any rate, to reflect them. The Bill has really had a very good Press from every type of paper and journal.
§ Sir H. Lucas-Tooth
I hope that the hon. Member is right, but my experience has been gained from talking to people in railway trains casually, not in my constituency only, and it is contrary to his.
§ Mr. Robinson
As the hon. Gentleman says, we must wait and see.
Having said that about the Bill, I had a number of criticisms to make on Second Reading. Perhaps only one of them was a fundamental criticism and most of them have by now been met, some by Amendment, some by a promise of administrative action on the part of the Minister and some by a promise of regulations to be made at a later stage. We are all, I am sure, extremely pleased that the powers of the local authorities, which were permissive only, are to become mandatory by directions under the National Health Service Act.
I wish to raise one matter again which we have not discussed for some time. It is the question of the duty which the Minister said that he would place on regional hospital boards of providing accomodation within the regions for all compulsory patients which they were likely to have to treat. The Minister said in Committee that he was having discussions with the regional hospital boards about this matter. He said:For a little while we have been engaged in discussions with the regional hospital boards regarding the question of rearranging accommodation according to our new classifications. These discussions are not confined to this aspect of the psychopaths …."—[OFFICIAL REPORT, Standing Committee E,12th February, 1959; c. 60.]436 I would only mention that the regional hospital board of which I am a member is not aware of any such discussions. There may be a slight misunderstanding here, but I suggest that it is very important and urgent that we should get this reclassification of hospitals done and these plans for the future laid now and not wait until the Bill receives the Royal Assent.
This, I suppose, is the occasion on which we must make our valedictions to the Board of Control, that body which has come in for a great deal of criticism in the past, much of it I think ill-founded; but apparently it is also a body which nothing becomes more than its departure because ever since its departure was announced no one has said anything but words of praise about it. For my part, I believe that the officers of the Board have made a very great contribution to the mental health services.
I would only mention once again that I think that all of us who are in any way connected with this work will regret the disappearance of those regular visits and reports which the Commissioners of the Board of Control used to carry out in respect of the mental and mental deficiency hospitals. I hope that whatever takes place in substitution, we shall still get the opportunity of a common yardstick being applied to these hospitals and that we shall also have what I think the Minister himself has called the cross-fertilisation of ideas between hospital and hospital and region and region.
I have said that most of my criticisms have been met in the course of the various stages of the Bill, but one has not and that one, I think, now remains the most serious blot on the Bill. It is that there are written into the Bill the powers of censorship, of interfering with the incoming and outgoing correspondence of both compulsory and informal patients. The Minister did not answer any of the points that I made about the administrative difficulties of censorship. I do not wish to repeat all over again the arguments which I have adduced on this subject before, but I would merely mention that it is quite impossible for any kind of censorship in mental hospitals as run today to be effective.
I submit that a censorship which is not effective is not worth having. Anyone can evade any kind of censorship imposed 437 in a hospital. The objects which the withholding of mail is designed to achieve are very worthy objects. It is designed to save people from distress and also to save the patient from harming himself. But, in fact, these permissive powers are only going to be used in a small minority of hospitals. I am fairly confident in, saying that in most mental hospitals today there is no censorship at all. Perhaps in the majority of mental deficiency hospitals there may be a censorship. But, in fact, we have written into the Bill what I still regard as illiberal provisions, although, I agree, from the best of motives, which are not going to be used by the majority of hospitals. Where they are used they can never be effective in achieving the objects which they are meant to achieve. They would really be better out of the Bill.
I have not had the support of my right hon. Friend the Member for Warrington (Dr. Summerskill) on the main question of censorship, but I did on the question of the correspondence of informal patients, a matter which we discussed yesterday. That question, I think, is especially deplorable because I agree with what was said by my hon. Friend the Member for Norwich, North (Mr. J. Paton) yesterday, that the knowledge that patients are going to have their letters read is inevitably going to deter some people from accepting voluntary treatment.
Another matter which I mentioned on Second Reading was that of the orders restricting discharge. Here a very considerable improvement has been made, and I certainly ought not to omit the Joint Under-Secretary of State for the Home Department from the tributes which have been paid to the Government Front Bench. By allowing patients access to the Mental Health Tribunal their position, I think, will be greatly improved compared with what was envisaged in the original Bill. But I have some misgivings still about their position, and I hope that in another place further consideration can be given to Clauses 65 and 66 of the Bill.
I want to say a word or two about the review tribunals. Again I think that they are in better shape than they were on Second Reading. We shell want to scrutinise very closely the rules of the tribunals when made by the Lord Chancellor and laid on the Table. I think that we all want to see the appointment to 438 these tribunals of people who have the highest qualifications for the job because an enormous proportion of the success which the Bill is or is not going to have will depend on the efficiency, and, indeed, on the humanity, of these review tribunals.
I was extremely pleased to hear that the Minister has decided to set up a working party to look into the rules of the special hospitals. So far as I am concerned, a working party is just as good as a Departmental committee, and it may he, I agree, a slightly more flexible instrument. I did not quite understand, when he was making the announcement, precisely what hospitals it would cover. I rather gathered that it would cover something more than the three special hospitals. Perhaps the Minister can say now, or the Parliamentary Secretary can say in winding up the debate, if that is so.
§ Mr. Walker-Smith
The working party as such will inquire into the three special hospitals, but, as part of the study will be into the classification of patients who will be received into them, that necessarily will have some consequential repercussions on hospitals as a whole. That is what I meant.
§ Mr. Robinson
I am obliged to the right hon. and learned Gentleman and I think that is quite satisfactory.
Like my hon. Friends and hon. Members opposite, I am very glad indeed to see this belated repentance on the part of the Medical Research Council. On many occasions I have criticised it for its neglect of psychiatric research. It has been showing considerable signs of improvement of late, and I think the announcement made by the Minister today is probably the most significant advance we have seen in this direction. The two committees to be set up will at any rate lift the status of psychiatry within the Medical Research Council. Possibly the day may even come when we shall see two psychiatrists rather than one among the members of the Council itself.
Finally, I echo what has been said—now probably almost ad nauseam—in the course of debates on the Bill, that when it becomes an Act it will not, of itself, achieve the treatment of a single patient. But it is an opportunity, a chance, for a great stride forward. Whether that stride is taken depends almost entirely 439 on the resources which are placed behind the Bill, resources not only of money—although a great deal of money will be needed both for hospital and local health authorities but opportunities for training of psychiatric social workers, mental welfare workers and psychiatrists who will be needed in considerably larger quantities than are available at the moment.
If this Government or succeeding Governments are prepared to devote the proper share of the nation's resources to this very great human problem, I think the debates on this Bill will have been one of the most significant landmarks in our history of social reform.
§ 5.43 p.m.
§ Mr. Peter Remnant (Wokingham)
I want very briefly to touch on one point in welcoming the decision of my right hon. and learned Friend to appoint a working party. I think we all agree that the terms of reference should not be wide enough to include the normal machinery as to terms of service, but, on the other hand, there are certain aspects which are causing, say, the Prison Officers Association a great deal of anxiety and which border on the terms of service. I hope the terms of reference can be drawn in such a way that the working party will not be debarred from considering that part of the terms of service.
The particular one I am thinking of is the rent to be charged for houses within the area of a special hospital. That obviously touches on the question of safety. To those who live in those houses, if they are to be charged an economic rent no account is being taken of the hardship which must follow from having to get out at the end of their term of service. If the working party could come to a decision that a certain number should live in for the purpose of safety, the rent to be charged might well be left as part of the process of negotiation.
I add my praise of the Bill and my thanks, not having been on the Committee, to all who have contributed in all its stages to making it the Bill which it is at the moment.
§ 5.45 p.m.
§ Mr. Christopher Mayhew (Woolwich, East)
The debate has produced a large number of tributes to the Minister and 440 to the work of the Committee. My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), in his typically sane contribution, drew attention to the value of the improvements which have been made. As an outsider who was unable to take part in the work of the Committee, what strikes me more than the improvements made in the Bill is the way in which the original conception was so well balanced and well designed that it has survived almost unaltered until the present stage. That is something for which the Minister can take credit just as much as for any changes that have been made in Committee. It was a good Bill, acceptable to both sides of the House, and for that reason it has survived fundamentally unchanged to the present time.
I feel at this stage a great relief that at last we shall be getting out of the constantly repeated consideration of this problem of mental health in its legal aspect. The hon. Member for Hendon, South (Sir H. Lucas-Tooth) spoke very interestingly about the public's attitude to the Bill. My hon. Friend rather disagreed with him about it. I cannot help feeling that the whole aspect of the public relations side of mental health will benefit when we can put behind us all this consideration of compulsion, detention and censorship and legal questions of that kind and get on to the more positive aspects of tackling this great problem to which reference has been made in the speeches this afternoon.
There has been a general feeling in the debate, as there was on Second Reading, that this Bill in itself achieves little, but what comes after the Bill is what really matters to the real welfare of mental patients and the mentally sick. As someone once said in relation to some other aspect of public policy, we should regard this Bill as a springboard and not as a sofa. What the Minister does when the Bill has gone through all stages is what really matters.
On the whole, I am not discouraged by what the Minister has done outside the Bill since Second Reading. He explained what he had done in relation to making mandatory obligations on local authorities. I followed what he said this afternoon because this was something I and others raised particularly on Second Reading. I read the speech he made on the subject in the Standing Committee, 441 but I am bound to say it did not have his usual lucidity. I could not understand a word of it. Nevertheless, I found it reassuring because my hon. and right hon. Friends who sat through the speech and had the benefit of the presence of the Minister themselves found it reassuring. His conception of the terms is, of course, absolutely vital to the whole concept of the Bill.
