§ Order for Second Reading read.
§ 4.20 p.m.
§ The Secretary of State for Scotland (Mr. John Maclay)
I beg to move, That the Bill be now read a Second time.
The purpose of this Bill, as the House knows, is to reform on modern lines the existing statute law on mental disorder. At present we have a whole series of Acts, some of them very old and much amended. They are a sort of legal labyrinth in which it is very easy to get lost. We intend to substitute for all this, one comprehensive code, as straightforward as the complexities of the subject permit, and one which is in keeping with present ideas about the treatment of mental disorder both in hospital and in the community. I am sure that the whole House will agree that this major reform is necessary.
I thought it desirable to publish an explanatory White Paper with the Bill so that Members and those outside the House who are interested in this subject should have available in reasonably convenient form an outline of the main provisions the Bill contains. I hope that hon. Members have found it of value. I should like to say at the outset that I shall welcome criticism from whatever part of the House it comes, and I will consider very carefully any suggestion which is designed to improve the Bill.
The last major Scottish legislation on this subject was in 1913 with the Mental Deficiency (Scotland) Act. The House might be interested to know that on that occasion the Government of the day—and I note the date—took the view that because the House had recently given a Second Reading to a somewhat similar Bill for England and Wales, they might be prepared to dispose of the Second Reading of the Scottish Bill very briefly—in fact, in thirteen minutes at the end of the day's business. Their optimism proved unrealistic. I hasten to assure the House that I have no intention of attempting to follow this precedent.
On the contrary, I must ask for indulgence if I must take some little time to explain first the principles on which 253 the Bill is based, and then some of its main provisions, more especially those which differ, for reasons which I shall give, from the Mental Health Act which my right hon. and learned Friend the Minister of Health piloted through the last Parliament for England and Wales.
First, the principles underlying the Bill.
Although we propose to repeal the existing Acts and enact a new code, that does not mean that the existing law was not good in its time, and that some of it is not good even now. Indeed, on this occasion we ought to acknowledge the foresight and the very enlightened approach of our predecessors. The original Lunacy (Scotland) Act of 1857 was founded on the Report of a Royal Commission, which is a remarkable document in many ways. It contains, for example, a description of what a mental hospital should be that even now sets us a high standard. The old Scottish legislation, too, inadequate and confusing as it is in some respects, has worked well in many ways. In particular, we have very little evidence that the existing law is unsatisfactory in practice, from the point of view of the liberty of the subject.
In these circumstances it is not surprising that when the Scottish Health Services Council Committee considered how the Royal Commission's Report might apply to Scotland, they took the view that the best traditional features of Scottish law and practice ought to be preserved and that they were not justified merely for the sake of uniformity in sacrificing provisions which have worked well in Scotland and in which the public have confidence. I accept that view, and our first principle, therefore, is to preserve in modern form the best features of the existing law.
Next, I come to the liberty of the subject. It is inherent in the types of mental disorder with which the Bill deals that the unfortunate patient sometimes cannot appreciate what is in his own best interest by way of treatment and care. An element of compulsion is therefore necessary in the patient's interest and it is sometimes also necessary for the protection of others. In farming this Bill we have had to keep the balance between the patient's best interests and the safety of the community 254 on the one hand, and a proper regard for the patient's liberty on the other. Wherever there has been legitimate doubt, we have tried to come down on the side of the patient's liberty by including the most ample safeguards we could devise. It is for this reason, as I shall explain later, that we have retained the Sheriff's part in the procedure for compulsory detention and we have retained an independent central body, the Mental Welfare Board.
In the third place, the main concern of this Bill is to lay down the rules which must be observed by those who are concerned with care and treatment. It gives the patient and others acting on his behalf the rights of redress he must have where zeal for his treatment and care might outrun proper discretion. The Bill provides a framework within which treatment and care proceed. For these things we depend on a devoted army of doctors, nurses, guardians, welfare officers, social workers, and last but not least, individuals giving their time on a voluntary basis. We have tried to keep in mind their point of view, and in particular the views of our Scottish psychiatrists. My third principle, therefore, in framing this Bill has been, particularly on medical matters, to take account, wherever I could, of the weight of opinion among the Scottish doctors who are concerned with the treatment of mental disorder.