Throughout the whole field, now is the time for starting big advances. All of us will agree that great advances have been made over the last few months in conditions in mental hospitals. Within the limitations set, hospital management committees have been doing extremely well, but there are still such problems as that of the overcrowding in mental hospitals. There must be thousands of patients who would willinely trade whole Clauses of the Bill for just a little more space between their beds and the beds next to them and for a little more individual attention from a doctor, a nurse, or a psychiatric social worker. It is this very aspect of the matter that we must now get on with.
I have not studied the new Young-husband Report, but this is the kind of thing about which the Minister must get very busy very soon. The references to the lack of staff to man the structure that is being built in this Bill are quite disturbing. I read, for instance:There is still a large unfulfilled demand for social workers in the Mental Health Service. Psychiatric social workers are still a mere handful in relation to the demand (though the local authority situation has improved slightly) and there is still no training for other mental health workers. This is all the more serious in that scope of the services, and the needs to be met, have grown as the Committee foresaw.Or again:… we cannot but deplore the time lost in the years since the Mackintosh Committee stressed the urgency of the situation. Even a series of modest experimental courses in the last few years would have helped newly recruited duly authorised officers and mental welfare officers to undertake the difficult and important work which awaited them, and would also have produced a useful body of experience on which to base recommendations for training.This is the kind of thing which we must really get on to now. This also applies to the whole sphere of research. We are all agreed that if we can make progress here it will be worth the progress made 442 in every other field. We were all very glad to hear what the Minister announced this afternoon, but research can be absolutely undermined by a lack of staff, a lack of talent and trained people. This, again, is going to be a tremendous difficulty in fulfilling the aims of this Bill.
It seems to me that the vital overall need today is to tempt young men and women to enter psychiatry and the mental health service far more than they have been doing so far. As other speakers have said, it is surely one of the most worth-while and exciting professions to enter. The problem is immense. We were told that about 50 per cent, of patients in hospitals suffer from mental illness, but, since the Second Reading of this Bill, a more striking figure than any other has been published by the Chief Medical Statistician, that 2 million persons every year visit their doctors for psychological illness, quite apart from those who are patients in hospitals. The size of the problem, it seems to me, is out of all proportion to the tiny number of people who are actually engaged in trying to tackle it.
I should have thought that for young men and women there could not be a better training than in this field, or one in which they would have a better chance of reaching the top of the profession, or a field of activity the status of which was increasing and improving more rapidly, or in which there was greater scope for the relief of human suffering. The whole development in this field is going to be immensely exciting in the years ahead. Exploring space will be a pedestrian affair compared with the interest in exploring the human mind with the new techniques which are now available to us. In terms of human welfare, this advance will be most beneficial and will have the most important impact on many parts of our national life, such as the prevention of crime and many other things.
All this needs a new outlook, a new system of priorities—and we are beginning to get it and more interest among the public, the medical profession, the ratepayers themselves—a vital element in all these calculations—and inside all the political parties without exception. If we get this, the chances are that we will make the same progress in mental health in the second half of this century as we made in physical health in the first half, 443 and, from every possible point of view, one cannot possibly exaggerate its importance. This Bill, and the spirit in which it has passed this House of Commons, seems to me to give us some reason for hoping that this immense target may possibly be achieved.
§ 5.55 p.m.
§ Mr. John Hynd (Sheffield, Attercliffe)
I do not propose to occupy the time of the House for very long, but as one non-expert in this field who had the privilege of serving on the Standing Committee, in the proceedings of which I was able to make some small contribution to the Bill, I should like to say how much I welcome the efforts which the Bill represents, and to add my little tribute to the way in which the Minister handled the Bill in Committee. Although it is true that he did not accept many Amendments, he did go a long way towards meeting our point of view as expressed in our Amendments on many important topics.
As has been said by many other hon. Members on both sides of the House, however, there is one part of the Bill which is not so reassuring and on which most hesitation has come. That is Clause 149, which provides that the Bill shall come into operation, with certain small exceptions, on a date which the Minister shall appoint. We have in the past had experience of Bills that have become Acts of Parliament which have taken many months or even years to implement, and which, indeed, have sometimes not been implemented for very many years. They were acts of faith, declarations of principle, machinery that was laid down, but nothing was done in the long run to implement them, sometimes for quite understandable reasons. I have in mind such things as the school-leaving age of fifteen, which, because of the shortage of schools, of teachers and other problems which have arisen, has not yet been fully implemented. This is the one reservation which many of us feel in welcoming the Third Reading of this Bill.
Having made that declaration about what we are going to do and having, as was very marked in the Committee, shown a very remarkable new attitude towards this problem of mental illness—because it was a feature of the Committee that, while trying to achieve within 444 the limits possible within society protection from the more violent expressions of mental illness on occasions, the whole concern of each member of the Committee was that the maximum protection should be provided for the human and civic rights of the patients who are unfortunately afflicted, temporarily or otherwise, by this mental illness—the great question is how determined are the Minister and the Government to proceed with the implementation of the provisions of the Bill. How soon, and to what extent, are we to expect that pressure will be put by the Minister and by his other colleagues in the Government on the Treasury to provide the maximum that can be made available in the shortest possible time to ensure that these provisions are carried out?
Surely, one of the greatest disservices which we could do to the mentally ill and those people associated with the mentally ill, for they have to be considered, is that while we pass this Bill and make it an Act of Parliament, describe the promises made to them, the new conditions under which these people are to be treated and the new civic rights which they are to have, their protection and all the rest, we should then disillusion and frustrate them by not giving effect to it except for a little patchwork job here and there.
Therefore, before we take leave of the Bill, I hope that the Minister will give some fairly firm assurance about the speed and the effectiveness with which it will be put into operation. Like some of my hon. Friends, even full implementation will still leave me with some doubts and hesitations as to whether we have adequately met our obligations to the individual patients. Over and over again we have questioned the new method by which the whole responsibility for confining mental patients in institutions or hospitals is to be placed on the shoulders of doctors, and the effect that that may have on doctor-patient confidence. On such things we can learn by experience, if and when the Act, as it will be, comes into operation, but we shall not get that experience until the Measure is operative.
Earlier today the Minister said that in his view the Bill did good to many and harmed none, but a little harm is being done to some individuals, and I call attention to this in the hope that the right hon. and learned Gentleman 445 can do something about it. I refer now to the gentlemen who are at present employed under the provisions of the old Lunacy Act as clerks to the visitors. Some have been appointed on a yearly basis and some on a part-time basis, being paid an emolument for their duties. In all I think that there are only ten of them.
Most of them, as I say, are appointed yearly, but one was appointed in 1938 on a permanent basis as a part-time visitors' clerk. He has devoted part, at least, of his time as a practising solicitor and as a part-time justices' clerk to this duty, for which he has been paid £500 a year. As a result of the Bill, that appointment and that payment will come to an end. Representations have been made to the Minister on this gentleman's behalf, but I believe that the right hon. and learned Gentleman has been unable to agree to make any concession.
I ask him to reconsider that decision. I believe that he has said that there are difficulties created by precedents in the National Health (Transfer of Officers and Compensation) Regulations and the National Insurance (Compensation) Regulations, There it is laid down that compensation in similar cases shall not be paid, but there is the more recent precedent of the Justices of the Peace Act, 1949, which provided for compensation to be paid for loss of emoluments by part-time justices' clerks. It may be argued that in the case of the annual appointments, the compensation would be quite a small amount, since the appointment technically would terminate in any case at the expiry of the current year's appointment, but the individual to whom I have referred, who was appointed on a permanent basis, will lose a considerable part of his income as the result of the passage of this Bill. There is no question of moving any Amendment—I do not know whether such an Amendment would have been in order at any stage, but in this Third Reading debate when we are dealing with the repercussions of the Bill, I ask the Minister to give further consideration to this case to see whether it is not justifiable and desirable that some recognition should be made of this one permanent official's services.
§ 6.4 p.m.
§ Mr. Richard Fort (Clitheroe)
I had much sympathy with what the hon. Mem- 446 ber for Batley and Morley (Dr. Broughton) had to say about the powers provided in Clauses 25 and 26 to keep people in institutions only on the certificate of two doctors, and without a magistrate, representing the general public, having any part in the decision. I know from my professional friends who have to deal with mental health what a severe strain that decision puts on them. We have made our decision but, as my hon. Friend the Member for Hendon, South (Sir H. Lucas-Tooth) has said, if, in a few years' time, we have amending legislation I shall not be greatly surprised if we do not have to look at these Clauses again.
I welcome the statement made by my right hon. and learned Friend the Minister of Health about the programme that the Medical Research Council has mapped out for helping to achieve the purposes of the Bill. That carries on the tradition to which I referred in my Second Reading speech, but it is undoubtedly an expansion of it, and I was glad to hear my right hon. and learned Friend's statement made in a form that will reach the ears of all concerned with mental health research.
If we are to implement the Bill we want more knowledge. As was pointed out by the right hon. Lady the Member for Warrington (Dr. Summerskill) and by the hon. Member for Bristol. South (Mr. Wilkins), although the Bill is based on the best thought of those who study mental health, its provisions may well arouse some anxiety in those who have not that advantage.
Those anxieties can be removed in two ways. One, as the right hon. Lady said, is for all of us who are concerned with mental health to explain the provisions of the Bill, and the hopes and expectations of those working in the mental health field. Secondly, we must have more people working in it. To make the Bill work properly it is very necessary to educate more psychiatrists, and to give psychiatric training to more doctors and psychiatric social workers. That is very necessary for the follow-up work.
Therefore, while we now welcome the Bill as a change for the better, we must make sure that the enthusiasm displayed in the last three or four years since the Royal Commission began its work does not pass away. Undoubtedly, in the future, as we have had in the past. we 447 shall have medical setbacks. We shall not make the progress, that we now hope for, and for this and for other reasons we may find that enthusiasm dying away.