These, then, are the three main threads running through this Bill—to retain the best features of the existing law, to weigh the balance wherever there is doubt in favour of the liberty of the subject, and to devise a code which is in harmony with authoritative medical opinion.
I now come to the actual provision of the Bill. At this point I should like to acknowledge the debt I owe to the two Reports prepared by the Scottish Health Services Council's Committee under the Chairmanship of Mr. John Dunlop. They undertook within a very short time a comprehensive review of the recommendations made for England and Wales by the Royal Commission and said how they thought they should be applied in Scotland. This was a powerful committee, including some of the leading psychiatrists and some of the laymen most informed on this whole subject in Scotland, and the Bill is to a very considerable extent based on the advice they 255 have given which was endorsed by the Scottish Health Services Council itself. I am sure that the House as a whole will wish me to express our appreciation of the work of this Committee.
Let me now say something in detail about the content of the Bill. It is in nine Parts, and there are five Schedules dealing with such matters as transitional provisions and the repeal and amendment of other enactments. At the very beginning of Part I of the Bill the existing lunacy and mental deficiency statutes are comprehensively repealed. As the Fifth Schedule shows, this involves the repeal of nine Acts, the earliest dating from over a hundred years ago, as well as numerous details of other Acts. Clearly, we need a new instrument. While we do not suggest that the present code has involved injustice or has denied to the mentally sick the help that they require, we believe that the time has come for a new and modern statute which can be the basis for further advances.
The Bill proceeds to the establishment of a new body to be called the Mental Welfare Board for Scotland, to exercise protective functions in respect of people whose mental disorder makes them incapable of adequately protecting their persons or their interests. This is at present among the functions—though perhaps not so clearly stated as we now have it in Clause 4 of the Bill—of the General Board of Control for Scotland who are to cease to exist when the new Board comes into being. The General Board of Control was brought into existence, under a different title, by the Lunacy (Scotland) Act, of 1857. It may interest hon. Members to know that that Act proposed that the Board of Commissioners in Lunacy (as they were then known) should cease to exist after five years, after which the task of ensuring that all went well was to be taken over by paid inspectors-general. When Parliament next turned its mind to this legislation, however, five years later, the Board had apparently earned their spurs and they were continued in existence indefinitely. The present Board is widely held in very high esteem in Scotland and I should like to take this opportunity of paying tribute to the work of its present Chairman, Dr. Jardine, and the Commissioners who perform this important public service.
256 It seems, however, right that a new statute should give effect to essential changes in function and this the Bill sets out to do. The Dunlop Committee clearly had in mind that what should be preserved was the protective functions of the Board, but even after the introduction of the National Health Service the present Board were left with a number of duties administrative in character rather than protective of the liberty and safety of the patient. The inconsistency of the Board's retaining one of these duties was recognised by the Committee when they suggested that its management of what are at present the State Mental Hospital and State Institution should pass to another central body. It seems right too that the Board should be relieved of other administrative functions such as the licensing of private hospitals.
There remained the question of the Board's name. Whatever validity the name may have had in 1913, when there were district Boards of Control as well as the General Board, there is no doubt that the title no longer has a meaning appropriate to the functions the protective body are to perform. To find an alternative title was not easy, but we think that "the Mental Welfare Board for Scotland" will be generally accepted. It stresses the Board's essential concern with the welfare of the individual patient and at the same time, we feel, avoids confusion between the protective body and those who actually provide and manage the mental health services.