We can make progress in helping the lot of the mentally sick only by making sure that research goes on, and that adequate numbers of those who can apply the research are trained, and we can gradually educate the public at large to understand the aims of the Bill. If we can do that, we shall have made progress. If not, we shall have missed a great opportunity.
§ 6.9 p.m.
§ Mr. B. T. Parkin (Paddington, North)
This is not the kind of debate in which one expects to answer arguments put by a previous speaker. In this case, I entirely agree with what the hon. Member for Clitheroe (Mr. Fort) has said; particularly with his remarks about the desirability of keeping going the momentum of pubic interest, public support and public enthusiasm for this development.
Like everyone else, I congratulate the Minister on the courage and energy with which he has seized his opportunity to make this massive addition to the structure of the Welfare State. Not only does the Bill, with its good timing and content, endeavour to interpret in legislative and administrative form the balance of scientific opinion at present; not only does it give encouragement to all those engaged in the medical profession who are experts on the subject, but in a far wider sphere it will give encouragement to social workers, schoolmasters, religious leaders and all those who have felt that there was something missing in the structure of the Welfare State. some point at which one had to drop a case or problem in despair, some feeling that it is the last resort when it gets into the hands of psychiatrists or mental hospitals.
I think that public opinion is level with the leaders of thought in this matter at present. Public opinion is ready to accept the Bill. Indeed, public opinion has moved very fast in the last few years towards accepting that there is equality of opportunity between the problems of mental health and physical health.
I look forward to the stage when more people are ready to seek help early and to boast that they have been cured instead 448 of mental illness being, as it has been in the past, a dirty secret which might affect a man's relations with his employers or his fellows if it became known that he had ever been in a mental hospital. I look forward to the stage when a person who has been mentally ill will be able to say to someone in the early stages of mental illness, "If I were you, I would go and get help. It is good. I did it and I was all the better for it." That is the climate of public opinion which one wants to see developed.
This brings me to the point which led me to intervene at a late stage in this discussion, although I did not have the privilege of being on the Standing Committee. We have now reached a stage when the mental health service will be on equal terms with the rest of the social services. It leads us to the problem of co-ordinating welfare work between one social service and another. I am sure that every one of us, in our own amateur advice bureaux, must have had so many cases where there has been an element of mental disorder which, if treated earlier, might have saved a situation and, in some cases, saved a life.
I have quoted before the case of an old man who was evicted from his house after a court order. When I took the matter up with the Ministry of Health, I received a rather tart little reply from the hon. Lady who is now Joint Under-Secretary of State for the Home Department saying that the first that the Ministry of Health knew about the case was that the man was found crying in the gutter. That is perfectly true from a Departmental point of view, but in these days of the Welfare State no man of 80 ought to be crying in the gutter because he has just been thrown out by bailiffs. Of course he was out of his mind. Of course he was certified. When he stopped crying, he climbed over the wall and escaped. He slept rough in the park for a fortnight, which is a very good effort for a man over 80. He lived to fight his case again.
I have had even sadder cases. I have had two cases of suicide in the last twelve months, I am very sorry to say, where constituents of mine have committed suicide while their cases were being investigated—and being investigated by the wrong Department. A lady sent me a telegram to the House of Commons, saying, "Come at once. I cannot get out 449 of bed ". If I had walked out of Parliament and gone to see her, although I knew about her case fairly well, perhaps she might not have committed suicide a fortnight later. She was obsessed with the idea that she had to have a particular kind of surgical boot, so it was the surgical boot department which was making lengthy inquiries when the case was, after all, an entirely hysterical case.
A few weeks ago I read with horror that a man younger than myself, who had come to see me because he was worried that he had not got work and whose case I had referred to the Ministry of Labour, had committed suicide. The coroner returned a verdict of temporary unbalance. It is true that the man looked a difficult case. He looked flabby, florid and weak, but he did not deserve to be misunderstood to that extent. If only we had been able to see this earlier and if only there had been some kind of co-ordination, catastrophes of this kind could be prevented.
I can give other examples. I can quote the example of the rascal who has lost 30 jobs in the last couple of years and has now reached the stage when he is so dirty and unshaven that he cannot be submitted for any vacancies and the National Assistance Board force him to take a rehabilitation course. I say "rascal". I do not know whether anything could have been done, or whether this state of affairs could have been stopped earlier.
I submitted another case to the Minister's Department a few weeks ago, of one of my constituents who is developing a capacity for suffering industrial injuries. He managed to quarrel with a vacuum cleaner on the steps of a cathedral and put in a claim for compensation for industrial injuries benefit. He wrote to me and said that he was employed at a hospital and had cut the end of his index finger with a surgical knife. He asked why he could not be granted industrial injuries benefit. I sent the case to the Minister of Health and said that this man was "going crackers". I received the usual printed postcard saying that it appeared to be a matter for the Ministry of Pensions and National Insurance.
From the Ministry I received a three-page letter saying that the most careful consideration had been given to the case and that, on balance, it was thought that 450 the man was entitled to two-and-a-half days' industrial injuries benefit. I ask hon. Members to consider the cost of such a case. We shall have an expensive case on our hands if we do not have the proper kind of co-ordination between the different welfare services.
It would be unfair to inflict a wholly new subject on the Minister tonight, but he may be ready. I expect that he will soon be telling us about the Report of the Working Party on Social Workers in the Local Authority Health and Welfare Services, which was issued a few days ago. I would not ask him to spend much time speaking on this if it will spoil any statement which he will make later.
§ Mr. Parkin
With respect, Mr. Speaker, I was going on to say that there is a good deal in this recently issued Report which is very strictly relevant to the mental welfare officers whose activities form part of the subject matter of the Bill. There are a number of references to mental welfare officers in this Report. With respect, Mr. Speaker, I submit that it is an important matter. I merely say that I would not wish the Minister to reply "off the cuff" at great length. not because the matter is out of order. but because it would be unfair on the Minister.
§ Mr. Speaker
The House is now on Third Reading of the Bill. On Second Reading, it would have been in order to introduce related matters, but, as the hon. Member knows, the rule on Third Reading is that what is said must relate to something in the Bill—either that the Bill is, for some reason, a good Bill, or that the Bill is a bad Bill for some reason.
§ Mr. Parkin
With respect, Mr. Speaker, it is a good Bill. It talks about the functions of local health authorities and of welfare authorities. Clause 8 deals with the function of welfare authorities and refers to the fact that some of these welfare authorities have the job of covering more than one branch of social work, in addition to mental health. It refers specifically to those who have to make arrangements for promoting the welfare of blind persons. It includes mentally disordered persons under the same heading.
451 It is highly relevant. Indeed the Report constantly refers to the Bill before Parliament. In dealing with the question of the training and appointment of mental welfare workers, the Report deals with the Bill as we see it now. If you will allow me, Mr. Speaker, I wish to refer very briefly to the point made in the Report that there has never been a recognised training or qualification for mental health social workers, who are included in the Bill, as distinct from psychiatric social workers.
The Report refers to the special problems of the mentally disordered among the blind, deaf and other handicapped persons and to the fact that another kind of handicap sometimes brings on mental disorder. Later, the Report points out that the way of life of a whole family may be affected by the permanent physical disablement or the onset of mental illness of one of its members and refers to the importance of dealing with the whole family.
It points out, for instance, that it is not sufficient to have a friendly chat with a crippled old lady if we do nothing about her daughter who is breaking under the strain of caring without remission for the old lady. This is another case where the social welfare worker dealing with the crippled old lady ought also to be urged to deal with the dangers of mental strain on the daughter.
The Report says that the existing combination of mental health and welfare functions under the National Assistance Act seems to indicate that this arrangement can work well in present circumstances, but it admits that the evidence shows no general agreement whether mental health functions are satisfactorily combined with welfare duties or whether they require a specialist officer. The Minister will have to make a decision on that point and to give a lead. He is faced with the fact, as the Report points out, that in 1956 there were 625 mental welfare officers employed whole-time in England, Wales and Scotland, but that an equal number of the other officers dealt with other welfare work at the same time.
The Minister has about half-and-half among his full-time welfare workers. He ought to study the position and to make the important decision whether this com- 452 bination of duties is a good thing in the general welfare service, helping to detect the onset of mental illness or disorder in its early stages, or whether it is a dangerous thing, because these cases demand expert diagnosis which the amateur cannot possibly make.
In the chapter of the Report on "Co-operation: co-ordination and team-work," the Committee drew its most encouraging conclusions from work done with children and very few conclusions from work done with the mentally sick. No doubt the Minister will wish to deal with the Report; certainly, he will have to deal with it in some respects administratively. I do not know how soon he will have an opportunity to talk to the House about it, but I hope that it will not be long delayed.
There is sometimes an assumption that we get better and better and more and more progressive as generations pass, but I am not sure that that has been so in mental health. The theological conception of the Middle Ages was perhaps better than some of the later conceptions. At any rate, in the theological conception it is not without significance that the word "silly" meant "holy". That was a good doctrine. Even during the later centuries, when the State became cynical and utilitarian about the matter, it was a doctrine which was always sustained by the family. The family has always been able to find a way to look after the weaker member. Sometimes it has involved much patience, and even heroism in cases of violence.
The Bill shows that the community is prepared to play this role. It will be a matter not only of help given by the service, but of encouragement given to the members of the family concerned, who will still have to bear the brunt of the work in the domiciliary treatment. That is where there will be the greatest encouragement.
§ 6.25 p.m.