There is one further Clause that I must mention in Part I of the Bill—Clause 6. It is a short Clause, less than two lines in length, defining the term "mental disorder", which is used throughout the Bill as the general term for all those requiring help because of their mental condition. The term is defined very briefly to mean mental illness or mental deficiency however caused or manifested. These two terms, mental illness and mental deficiency, are not defined in the Bill. Each is accordingly used in its accepted clinical sense and not with a special statutory meaning. This is a matter which we can discuss in more detail when the Bill goes into Committee. The Bill here follows the recommendation of the Dunlop Committee and we believe this to be what the medical profession in Scotland wish to have. Scottish doctors are satisfied that 257 this definition will enable them to reach and assist all those for whom the medical services may have something to offer. For my part, I am satisfied that the scope of compulsory powers is precisely the same as under the Mental Health Act which the last Parliament passed for England and Wales.
I now pass to Part II of the Bill which is concerned with local authority services. A great deal has been said, and has rightly been said, in recent years about the part that care in the community can play in assisting the mentally ill and mentally defective Clearly, our hospitals and the specialist services based on them will continue to play a vital part in dealing with mental disorders. The great strides that medical science has made, however, coupled with a wider public understanding and a more tolerant attitude to mental disorder, make it more often possible to treat patients satisfactorily without cutting them off at all from their homes. Full expansion of this community care of the mentally disordered requires all the resources that can help to be used to the full.
This part of the Bill therefore makes it possible for local authorities, as health authorities, as welfare authorities, as children authorities, and as education authorities to provide all the services that may contribute to the well-being of the mentally disordered in the community. Thus Clause 7 includes among the purposes for which local health authorities may make arrangements a number of services for the mentally disordered, ranging from provision of residential accommodation to informal supervision of mental defectives.
Clauses 8 and 9 ensure that welfare authorities and children authorities are not precluded from using their powers to assist the mentally disordered by accommodating them where appropriate in accommodation that may have been initially provided for other purposes. Clause 10 seeks to ensure that no person, notably children and young persons, is left without the comfort of visits when in hospital whether for mental disorder or for any other reason. The later Clauses of this Part of the Bill are concerned with continuing existing provisions for suitable training and occupation of mental defectives and of other mentally disordered children with an 258 added power to compel all children of school age to attend a training and occupation centre provided by a local health authority.
Part III of the Bill is concerned with private hospitals and with the registration of residential homes for mentally disordered persons. I should point out that the definition of hospital given in Clause 109 of the Bill includes a private hospital registered under this Part of the Bill, and that "private hospital" is used in a very limited sense. It is confined to premises for the reception and treatment of patients who are subject to detention under the Bill.
We are not concerned here with, for example, a nursing home which may include among its patients an old person who may at times be mentally confused but is not subject to the compulsory provisions of the Bill. These nursing homes will continue as hitherto to be registered under the Nursing Homes Registration (Scotland) Act, 1938, by the local authority. We are concerned here with the central registration of those hospitals, at present few in number and likely never to be many, which are privately owned and in which patients may be detained. The places to which these provisions would at present apply are five certified institutions and one private hospital run by the Roman Catholic authorities. At present, registration and licensing of these institutions and hospital is done by the General Board of Control, and I think that it is appropriate that the function should pass to the Secretary of State.
This Part of the Bill also deals with residential homes for mentally disordered persons, bringing them within the scope of the system of registration and inspection of homes for disabled persons and old persons, already provided in the National Assistance Act of 1948.
I come now to Part IV of the Bill, which may be regarded as the keystone of the whole so far as the liberty of the subject is concerned. We have gone to great pains to ensure that this Part of the Bill holds the balance between preservation of the individual's liberty and protection of society. At a very early stage in this part—Clause 23 (3)—it is specifically stated that nothing in the Bill is to prevent a patient from receiving 259 the treatment he needs without being liable to detention. More and more of the patients who enter our hospitals for treatment for mental disorder do so voluntarily. Quite apart from those entering psychiatric units to which the present Lunacy Acts do not apply at all, as many as four out of five of the patients entering mental hospitals do so voluntarily. At present, however, they still have to sign an application for admission which requires the approval of the General Board of Control. This has the unfortunate result that those who may have no objection to entering hospital, but whose condition makes them unable to sign a form, have at present to be certified. Old people in particular suffer in this way.