§ Mr. Norman Dodds (Erith and Crayford)
Before the Bill leaves the House I want to repeat what I said on Second Reading—that is, that I welcome the Bill. It represents a very big step forward. It would be too much to expect of a Bill of this magnitude that every hon. Member on both sides of the House is satisfied with all its provisions. Indeed, it is possible that among the 453 advisers there are some disagreements about what should or should not be in it. Although I have some reservations and some fears, I welcome the Bill and congratulate all those responsible for introducing.
I have said some hard things about the Minister from time to time, and I have a feeling that I shall do so in the future if he lasts long enough, but I congratulate him on this occasion. I have been on many Standing Committee, but I feel that when I look back at the Committee on this Bill I shall regard it as one of the greatest experiences I have had in Parliament. I am amazed at the Minister's grasp of this complicated subject. He had not this grasp at the beginning of the Bill, hut he certainly has it now; his has been a remarkable performance.
I also congratulate the Parliamentary Secretary, who has been a splendid lieutenant. Whenever he has been asked to speak he has done so with courtesy and much patience. Neither the Minister nor the Parliamentary Secretary are so superhuman that they could have succeeded in this tremendous task without some wonderful advisers on this work. I also congratulate the Joint Under-Secretary of State for the Home Department, something which I do not often do in the House. I sympathise with him in having to reply to some of the complicated legal problems which were often put to him off the cuff". He can look back with pride at his work in Committee on the Bill.
In referring to what I regard as the greatest weakness of the Bill I am echoing the words of my hon. Friend the Member for Batley and Morley (Dr. Broughton), to whose experience and ability the Minister, when it suited his purpose, paid great tribute. I think that there can be no doubt that the greatest weakness of the Bill is in the simple fact that the liberty of the individual has been taken out of the hands of the civil authorities and has been lodged with the medical profession. My hon. Friend the Member for Batley and Morley and others mentioned that it could endanger relations between doctor and patient.
The sittings of the Standing Committee were remarkable. They showed how people with different political faiths could work together. Party politics were non-existent. Even when they disagreed, 454 all hon. Members were concerned with doing the best they could for the unfortunate people for whom we are legislating. It was a remarkable achievement. If Parliament were to be televised, that is the kind of occasion which I should like the people to see, showing how it is possible on such subjects as this for people to work together despite their party allegiances.
What astonishes me is the faith which we have in the mental health review tribunals. I have said previously that they are a wonderful piece of machinery which, I feel, will do a great job. One feature, however, has been missing from our debates. It seems to me that there has been a lack of knowledge of the experiences of patients. We know that even if they have been mental patients for only a matter of weeks, patients can seek the aid of the tribunal. Once a person has been certified he can have his case considered by the tribunal in a reasonably short time.
The essential feature, however, is that these people will have been certified. We know very well from experience that it is immaterial whether the period of certification was a week, a month, a year or even longer. The very act of certification is enough to prevent people from getting a job subsequently. Recently, I saw in a prominent national newspaper a reply to one of its leading articles. It was headed, "Cured mental case. Misery of being publicly branded."
The letter began:In your leader column you posed the question: ' Why do not men and women preserve their mental health? Why, when they have apparently been cured, do they so often return to hospitals?' Some of us who have suffered from mental sickness can provide an answer in part.The letter went on to explain the feelings of a patient who had been certified and ended by saying:… the main tragedy comes when, released from hospital as cured, and faced with the immediate necessity of obtaining employment in order to live, one encountered the full force of the public reaction to the stigma ' of mental illness.I should have liked some similar provision to that of the mental health review tribunal before reaching that stage of certification. Now the matter is in the hands of the medical profession alone. This is a great weakness in the Bill from the point of view of the liberty of the individual. and also because of the harm that it may 455 do to the relationship between patient and doctor. From reading past debates I have noticed the great store that has been set on justices of the peace and the Board of Control, and I fear that in the future grave injustice will be done because we have eliminated the civil authorities from the case. I feel that we could have done something better in this respect. Never-theless, the Minister and his advisers have considered the point, and, therefore, we must make the best of it.
I should like to draw attention to the contrast between the treatment of law-abiding citizens who are said to suffer from mental illness and criminals who are deemed to suffer from mental illness. As the Minister knows, medical testimony can be demanded by and given to the criminal and he can contest it. He can have medical and legal representation. All that can be done before he is certified as suffering from mental illness.
I appreciate that much of this safeguard will apply when the mental health review tribunals are set up, but my paint is that it will then be too late. It may save people from a long stay in a mental hospital, but it will not prevent them from getting the stigma which makes it so difficult for them to return to the community and remain there. Because of this many people who have been discharged as cared have been forced back into mental hospitals owing to the difficulty of getting work outside.
I appreciate that our deliberations have had a considerable effect on the public mind. There is a new approach to this subject by the general public. I have met many who want to help these people obtain employment. But the only way in which they can get employment and keep it is by getting a helping hand from an influential, kindly disposed person. If they try to get work on their own, too often they are driven back into the mental hospital.
A good deal of Clause 136 is devoted to the disposal of money, the property of patients, perhaps pensions of mentally disordered patients. As I said in Committee, there are in the Bill many ideas about what should be done with patients' money, but there is nothing in the Bill which states that it should be paid into an account so that when a patient is discharged he will have some money which 456 is so vital during the rehabilitation period. More attention must be paid to that point if we are to get the full benefit of this Bill.
In the part of the Bill dealing with those discharged at the age of 25, it is provided that should patients be deemed to be dangerous to themselves or to others, or should they, if discharged, be likely to be the victims of serious exploitation by others, they can be prevented from obtaining their liberty. They can be detained in hospital. I wish to put a point which the Minister did not answer in Committee. While I agree that patients must be protected from people who would seriously exploit them outside the hospital, I should like to know what the Minister intends to do to prevent them from being seriously exploited in the mental hospitals.
As the right hon. and learned Gentleman knows, I have raised the case of patients who are working 30 hours a week for up to two ounces of tobacco. We should make better use of our welfare officers and we should do something to clear up this out-of-date practice. It was the Parliamentary Secretary who said that the giving of tobacco is an old-established practice, which, apparently, is the justification for giving tobacco instead of money.
I ask the Minister to look into this problem of those who are doing useful work in hospital. There are many thousands who would be out of hospital but for the fact that they have nowhere to go. The system of therapeutic treatment is not operating satisfactorily. As was explained in the Kathleen Rutty case, there are 3,000 people still in hospital who would be discharged but for this fact. No doubt, the hon. Baronet the Member for Hendon, South (Sir H. Lucas-Tooth) will recall sending me a letter stating that as a result of a census it was known that many people were in hospital who would be out but for the fact that they have nowhere to go. He added that this state of affairs was continuing.
While we are not satisfied that local authorities always have the wherewithal to follow up the good work done in the mental hospitals, I ask the Minister to ensure that when patients have to face the world they at least have some money of their own as a result of working in the 457 hospitals. It is false economy to send them out without any money. Many of them are sent back because they are not able to maintain themselves for two or three weeks except by going to the National Assistance Board—and we know how much time elapses before assistance is given in such cases.
As I said, this is a good Bill. Hon. Members who have worked in the Standing Committee have done their best to put on to the Statute Book a Measure which they believe is important for the welfare of the mentally afflicted. But it is not merely the words in the Statute which matter. What also matters is the way in which they are carried out by others. I fear that for many of the things which we say shall be done we have not given those who will be concerned with them the tools for the job. Fine words will not solve this immense problem. The local authorities must have the money to carry out their functions.
I hope and believe that all that has been said and done will be transmuted into human happiness where there would otherwise be misery. My final word is this: the price of liberty is eternal vigilance.
§ 6.40 p.m.
§ Mrs. E. M. Braddock (Liverpool, Exchange)
About six years ago I was asked to be a member of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency. During its discussions the Royal Commission took the view that it had to do something in advance of public opinion, and it adopted a very advanced line of thought.
I hardly thought, when I was asked to be a member of the Royal Commission and thereafter attended very many meetings of it and helped to draw up its Report, that I should on this occasion he able to congratulate the Minister on carrying out practically every recommendation it made. My experience in reading about Royal Commissions had led me to believe that they were set up in order to prevent things being done for a very long time. I confess that I accepted membership of the Royal Commission with a little trepidation on that score.
The Bill is here, and I join with all right hon. and hon. Members who have congratulated the Minister upon it. I thank him and I thank his staff. Also, 458 I thank the staff which was responsible to the Royal Commission. Without the excellent staff and the excellent secretary we had, I am certain that the Report of the Royal Commission would not have been as broad and as completely conclusive as it actually was. My only sorrow is that the Chairman of the Royal Commission has not lived to see this great alteration in the law which he envisaged on its way to the Statute Book.
I very much welcome the Bill. If I may, I should like to make one or two comments about what I regard as the most important parts of it. The first feature I wish to mention is the provision which means that no longer will old people who have given great service to the country and brought up families, but who have come to the point of needing assistance from a hospital, have to be certified by legal process in order that they may obtain a hospital bed. One of the first things I said at, I think, the first meeting of the Royal Commission was that I wanted to see the certification of old people go altogether. Some provision, I felt, should be made for their care in hospital without their being labelled lunatics under the present law.
Secondly, I wish to remark upon the completely new approach to mental deficiency. Lady Adrian was very strict indeed in her approach and insisted that there should be a reference in the Report to training and occupation. She insisted that it was most necessary that there should be some provision in any new Statute which would require the training of mental defectives. It should be possible to find out what they could do—almost everybody can do something—and they should be trained to do what they could do best so that their minds would be occupied. Otherwise, they would be merely retained in institutions, sitting about, being entertained or entertaining themselves as best they could. The fact that there are in the Bill some very strong provisions about training and occupation must be a source of great gratification to Lady Adrian and others of us who insisted that there should be something of that sort in any new Measure.