The Bill changes the procedure to avoid this situation. In future, patients will be able to enter hospital for treatment for their mental disorder just as they can at present for physical disorder without signing forms which have to be approved. The Bill achieves this first by repealing the existing provision requiring mental hospitals to be designated and so set apart from the rest of the hospital service. Secondly, Clause 23 makes it clear that formal procedure will be used only when compulsion is really necessary. This important change will reduce the proportion of patients detained under compulsory powers. There will remain some, however, for whom compulsion continues to be necessary and this somewhat complex part of the Bill has been provided to ensure that in these circumstances there will be proper safeguards.
The first half dozen Clauses of the part lay down the tests that must be made before compulsion can be used. I trust that the House does not feel that I am going into too much detail. I believe that this very important part of the Bill should be fully explained at this stage.
First the person concerned must be suffering from a mental disorder that requires or is susceptible to medical treatment. Then two doctors must make recommendations in due form for his admission to hospital or reception into guardianship. Each has to state the form of mental disorder from which he believes the patient is suffering; he 260 must give an opinion also that the disorder is of a nature or degree warranting detention in hospital or reception into guardianship and that the interests of the health or safety of the patient or the protection of other persons cannot be secured otherwise than by detention in hospital. Where the patient is to be placed under guardianship, the statement required is that this is necessary in the interests of his health or safety or for the protection of others.
In every case, therefore, the doctors must address their minds to the question whether the mental disorder requires or is suscepitible to medical treatment, whether it is mental illness or mental deficiency, whether it is of such a nature or degree as to warrant detention or reception into guardianship, and, last, whether the health or safety of the patient or the protection of others requires the proposed use of compulsion. The form of the medical recommendations is to be prescribed in detail and doctors will be guided towards giving in effect a fairly full account of the patient's condition. These, quite properly, are very restrictive conditions for the use of compulsory powers.
There is, further, specific provision in Clauses 23 and 40 of the Bill for two special classes of patients. These are patients whose mental deficiency does not make them incapable of living an independent life or of guarding themselves against serious exploitation, and those who are suffering from a mental illness recognisable only because of persistent disorders of behaviour. The use of compulsion in relation to such patients, as respects either admission to hospital or guardianship, presents special problems. What the Bill proposes is that compulsory powers can be invoked in relation only to persons under the age of 21; but where this has been done these powers can continue to be exercised until the person reaches 25.
Clause 28 provides for the submission of the documents relating to admission or guardianship to the sheriff for his approval. The intention is that before any person is deprived of his liberty, a judicial authority should have an opportunity of ensuring that the statutory provisions have been properly and reasonably carried out. The standing, training and experience of the sheriff clearly make him the proper man to continue 261 this function, which varies only slightly from that he performs under the present law. I have found in the consultations that have been held in the preparation of the Bill that there is complete unanimity among those consulted that the sheriff's part in compulsory procedure should be retained.
I should like to point out too, that under later provisions of the Bill the sheriff is to continue to act as a court of appeal against wrongful or improper detention. The sheriff's part in these matters has a long tradition in Scotland which is evidently accepted, and indeed welcomed, not only by law, but medical opinion, and I hope that the manner in which it is proposed to continue this will commend itself to the House.
The effect of the admission procedure when carried out in full with the sheriff's approval will be to permit the admission of the patient to hospital and his detention there for one year; and similarly as regards guardianship. Before the year is completed he has to be medically examined. The doctor concerned may then report that further detention, or care under guardianship, is necessary, whereupon the patient will be liable to detention or guardianship for a further year, and so on thereafter for periods of two years at a time. On every occasion of renewal of detention the patient will have a right to appeal to the sheriff to order his discharge.