Thirdly, I wish to refer to the subject of cash, so much a week for those who need to be detained in mental deficiency 459 institutions or mental hospitals but who have no income whatever. Many people who go in and stay for some time have their sickness pay if they have been employed, but there are, on the other hand, many thousands in mental hospitals and institutions who have no income at all. They were admitted before they could work, and they are still there. They are now to receive something through the Ministry of Health, not through the National Assistance Board, exactly as aged people in aged persons' hospitals receive 10s. This is something which should be recorded on this occasion and on which we must congratulate the Minister. However mentally deficient or ill people are, they need some extras. It has been one of the blots on our mental deficiency institutions and hospitals that patients have always been dependent on people coming in from voluntary organisations or on their relatives for buying the little extra necessities of life.
I particularly pinpoint those three features in the Bill. There are many others. I do not want to go into them because they will be known throughout the country when the Bill becomes an Act and when it is necessary for the various service authorities to pay attention to them and to put the new procedures into operation.
My hon. Friend the Member for Batley and Morley (Dr. Broughton) and my hon. Friend the Member for Erith and Cray-ford (Mr. Dodds) spoke about justices of the peace and their insistence throughout all stages of the Bill that, somehow or other, the justice of the peace should come in. It is because so much has proved to be wrong in the past that a drastic alteration was necessary. It was the law and the justice of the peace coming into it which gave the present certification procedure the character which my hon. Friend the Member for Erith and Crayford so much deplores. There needed to be a completely new approach to the matter.
If a doctor at any time has the right to discharge a patient, surely he must have the right to admit a patient for treatment for mental illness. The right of discharge is always there, and because the right of discharge is there, there must also be the right to accept for admission. At any rate, if there happen to be any 460 difficulties in the matter, a Bill of this sort, which makes a very great change, as everyone knows, can be subject to further consideration. Whenever things are being done, there is always the possibility of mistakes. It is when nothing is done that there can be no mistakes.
§ Mrs. Braddock
The Royal Commission made five different suggestions for five different procedures of appeal. We realised that, if the legal responsibility of certification was to be taken away, something had to be put in its place in order that the liberty of the subject could be safeguarded.
There are four different provisions for appeal in the Bill. There is the medical superintendent, who will act not on his own opinion but on the advice of those who are looking after the patient. The Bill says quite definitely that the medical superintendent may say that a person shall not be discharged. Then the management committee can have something to say about it. If the management committee, after asking for all the reports, agrees and upholds the decision of the medical superintendent, there is recourse to the review tribunal. If the tribunal upholds the decision or suggestion of the medical superintendent, there is then something else in the Bill which everyone seems to have lost sight of. In the final analysis, the Minister is responsible on the Floor of the House of Commons for what happens. Four different ways of appeal and four different ways in which a case can be looked at have been put into the Bill in lieu of the signature of a justice of the peace who may not know anything about mental illness at all but who signs the document.
We had evidence before us, which made us agree to make the recommendations which we did, that there were specific justices of the peace in various parts of the country who were there to be called upon to sign documents for people to be certified and admitted to mental hospitals. It was because something different was needed that these recommendations were made.
461 In fact, this is a big change and I agree that it is in advance of public opinion. Matters of this kind must always be in advance of public opinion because they cannot be carried out every two or three years. The last Act of Parliament on this subject, although it was amended on various occasions, was the 1890 Act. That is more than sixty years ago. This Bill repeals all the old laws and provides a code for new legislation which will give an opportunity for advancement and improvement in the years to come. It is very easily capable of amendment and I believe that amendments may have to be made, but they must never be such that we go back to what we have decided has become a blot on the community, whereby someone, by means of a legal certificate, can say that a person is out of his mind or needs treatment for mental illness.
The Bill will bring very great changes. It cannot be put into operation at once. There is not the staff available to do that because the Bill is very far-reaching and tries to express what will be needed in the years to come. In fact, all the things that are necessary will have to be obtained in order to meet the requirements of the Bill.
What will happen in the teaching hospitals? From information that I have been able to obtain from my own board of governors in Liverpool, very little is done in taking into teaching hospitals mentally ill people. It is in the teaching hospitals that the doctors are taught and where a very highly qualified nursing staff is recruited. There is a need in the teaching hospitals to train doctors to know a great deal about mental illness. The teaching hospitals have done very little in that direction so far. I believe that under the Bill the teaching hospitals will be required, where possible, to give this training, and I hope that this will be done in the new teaching hospitals that are being built.
Only last Friday I raised this matter with my board of governors in Liverpool on the proposition for the new teaching hospital in Liverpool. I asked whether consideration had been given to the new Mental Health Bill and the requirement for the provision of a ward for the treatment of mental illness. I believe that the building of this hospital will commence in 1962–63.
The whole approach to teaching and training will alter as a result of the Bill. 462 Some of the young doctors who eventually become general practitioners and who go into hospitals for training often do not see mental illness cases at all, or very few. The training of doctors includes very little psychiatric or mental illness training. All these things will have to be provided.
The nurses in the mental hospitals at the present time are almost tied to those hospitals. They will in future be able to have an interchange through the requirements of local authorities for the mental officers and staff which will be needed for the various services of the local authorities. I believe that this will give an extra push to the recruitment of nursing staffs in hospitals because under the Clauses of the Bill it will become necessary for almost every hospital to provide accommodation for dealing with mental illness. Therefore, nurses will be able to take some training in the nursing of the mentally ill.
Recently we were discussing the question of youth employment. I believe that we are opening up to the youth of this country, both men and women, an opportunity for training which will enable them to give a service and have security in employment if we make provision, when this Bill becomes an Act of Parliament, for the training that will be necessary. Arising from the Bill it may be necessary to give some preliminary education in the schools concerning mental illness and mental deficiency in order to prepare those who intend to undertake this work for the curriculum which they will have to follow.
I hope that when the Minister is discussing, as he said today he would be, the question of officers and staff for local authorities he will not place the qualifications too high. I am always a little afraid that we may get such a high basis of qualification for staffs that they will lose personal touch with the ordinary people with whom they have to deal. I hope that whatever qualifications are required for the training of staffs and students will enable them to keep in touch with the people. I find it fatal to get someone with a very high academic qualification doing a job which needs a lot of common sense. A person with high academic qualifications has often forgotten how to use his common sense. In dealing with qualifications, let them be of the necessary standard. but do not let 463 us train people to the extent that they cease to have any social connection with or understanding of the people who require their services.
I can find no fault with the Bill at all. I know that hon. Members will understand my saying that because it embodies all those things which we discussed for so long and practically everything that the Royal Commission's Report recommended should be made law in relation to mental illness and mental deficiency.
I would say in conclusion, as I said during the Committee stage of the Bill, that this is a complicated Bill. Many people in many different walks of life will have to understand it. We in this House have to learn how to understand Bills of this sort. We cannot expect the ordinary person, whether a voluntary worker or a person who comes under the provisions of the Bill and who wants to know what it is all about, to understand the drafting and the technicalities of a Bill such as this.
Will the Minister consider, as I asked him to do in Committee, publishing as soon as possible a simplified version of what the Bill intends to do? Many people have become conversant with Clauses 19 and 20, and if these and other Clauses could be explained in detail but quite simply, without all the trimmings of an Act of Parliament, I am certain that that would be of great use to voluntary organisations and to all those people who require to know something about the Bill and how to put it into operation.
I wish the Bill, when it becomes an Act, very much success. I am happy to feel that I was a member of the Royal Commission which made the recommendations. I was merely one of a number having, perhaps, not quite the same experience as some of the members of the Commission, but with at least a down-to-earth knowledge of how people are affected. I am very happy to have been in that position.
If nothing else can be said of anything that I have done, I would like my name to be associated with the Bill and with the recommendations which have been made by the Royal Commission. If by any peculiar mischance the present Government come back into power, I hope that the present Minister will still be Minister 464 of Health to give a hand to putting into operation those things that he has so well recommended arising from the Royal Commission's Report.
§ 7.1 p.m.
§ Mr. R. W. Sorensen (Leyton)
After the concluding words of my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock), I am sure that the Minister is very moved and will give to himself at least the consolation that for all time, whether he is in or out of office, the Bill will no doubt be known as the Walker-Smith Bill.
I am, I believe, the only hon. Member now in the Chamber—perhaps in the House as a whole—who sat on the Committee which dealt with the Bill that later became known as the Greenwood Act of 1930. It was certainly a great experience on that occasion to go through a long and technical Bill. It has been an even greater experience on this occasion, not least because one has been able to listen to the wisdom, knowledge and experience of a large number of members of the Committee, not least of whom was my hon. Friend the Member for Liverpool, Exchange.
Certainly, that experience has been a great privilege, for it has enabled me not only to be more informed than otherwise would be the case, but also to register again the very great further advance which has been made in recent years in the whole question of the treatment of mental disorder.
The very name of the Bill is highly significant. It is not a Mental Treatment Bill, but a Mental Health Bill, thus emphasising that the real object of the Bill is to try to make people whole once more or thus to restore them to health. It has a positive rather than negative content and that in itself is symbolic of the great advance which has taken place.
Even more important than that, however, the Bill in many respects implements what is already taking place. One must not deprecate or underestimate the substantial advance which has taken place in the last twenty years or more. A fortnight or so ago, I had the opportunity to revisit a hospital on whose committee I had served for about twenty-one years, although it is many years since I withdrew from that committee. While, despite the war years, I had seen a great advance in that hospital and in other hospitals 465 with which I was formerly familiar, I was deeply impressed and heartened by what had taken place since my withdrawal, not, I hope, because I withdrew, but because of the introduction of superior techniques and the fuller knowledge and greater understanding of this most difficult of all the illnesses that affect mankind.