At any time during detention the nearest relative of the patient may take action with a view to taking a patient away from hospital or guardianship. He can arrange removal unless the doctor in charge of the patient reports that the nature or degree of the patient's mental disorder at that time would still warrant compulsory detention, or, with a hospital patient, that if he were discharged he would be likely to be a danger to himself or other persons. If the doctor so reports, the patient is not discharged, but the nearest relative may then appeal to the sheriff to order his discharge.
Besides this right of the nearest relative, and the power of the sheriff to order discharge on appeal, the board of management of the hospital in hospital cases and the local health authority in guardianship cases are to be able at any time, with the consent of the doctor concerned, to discharge a patient. In addition, the doctor concerned and the Mental Welfare Board 262 are to have a duty—not merely a power, but a duty—to discharge any patient whenever he or they are satisfied, either that he is not suffering from mental disorder, or that it is not necessary in the interests of his health or safety or for the protection of other persons that he should continue to be subject to compulsion.
In this way we have sought to provide that no person becomes liable to compulsion or continues to be detained unnecessarily. While the issue on the need for detention is primarily a medical one, we have sought to provide a right of formal appeal to the sheriff on those occasions when it seemed necessary. In addition, I would like to emphasise that a patient, or his relative, will also have the right of access to the Mental Welfare Board at any time. The Board has a duty to look into any case where it appears to it that there may be improper detention and to discharge the patient where appropriate.
Before I leave this Part of the Bill, I should like to mention one matter in which I know this House is rightly jealous of the rights of the individual. Clause 34 and Clause 100 of the Bill provide for the interception of patients' correspondence. Censorship of this sort is always a delicate matter, but I hope it will be agreed when the Clause has been studied that we have drawn the power as narrowly as the interests of the patients allow.
With Part V we come to the special provisions dealing with mentally disordered persons involved in criminal proceedings of one kind or another. We are making no startling or fundamental changes in existing law and practice, which I think it would be generally agreed has worked well and fairly for many years. Existing procedures have, however, been adapted to fit in with the general principles and terminology of the Bill.
Perhaps the most important Clauses are 55, 58 and 60. Clause 55 will enable the courts, as an alternative to imprisonment or other penal sanctions, to make orders for the admission to hospital or placing under guardianship of persons involved in criminal charges who are found, on appropriate medical evidence, to be mentally disordered. Clause 58 provides that such persons shall be treated in the same way as patients admitted to hospital or guardianship under the 263 ordinary procedures of Part IV, with two principal exceptions; namely, the nearest relative's power of discharge and the age limits on the admission or detention of certain patients under Part IV will not apply. In other words, these persons, if their disorder manifests itself in criminal acts, can be admitted and detained at any age, so long as their condition calls for medical treatment. This, I think, is clearly right and proper.
Clause 60 provides that where a court, in criminal proceedings, makes an order for the admission of a person to hospital the court may, if it thinks it necessary for the protection of the public to do so, add an order restricting the patient's discharge. If a restriction order is made, the patient's discharge will be subject to the control of the Secretary of State.
Clause 63 makes certain changes in the procedure to be followed in relation to persons found insane in certain criminal proceedings. It has long been part of the common law of Scotland that a person charged on indictment who is, on account of insanity, unable to understand the charge against him or instruct his defence, cannot be tried; and that insanity may, in certain circumstances, be a ground of acquittal even where the accused did the act charged. The Bill does not alter these rules of the common law. It provides for the detention of the persons concerned as if they were subject to a hospital order plus a restriction order. This comes in practice to the same as the provision in the existing law for "detention at Her Majesty's Pleasure", but the opportunity is taken, in this context, to drop that somewhat archaic phrase.
The most important change in the law effected by Clause 63 is the application of the common law rules relating to insanity in bar of trial to summary courts. Under the existing law a summary criminal court may order the detention in a mental hospital of a person charged before it only if it is satisfied on evidence that the accused did the act charged. But it has been represented that, where the mental disorder of the accused person is such that if he were charged on indictment, he would be found insane in bar of trial, this provision is in conflict with the general principles of the law of Scotland, since it involves leading evidence against 264 a person who is unable to defend himself. Clause 63 removes this conflict by applying to the sheriff summary court the common law relating to insanity standing in bar of trial.
Clause 54 contains an important new provision which will enable a court to commit to hospital instead of remanding in custody persons who appear to be mentally disordered. Clauses 65 to 71 contain various provisions for the transfer to hospital of people detained in prisons, borstals, approved schools and similar establishments who are found to be mentally disordered.
As I have said, the changes which Part V of the Bill makes in the existing law are principally designed to bring the treatment of mentally disordered people who have been involved in criminal proceedings into line with the general provisions of the Bill for the treatment of mental patients. An important practical question is, therefore, how is Part IV of the Bill to be applied to patients who have been dealt with under Part V? This is inevitably a somewhat complicated matter, but all the answers, I trust, are to be found in the ingenious table contained in the Second Schedule of the Bill, which I commend to hon. Members to round off their study of Part V.
I have already taken up a good deal of the time of the House, but I should like to add a little explanation of the later Parts of the Bill. Part VI is concerned with the transfer of patients subject to compulsion between Scotland and other countries in the United Kingdom. This completes the simplification of these matters begun in the Mental Health Act, 1959. The general principle that we have adopted is that any patient subject to detention or guardianship should, on transfer to another country, be treated in accordance with the mental health code of the receiving country.
Part VII of the Bill replaces existing provisions for State Mental Hospitals and State Institutions for mental defectives. These are hospitals for patients requiring conditions of special security. The State Mental Hospital at Carstairs is provided under the Criminal Justice (Scotland) Act, 1949, while the State Institution adjacent to it is provided under the Mental Deficiency and Lunacy (Scotland) Act, 1913. Under the present 265 statute they are managed by the General Board of Control for Scotland, but as I have said earlier it seems desirable to provide for their management by someone other than the body constituted to protect the individual patient. Accordingly, the Bill leaves the Secretary of State free to constitute special committees to manage these hospitals on his behalf. They will not come within the arrangements for regional administration of hospital and specialist services within the National Health Service.
Part VIII of the Bill is concerned with patients' property. At present if a person cannot manage his affairs, the court may appoint a curator to do this for him. The Bill makes no fundamental change in the law, but it seeks to stop up one gap in the present provisions. Occasionally it is found that there is no one to make the necessary approach to the courts in the ordinary way and this cannot at present be remedied short of an application to the Court of Session. The Bill seeks to provide for this by requiring the local health authority to act in these circumstances.
Part IX of the Bill deals with miscellaneous matters to which I think I need make no detailed reference here, although I should not like it to be thought that I did not 'regard as important such Clauses as those dealing with ill-treatment of patients or with the offence of assisting patients subject to detention to be absent without leave.
I hope that the House will consider that I have fully explained the Bill. The subject dealt with in the Bill is one which I am sure all of us approach with an honest endeavour to make the best provision possible. We for our part shall give careful consideration to any suggestions put forward to improve the Bill, but I am sure that in principle at least it will meet with the approval of the House.
§ 4.54 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I am sure that hon. Members on both sides of the House are grateful to the Secretary of State for his explanation of a Bill which, in parts, is very difficult, highly technical and legal. We on this side welcome the Bill. During the past twelve years, since 1948, the National Health Service has performed wonderful work in this country by providing for our people a service which is admired and 266 envied by ordinary people all over the world. I will go so far as to say that if the first Government with a Labour majority had done nothing else but make this service available to all our people, in face of strong opposition, its time in office would certainly not have been in vain. I am sure that I am voicing the wishes of all when I wish my right hon. Friend the Member for Ebbw Vale (Mr. Bevan), who introduced the National Health Service, a speedy recovery to full health.
As in other fields of medicine, there have been important developments in the treatment of patients suffering from mental illness, but I do not think that anyone would deny that so far mental health has been the Cinderella of the National Health Service. We wish to make certain that the provisions of the Bill will accord that the care of the menally ill all that modern science and enlightened thought can give.