It should not be assumed, therefore, that nothing has been done since the passing of the last Act and that everything beforehand was bad. The Minister himself will agree, I am sure, that considerable advance had taken place. In many respects, therefore, the Bill implements what has taken place but also gives opportunity for expansion in the future.
Looking still further back into the past, all of us have been profoundly impressed by the complete transformation of approach to the question of mental illness and mental disorder. Gone are the days when mental disorder was looked upon with an eye designed to punish and censor. The punitive approach has disappeared. In the Bill and in the whole field of mental disorder, we have now what I might call the redemptive approach. If I am not dragging in extraneous matters and being insensitive to the general atmosphere of the House, I would say that in this extension of the redemptive approach to this kind of sickness, we have what I would call the Christian method.
It may not be exclusive to Christianity, although I believe it is supreme in that particular faith. It is, in other words the attempt to redeem and reclaim those who are sick or ill rather than to punish them and inflict upon them sometimes even torture, as was frequently the case in the past. Gone are those days, thank God.
It is, perhaps, not altogether without significance that one of the greatest advances made in the more informed and enlightened treatment of mental disorder began under the auspices of the Society of Friends, at York. It is not altogether without significance because the members of that Society attempted this redemptive approach at a time when, generally speaking, the approach was quite otherwise. Miracles have taken place in this sphere, miracles that are just as surely miracles as the more traditional miracles which, 466 it is alleged, took place on certain single occasions. We do not sufficiently realise the amazing amount of successful redemptive work that is taking place today which was completely unthinkable a thousand or a hundred years, ago. or even less.
We have now reached a stage when we are realising how it is possible by medical, psychological and social means to adopt a therapy of release for the patient from many subtle and complex mental burdens and to do so in a way which previously was entirely unexpected. This should hearten us. At the same time, we should realise that while the Bill puts forward excellent proposals for reformed administration, without the presence of two other factors the new administration will not go very far.
The first of those factors is an increasing willingness to accept service in the world of mental disorder and the restoration of patients to mental health as a vocation and not merely an avocation. There are large numbers of nurses and doctors who have that sense of vocation now. I am not criticising those who do not possess that sense of vocation. Many do their job conscientiously, but they do not have that something extra which enables them to feel that they are not merely efficiently and conscientiously performing their duty but also giving their best service because of a deep personal concern with the patients themselves.
This matter cannot be dealt with by legislation. We cannot by passing a law demand that people shall have a vocation instead of an avocation. We can only hope that in the days to conic, there will be an ever-increasing sense of personal spiritual responsibility which inspires men and women to take up this sphere of service not merely because of the financial reward which it gives, but because, in that way, they find their highest fulfilment.
The second factor, although, obviously, on a lower plane, is that without adequate funds being available, many of the proposals made in the Bill and many of the propositions which have been put forward can never be properly implemented. Here again, what is involved is that society as a whole must be willing to bear the burden of giving sufficient funds to enable the possibilities outlined in the Bill to be put into operation.
467 Although we have seen miracles of reclamation, reformation and redemption taking place in this sphere, unhappily, as one hon. Member already has said, a number of those afflicted with mental disorder seem to be beyond all our attempts to reclaim them from their burdens and their distress. There is an enigmatical and mysterious factor of perverseness, no doubt genetic in origin, which for a long time to come will remain impervious to all therapeutic treatment.
We must accept that fact. We must accept that in the mysterious world of genes and chromosomes we still know very little indeed, but that genetically based and originated there is sickness afflicting some unfortunate fellow human beings of ours who, none the less, do not deserve to be treated as useless or futile but who deserve our good will, our sustained devotion and, indeed, every effort to make their lives as tolerable as they possibly can be.
Reference has been made once or twice in the debate to the passing function of the justices of the peace. Like other hon. Members, I have thought about this matter very carefully. One weighed full well the argument that the justice of the peace retained at least this significance, that he or she represented the civil approach, responsibility or civil criterion rather than the purely medical approach.
In the end, I agreed with the majority of my colleagues on the Committee that, nevertheless, this remnant of a function on the part of a justice of the peace which belongs to the past should go. I did so for one reason, namely, because in the end the justice of the peace has to rely upon medical authorities. I found that out when I served on a mental hospital committee. In those days, it was possible for lay members of the committee to discharge patients even against the recommendation of a doctor. But, generally speaking, those of us who served on the committee listened to what the doctor had to say. If we did not, as was the case with one or two members in the early days of their membership, discharges took place with lamentable results. It was learnt by experience that it should be the doctor who must be relied upon to give advice which laymen should accept.
468 I speak feelingly in this matter, because I know a lady who has acted as a justice of the peace for certifying purposes for many years. In spite of a most regrettable experience which she had recently, when a frenzied patient threw her downstairs, she still feels that she and others like her should continue to serve. Nevertheless, I disagree with her for the reasons which I have given. It should be the expert, the specialist, the one who knows the nature of the case who should exercise direct rather than indirect responsibility and not a magistrate or justice of the peace.
There are dangers in this matter whichever way we look at it. That is why we should accept the belief that doctors in future will exercise their responsibility with every sense of responsibility of what they do. Doctors are only human, like the rest of us. They are human not only in any weakness, but also in their due sense of responsibility. Under the Bill, two doctors are now required to certify a patient. I earnestly hope that in future two doctors will be accepted as being as much able to exercise responsibility for the comprehensive care of the patient's dignity as well as sickness as any of the laymen who have done so in the past. If they make mistakes it will indeed be their responsibility; but have not magistrates made mistakes as well?
We have been trying to remove the stigma which attaches to mental disorder, and rightly so. We have been trying to make it clear that there is no essential difference between the treatment of physical illness and mental illness. We hope that the Bill will go a long way towards removing that stigma. Is it not, therefore, rather regrettable that once or twice today and elsewhere it has been suggested that those unfortunate elderly persons who have been retained in mental hospitals are apparently suffering from a stigma for that reason?
One knows that there are a large number of elderly patients who are mildly mentally sick who need other kinds of treatment in other kinds of institutions. Unhappily, it may be some time before those institutions are provided. Meanwhile, do not let us leave the public with the impression that the hundreds, or perhaps thousands, of elderly persons who are in mental hospitals today are suffering from some kind of shame or 469 degradation. They are not. I have seen them myself. It seems to me that there is an inconsistency if, at the same time, as pleading for the removal of the stigma attaching to mental disorder we make statements or insinuations that if elderly people are in mental hospitals they are suffering the stigma which we want to eradicate.
I want to join in the congratulations to the Minister and to those involved in making this excellent advance in the treatment of our fellow human beings. I end as I began by saying that this demonstrates one more way by which the principle of reclaiming the individual rather than punishing him or casting him on one side is being embodied in this great national service, particularly to those afflicted by mental disorder. The distinction between those afflicted with mental disorder and those, like ourselves, I assume, who are normal, is very thin.
One reason why I find the study of mental disorder in an amateur way so fascinating is that it illumines for me not only many dark patches of my own personality but many dark patches in the personalities of my colleagues. When one looks round the House sometimes, one discovers that there are signs—I will not say on which side—of the very factors which, taken to excess, would bang those who show those signs within the ambit of this Bill and similar Bills.
This country can be proud of having this Bill brought forward. Let us not grudge honour to the Minister and to those associated with him, including those on this side, who have helped to make the Bill a Bill worthy of our country's concern for those who are mentally infirm but who may be made whole.
§ 7.17 p.m.
§ Mr. Arthur Moyle (Oldbury and Halesowen)
I am certain that the Minister never expected that two such rebels as my hon. Friends the Members for Erith and Crayford (Mr. Dodds) and Liverpool, Exchange (Mrs. Braddock) would lay bouquets at his feet. The occasion of this Third Reading must be something which gives him a great deal of pride, because it does not fall to many Ministers to have the honour and privilege of introducing such a comprehensive Measure as this in the sphere of social well-being. I hope that the Bill will fulfil all the 470 wishes that have been expressed not only on the part of the Minister and his Department but on the part of the community, and, above all, on the part of those who are engaged in the work of running our mental institutions.
It would be a mistake to get the matter out of perspective. It is true that there have been unfortunate occurrences. In some cases people have been deprived of their liberty. But it would be wrong to assume that those engaged in all branches of mental health are not endeavouring to do the best they can for the unfortunate people committed to their care. I am certain that if hon. Members saw, as I have seen over a period of thirty years, the remote places in which our mental hospitals and institutions are situated—some of which, unfortunately, are in a very bad state—they would require special inducements before engaging in the work of mental health.
I am glad that my hon. Friends have commended the Minister on his decision to appoint two important committees whose main work will be to deal with research into mental diseases. That is a great step forward. The great thing that I like about the Bill, and something to which my hon. Friend the Member for Liverpool, Exchange has referred, is the change of nomenclature, We have, for instance, "mental illness" instead of "lunacy" and "special hospitals" instead of "State institutions". These changes indicate progress towards a sensible attitude to this great problem of mental disorder which unfortunately is the experience of so many human beings. They are two milestones which indicate the progress made by the introduction of the Bill.
I voted reluctantly with the Minister on the disappearance of the magistrates because I thought it was simply a provision to ally two medical practitioners to the magistrates so that the community would be represented at the point of certification. That, however, is not provided for, but the mental health review tribunals are a fine safeguard in the interests of liberty. For all these reasons, I have the greatest pleasure in commending the Bill and in wishing the Minister well in its progress until it reaches the Statute Book, and subsequently as an Act of Parliament.
§ 7.23 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
We Cain say with complete honesty that all those who have taken part in the work on the Bill in Committee and since, have enjoyed working on it because we have felt that we have been taking part in a useful, constructive job of work that needed to be done. The tributes paid by my right hon. Friend the Member for Warrington (Dr. Summerskill) and my hon. Friends have been fully justified. They are completely deserved by all who have been responsible for bringing the Bill forward, explaining it and seeing it through its various stages.
Some of us who have been very critical of the Minister, and may well be again before very long, would rightly take this opportunity of saying how much we have welcomed the clarity of the explanations he gave us as the Bill went through Committee. I am sure that tribute is well deserved. Mention has been made of the debt we owe to members of the Royal Commission and, on this side of the House, our great debt to my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock) who, as again in her comments today, has shown a good, vigorous approach to the problem and has put extremely clearly some of the difficulties and the tasks that lie ahead.
It is right that while we exchange compliments, properly, on the preparation of the Bill, the form it now takes and the way in which Amendments have been made to it, we should not delude our-selves in any way about the tasks that lie ahead and the very real difficulties to which reference has been made today on both sides of the House. The Bill does not solve the problem, it emphasises it. It emphasises the need for staff, for fresh accommodation, and for resources of money to enable these things to be done. It would be right that we should devote a short while on this concluding stage of the Bill to examining the way in which this Measure, which on the whole we are proud to have seen through the House, is to be implemented.
I, like my hon. and right hon. Friends, am very glad that in Committee the Minister included in the Bill clearer provisions dealing with the way in which he intends to impose duties upon local authorities. They are included in the latter part of the Bill in a new Clause 472 which the right hon. and learned Gentleman moved in Committee. I was glad to have his explanation in Committee, and I am sorry that one of my hon. Friends found it difficult to understand when he read it. I thought the right hon. and learned Gentleman's intentions were reasonably clear as he discussed them with us in Committee.
It would be right to emphasise today the problem of the application of the Bill. The Minister has told us that, as soon as possible after the Royal Assent has been given, it is his intention to issue a direction under Clause 6 defining local health authority duties, and that he intends to issue a direction under Section 20 of the National Health Service Act, 1946, requiring local authorities to submit their proposals within a period of six months. The proposals will then come in for his examination and he will make his decisions on them.
We welcome that procedure. It is clear, and it is on the lines that we had contemplated. We notice that the Minister has taken action already in issuing to local authorities a circular explaining what they can be doing even in advance of the Bill being passed into law. We welcome all that, but what we find still difficult to see is how the Minister relates his imposition of a clear duty upon local authorities with the financial provisions that are available to them.
Although we have had some discussion of this in the past, we still feel that this is one of the major problems that must be tackled. We still feel that many local authorities, faced with the financial burdens which some of these provisions will inevitably involve, will not be very eager to implement them as fully as we would wish. We feel that it is something of a tragedy that provisions which we welcome so fully should in any way be negatived by the financial circumstances. We think it unfortunate, to put it mildly, that the Government have imposed difficulties upon themselves because of the changes which they carried out earlier in local government finance.
I fail to see what the Minister's reply will be to local health authorities who submit inadequate plans and proposals to him. What kind of sanction can the Minister have now? Presumably, he cannot withdraw the block grant, which covers the whole wide field of local 473 authority activity. The intention with the block grant was to provide that local authorities would have the right to a wide range of choice as to what services they ran and to what extent they ran them. I do not see how the financial side runs with the broad principles and obvious functions of the Minister in trying to carry out the proposals.
Other hon. Members have rightly cornmented on the problem of staffing, which we realise is one of great difficulty. We all know of the shortage of staff and the urgent need for training in all branches, medical, hospital and social welfare. We are glad that the Report of the Working Party on Social Workers has come out at this opportune moment to enable us to concentrate further attention upon the way in which we can provide training for mental welfare workers without losing contact with the commonsense view and with the general public, as my hon. Friend the Member for Liverpool, Exchange pointed out.
Certainly there are dangers in over-training as well as in not having proper facilities for it. Like my hon. Friend, hope that in this wider concept of the work of mental welfare officers, and others who will be involved in much of the domiciliary work, some of those who have been employed within the hospitals will take part in the work outside the hospitals as well. There is great scope here for experiment and development.
I can think of a number of mental nurses, for example, who would be useful in the community services, and I hope very much that they will not be ruled out. Indeed, it will be excellent for the service as a whole if there is a great deal of interplay between the hospital services on the one hand and the domiciliary services on the other. In that way we could offer much wider avenues of development for new entrants into the mental health services than we have been able to offer in the past. So I hope that will not be overlooked.
The Minister emphasised in Committee. and repeated in his circular to local authorities, the urgent need for close cooperation between the local health authorities, the hospitals and the general practitioner doctors. I imagine that in any further circulars he issues the Minister will particularise rather more fully, because it is clear that since we are so 474 short of trained medical staff it would be a shocking thing if there were any overlapping and if we did not make full use in our domiciliary services of the professional staff available at the hospital level. Indeed, I do not see how we could conceivably contemplate developments in the domiciliary side unless we use the consultant and specialist staff of the hospital services.
As I said during the Second Reading debate, I hope very much that this Measure will provide the opportunity for a growing together of our health service in many different ways. I hope this will offer an opportunity for breaking down the separation between the three branches of the National Health Service. Much can be done in a practical way without arguing about setting up more special committees for the purpose. Indeed, it it rather more a matter of getting the people on the spot to co-operate.
To me, it does not matter very much whether the initiative comes from the medical officer of health, the local authority, the hospital or from someone in general practitioner work. There is obvious need for all to participate, so I hope that more and more general practitioners will be encouraged to take postgraduate courses and do other work to enable them to play a big part in this work, which is supremely theirs because it is they who first come in contact with mental cases on many occasions.
May I make a brief comment on the other problem which worries all of us. the fact that we are encouraging people to hope, and rightly, for a far better standard of service in the future. Amongst other things, this must mean a new view about the future type of hospital accommodation which will be needed. If the concept of the Bill is to be realised we shall be thinking of the hospital as much more closely related to the community services. The old type of buildings are almost impossible of adaptation for this purpose. We have tried to do that for far too long. I hope, therefore, that the Minister will urge the Chancellor of the Exchequer to give him authority to go ahead with a fairly long planned campaign of getting rid of the older of our mental hospitals and replacing them. where necessary, with modern, flexible, adaptable units that can be much more easily altered, and can provide facilities 475 for the community services as well as for the strictly in-patient care.
These new units may well be within the curtilage of the general hospital. I know that experiments are going forward. Above all, the emphasis must be on adaptability. We must have no more of the huge structures that cannot be altered. The one certain thing about this work is that by the time the hospital is built the needs have changed. Fortunately, today it is possible, with modern design, to alter the function of units in a way that was not possible in the past.
I am glad, too, that my right hon. and hon. Friends have made further comment upon research needs, and we all welcome the statement about the Medical Research Council and its new committees that are to be established. We shall watch this development with great interest because many of us, including my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), have been concerned at the way in which we appear in this country to have lost some of our more brilliant research workers who have gone over to the United States. Of course, they are not lost to medicine as a whole. We hope, however, that the new developments under the Medical Research Council will offer better prospects for research workers, and will therefore encourage more research workers to stay here than has been the case in the past.
I end as I began. with emphasis upon the problems that lie ahead, and I am sure the Minister will welcome all the constructive pressure that we can and will put upon him to make sure that the hopes encouraged by this Bill will be fulfilled as rapidly as possible. We all realise that this cannot be done by waving a magic wand. We know the size of the problem. That is why we are concerned about the financial aspect of the matter. It would indeed be a tragedy if we pass this Bill hoping for great developments in the future, only to find that the resources are not made available. So we shall all be determined, having set our hearts and minds upon this development, to ensure that the necessary resources are made available.
§ 7.40 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)
It is with feelings of some 476 humility that I rise to wind up the debates on a piece of legislation as fundamental and as important as this one.
I would say how much my right hon. and learned Friend, my hon. and learned Friend the Joint Under-Secretary of State for the Home Department and I appreciate the numerous very generous tributes from both sides of the House which we have received today. The only comment I would make is that the very happy result which we have achieved in the Bill most certainly could not have been achieved without the ready help and cooperation of hon. Gentlemen opposite, which I most warmly acknowledge.
We have now reached the final stage of what I believe is the greatest measure of reform of mental health legislation in our history, and, I believe, in the history of any other country. It is a solemn moment. We can honestly say that the main purposes and intentions of the Royal Commission have been effectively translated into a good Bill. which, I agree, has been further improved and refined in its passage through the House.
After some sixty hours of debate, it is not easy to strike a note at this stage of the proceedings which is not merely dully repetitive or rather tediously platitudinous, and I do not want to do either. Perhaps I can best serve the House by indicating the immediate steps that we propose to take to make the Bill a reality and not just a Parliamentary milestone. We have all said that we like most of the Bill, if not all of it. The important thing now is to get it under way and make it part of our social structure. Nothing has been more striking in the long series of debates that we have had than the determination of hon. Members on both sides that these great changes in our approach to the problem should be translated into reality as soon as possible.
One or two hon. Members have said kind things, now that it is going out of existence, about the Board of Control with which I agree. I would add, looking at the valuable measure it leaves behind, what was said of Charles I, thatNothing in his lifeBecame him like the leaving it;The timetable for the implementation of this Bill has already been announced to some extent by my right hon. and learned Friend, but I would underline that part of what he said because I think 477 it has great relevance to what we all want, that the Bill should be an effective reality. He hopes to issue his directions under Section 28 of the National Health Service Act, imposing duties on local authorities to provide mental health services, very quickly after the Royal Assent. As soon as possible after that he will issue a direction under Section 20 requiring the submission of revised proposals in the light of the Section 28 direction and within a period of, I should think, six months. The circular containing this direction will probably also contain detailed suggestions in the form of a model scheme, on which we should first of all consult the local authority associations. Consideration of the proposals submitted will then follow, and their implementation will be worked out as a phased programme in suitable stages according to the circumstances of each authority.