The Bill could represent a revolution in our attitude to mental illness. Although the attitude of the general public has changed considerably in the past few years, in the minds of many people there is still a stigma attached to mental illness in any form. It is an improvement, we feel, that the word "mental" will disappear from the name of the hospital, but names tend to stick in an area, and it seems to me that it will be an even greater improvement when those who are gravely mentally ill can be treated in a general hospital and when many others of the mentally ill are able to remain at home or in a hostel during treatment. All of that is made possible under the provisions of the Bill.
I could not emphasise too strongly the need for the after-care of those who suffer from mental illness. If this aftercare is to be successful, as I think we all wish it to be, many psychiatric social workers will be needed, both for those who have been mentally ill and, in many instances, to help and to advise the families of those people. We should like to know what provision the Government propose to make, first for the recruitment and secondly for the training of such workers. This will be highly specialised work. Every incentive must be given to recruit suitable men and women for this work and we must ensure that their conditions are 267 sufficiently good that they will remain in the work. I hope that when the Joint Under-Secretary of State winds up the debate he will tell us something about the ideas which the Government have both for the recruitment and for the training of those people, who will be of the greatest importance if the community after-care of the mentally ill is to be properly undertaken.
Although we admire the work of the General Board of Control and respect the devotion of its members who, in many cases, have shown great devotion, it seems to me an improvement to put in its place the Mental Welfare Board. The General Board of Control has a dual responsibility—a responsibility to the Secretary of State for Scotland and another to the patients.
As far as I can learn from my study of the Bill and of the other papers that go with it, the main duty of the Mental Welfare Board will be to protect people who are incapable of looking after their own interests. I think that is a good thing. We also welcome the decision of the Government concerning the duties of the sheriff, since again we feel from our study of these matters that it provides a necessary protection of civil liberties. Indeed, I feel sure that many of the English hon. Members on this side of the House would have liked very much to have had a similar provision in the Bill that applied to England and Wales. We welcome it very much since we feel that it is of the greatest importance that the civil liberty of those mentally afflicted should be safeguarded in every way possible.
These are many of the things with which I agree, but I now want to come to one provision of the Bill with which I disagree very much indeed. We find it in Clause 12, which deals with the training of persons unsuitable for education and with the training provided for mental defectives. The Clause states:It shall be the duty of the local health authority to provide or secure the provision of suitable training and occupation …I think that most of my hon. Friends take exception to that provision. Education is not just the teaching of formal subjects such as writing and arithmetic. Whatever training or occupation is provided for any child at all, surely that is 268 the education from which the child is considered capable of benefiting.
In this enlightened age we do not wish to give the title of "ineducable" to any child at all. The Royal Commission itself wished to limit as far as possible the differential between physical and mental illness. The separation of those children described in Clause 12 from all the other children really makes them very different indeed from the other children. It at once places a stigma upon them, a stigma which in other parts of the Bill we are trying to take away. In Committee we shall argue very strongly indeed that whatever training or occupation is provided for these children, and for youths over 16 years of age, shall be the responsibility of the local education authority and not that of the health authority. In Scotland there are important bodies which support us in that contention.
I now come to what I consider one of the most important parts of the Bill. In paragraph 2 of the Explanatory and Financial Memorandum we find the following words:The Bill does not involve any substantial new net charges upon central or local funds.At the end of paragraph 4, which deals with certain Acts, we find that the Bill giveslocal authorities greater freedom to provide services for mentally disordered persons within their health, welfare or child care services as appropriate.We fully support that part of the Bill which makes provision for greatly expanded community care. We have no doubts about that. But this will only be possible if the local authorities have the money with which to provide such services. To say that they have the freedom to do it without providing them with adequate finance is as ludicrous as saying to an old-age pensioner with no other source of income than his pension that he is free to go to the Ascot Races or to Honolulu.