As soon as possible after the Royal Assent, my right hon. and learned Friend intends to make an order repealing those provisions of the present Lunacy Act which at present prevent designated mental hospitals and registered hospitals and licensed houses from receiving patients informally without powers of detention and without the signature of a voluntary application form. This will be done as soon as the necessary order and administrative circulars can be prepared. This will allow the informal admission of patients to mental hospitals—and decertification of any existing patients who can suitably remain on an informal basis —to start at once without waiting for the longer preparations for repealing the whole of the existing Acts. The remainder of the Bill, except Part VIII, hangs together, and no one Part can be implemented without the others.
A great deal of preparatory work will be needed before the Bill can be brought into force. I would mention, first of all, that the names of persons suitable for appointment to mental health tribunals have to be collected and appointments made. Then we have the preparation by the Lord Chancellor of rules of procedure for the tribunals under Clause 123 and for the county courts under Clause 54. Then there is the preparation of regulations under Parts IV and V of the Bill, including the prescribing of new statutory forms and matters of that kind. Then there is the preparation of any necessary 478 regulations under Part III of the Bill for the conduct and inspection of nursing homes and residential homes for mentally disordered persons.
Then we shall have the administrative circulars prepared for issue to hospital authorities, local health authorities and possibly also local education authorities, children authorities and welfare authorities, drawing their attention to the provisions of the Bill which they will have to administer, and also giving advice on a good deal of administrative detail not contained in the Bill itself but necessary as a background to its implementation. This will take a certain amount of time, and will involve consultation with the local authority associations, hospital authorities and professional bodies.
If the Lord Chancellor's Department and the Court of Protection are ready to operate Part VIII of the Bill before my right hon. and learned Friend's preparations, which I have described, on the rest of the Bill are complete, it would be possible to operate it separately in advance of the rest of the Bill, and I think this might well take place.
So then, the general picture is that some simple but important steps will be taken as quickly as possible after the Royal Assent to get the matter moving. The implementation of the main provisions of the Bill will need, as I have said, a good deal of preparatory work, but we shall get on with it as fast as possible and hope to achieve an early result.
I would say a word or two about one or two points which have been raised by hon. Members during the debate. The hon. Member for Batley and Morely (Dr. Broughton) again referred to his doubts about the abolition of judicial orders for admission, and one or two other hon. Members felt the same way as he did. The question whether justices of the peace should continue in future to take part in the procedure for the compulsory admission of patients to hospital was one that we discussed at very great length in the Standing Committee, and I am sure that the decision that we arrived at—which, incidentally, was in accordance with the Royal Commission's views—was the right one.
It seems to me that it was clear that the view of the overwhelming majority of the Committee was that to have retained the 479 justice of the peace would have cut at the very roots of the Bill, which provides a new system of checks and balances and, in particular, new mental health review tribunals to take account of the abolition of the judicial order. The Amendment was rather heavily defeated. I perfectly understand the sincerity and depth of the hon. Gentleman's feelings on this matter, but I think we took the right course.
My hon. Friend the Member for Gosport and Fareham (Dr. Bennett), the hon. Member for St. Pancras, North (Mr. K. Robinson) and my hon. Friend the Member for Ilford, North (Mr. Iremonger) raised the question of the need for special hospital units for psychopaths and for more experiments and research into this hard and intractable problem. A great deal of thought and effort has been devoted to the subject by members of the medical profession and by the Ministry of Health. Valuable experimental work is already being done at various hospitals, as hon. Members know, and I have the Belmont Hospital particularly in mind.
The Bill will undoubtedly stimulate fresh activity on these lines. Specifically, my right hon. and learned Friend announced, as hon. Members will remember, the setting up of two important committees by the Medical Research Council, and I am sure that they will provide a great deal of help in this matter. Another contributory factor is the Working Party into Special Hospitals, which will be able to consider the provisions which should be made for difficult psychopaths, both under the regional hospital boards and in the special hospitals under Part VII of the Bill.
The hon. Member for Bristol, South (Mr. Wilkins) was in some doubt about the precise division of functions in mental health work. It is for the local authorities to provide the community care and it is for the regional hospital boards to provide the hospital care. As the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) so wisely said, it obviously makes all the sense in the world that there should be some coming and going and some interchange between those who work for those two different authorities.
The hon. Member for Paddington, North (Mr. Parkin)—and I regret that I 480 did not have the pleasure of hearing his remarks—raised a question which I know to be very dear to his heart since he has raised it with me before. That is the need to co-ordinate the immense mass of social welfare work which is now going on and which sometimes seems to leave gaps and sometimes to overlap. He mentioned the Younghusband Committee. As he knows, the Report of that Committee was published only last Monday. It recommends the setting up of a national council for social work training, the provision of new general training in social work provided outside the universities, and the creation of a new grade of welfare assistant to meet straightforward needs and to give short in-service training.
This Report, which is a very solid document of 350 pages, has to be studied by the local authority associations, because the local authorities will be the employers in this case, and also by the interested professional bodies. This Report might well contain the germs of the kind of solution which the hon. Member would like to see us reaching.
The hon. Member for Newcastle-upon-Tyne, East, expressed doubts, which he has expressed before, about the financing of the whole of this operation. I do not accept the view that the development of local authority mental health services will be starved for want of adequate aid from the Exchequer. On the contrary, the Government have accepted the need to take into account, in the new general grant arrangements, the importance of expanding the local health authority mental health services. The allowance already made for this purpose in the total of the general grant for the first grant period has been made on that basis.
The total amount of the general grant for the period covering 1959–60 and 1960–61 has been determined by an Order made by my right hon. Friend the Minister of Housing and Local Government, after consultation with the local authority associations concerned. The Order was approved by the House without a Division on 8th December last year. The expenditure on mental health services in 1959–60 taken into consideration in the calculations is in fact more than £900,000 more than the estimated expenditure for the current year, and in 1960–61 more than £1¾ million above that for the current year.
481 It is not true, as some people think, that activity in this matter in the past has been so small that an increase of 2½ times—and that is the increase—is of little consequence. Local health authority net expenditure on services exclusively provided for the mentally disordered is estimated at more than £4 million in the current year and the other services which they provide, such as domestic help, home nursing and health visiting, are available to the mentally disordered as to the rest of the community, and expenditure on those, too, is expected to increase.
Of course, it is true that the allowance made in the general grant for increased expenditure on mental health services does not oblige authorities to increase their expenditure to this extent, nor to spend their money on this particular service, a matter about which some hon. Members have been uneasy. However, accepting the argument that they might not so spend the money betrays a lack of faith in local government and its ability to meet the local needs of its people. There is plenty of evidence of interest and achievements in local authority health and welfare services, irrespective of the exact basis on which they have been grant aided by the Exchequer.
§ Mr. Blenkinsop
Does not the hon. Gentleman recognise from practical experience the pressures which will now be put on the chairmen of finance committees of local authorities by all those bodies wanting to get an increased share of the total sum, so that the poor mental health service will be a poor runner in some cases?
§ Mr. Thompson
I do not accept that this is such a disappointing horse, and I also think that the very passage of the Bill will create a climate in which it will be very difficult indeed for the laggardly local authority—which the hon. Member probably has in mind—to fall down on its undoubted responsibilities.
There was one small matter raised by the hon. Member for Erith and Crayford (Mr. Dodds) to which I want to refer. He was concerned about token payments to patients in mental hospitals. I did not actually hear his words, but I understand that he felt that this was an inadequate or improper way of making payments. I can help him on that by quoting the 482 last paragraph of a circular which my right hon. and learned Friend sent out only on Monday of this week. It says:The Minister understands that it is the practice at some mental and mental deficiency hospitals for payments to be made to patients in kind rather than in cash. In particular, it is known that some hospitals give rewards payments in the form of tobacco. The Minister considers that such arrangements are in principle undesirable and that all payments to patients who are capable of appreciating the value of money should be made in cash or by placing sums to the patients' credit. Hospital authorities are therefore asked in future to discontinue the practice of making rewards and other payments to patients in kind.
§ Mr. Thompson
I recognise how insatiable the hon. Member is on this subject. We will keep that suggestion in mind.
In conclusion, I want to speak about public opinion. Various views have been taken in the House today about which way public opinion is moving in its attitude to the Bill. I am certain that if we are to create the right climate for the Bill to be the success which we all want it to be, we have to take public opinion with us. It can be argued that this House would be receptive and sensitive to public opinion, and it can be said that it also has a function to create and to lead it. I am sure that it is that latter function which should be superimposed in our minds, particularly in connection with the implementation of this Bill.
I hope that what I said at the beginning of my remarks will show that we intend to press on with the translation of the intentions contained in the Bill into reality as quickly as we can. In doing so, we are fortified in the knowledge that there is no kind of party difference between us. We have produced one of the most enlightened pieces of legislation ever to go through this House which may well become a model and standard in its field, and I confidently ask the House to give the Bill a Third Reading.
§ Mrs. Braddock
Could the Parliamentary Secretary answer the question I put 483 to him about the introduction of a simplified statement of the terms of the Bill?
§ Mr. Thompson
I apologise to the hon. Lady, whose contribution to this Bill and whose help in Committee we are all glad to acknowledge. I am happy to tell her that a simplified version, a layman's version of the Bill, is being prepared, but I cannot tell her precisely when it will be available. It may have to await certain parts of the Bill becoming law, but we are giving our advice and co-operation to the National Association for Mental Health and I think we ought to get a fairly speedy result.
§ Question put and agreed to.
§ Bill accordingly read the Third time and passed.