The Royal Commission recommended that up to 75 per cent. of local authority provisions in this field should be paid by the Exchequer over a period of time until such services were really established. We in the Labour Party, being seized of the urgency of these matters, and just to show that it is no new 269 thought on our part, I shall quote from our policy statement on health:There will be 100 per cent. Exchequer grants for these services until the desired standards are reached.The Secretary of State may have my copy of "Members One of Another", not because of what it says about mental health only but because of what it says about our whole health services.
Taking the Royal Commission first, it realised very fully, in connection with its proposal that 75 per cent. of the cost should be provided, the importance of the community services that were going to be provided by the local authorities, and also that one of the ways of ensuring that they were provided as speedily as possible was to give them the money from the Exchequer.
If the Government really believe, and I think that they do, that community services must play an important part in the treatment of mentally ill patients, they must realise that the provision of these services will place a very heavy financial burden on the local authorities. Surely the Government are already a ware of the fact that with reference to the provisions under Part III of the National Assistance Act and Part III of the National Health Service Act many local authorities, with the best will in the world, have not been able to make adequate provision for the services specified in those Acts.
It will be no use the Joint Under-Secretary saying to us tonight the provision is or will be made in the block grant. These matters have been thoroughly argued and discussed in the House on many occasions. We shall return to the matter again in Committee, but I want the Joint Under-Secretary when he replies tonight to explain to us exactly what financial help will be given to the local authorities in order to help them provide as speedily as possible the community services mentioned in the Bill.
In the Bill the duty placed upon the local authorities to provide these services is permissive and not mandatory. Again I deprecate very much indeed the fact that the Government have not accepted the strong recommendation of the Royal Commission which we find on page 241, paragraph 715, of its Report. That recommendation is printed in very heavy 270 black type. That was done to show how strongly the Royal Commission felt about the matter. It says:And if the general re-orientation of the mental health services which we have recommended, in the direction of a considerable expansion of local authority community services, is to be achieved, we have no doubt that the provision of community services for all groups of mentally disordered patients should be made a duty".Nothing could be more clear, and the Government in those circumstances should accept the advice of the Royal Commission and make these duties mandatory and not permissive. The people who served on the Royal Commission were very knowledgeable indeed. The Parliamentary Secretary will have to explain to us tonight why the Government have not followed the strong advice of the Royal Commission. I hope that, as the Secretary of State said when he opened the debate, the Government will be ready in this instance to discuss the matter fully in Committee. I hope that the result of those full discussions will mean that eventually these duties will be made mandatory on local authorities.
The Royal Commission reported in May, 1957. Before the Bill is on the Statute Book, over three years will have passed. I do not make any great complaint about that, because it was an immense task for the Government to study the Report and to prepare the legislation. I should like to join with the Secretary of State in congratulating the members of the Committee set up by the Scottish Health Services Council. They did a very good job in a very short time and helped us in the House to come to decisions that perhaps in some instances were different from those which were suggested by the Royal Commission. Three years will have passed since the Royal Commission recommended that these new provisions should be brought in. How soon after the Bill becomes law do the Government expect local authorities in particular to be ready to make the necessary provisions for community care? I ask that particularly, because I remember that in 1918 it was put on the Statute Book that the school leaving age would be raised to fifteen on an appointed day. We had to wait for over twenty years, when a Labour Government honoured that part of the legislation.
271 A specific time should be stated in the Bill for when local authorities will have to be ready with their plans to put forward to the Secretary of State. The plans should show clearly, first, that they are seized of the importance of community care and, secondly, that they are ready to put into being those measures that will ensure that the best community care is given. I hope that in Committee the Secretary of State will be most amenable and be ready to accept an Amendment which we will table to ensure that we obtain from local authorities their plans within a stated time. This would urge on those local authorities which are a little slow and would help those which try to do a good job.
We wish the Bill to provide us with an opportunity of ensuring that as quickly as possible the mental health services will at least reach the standard of the rest of the National Health Service. To do so, we must have the provision for training facilities as speedily as possible. We must make provision for much more research in mental health than we have ever had before. Money will be needed for both training and research. We want to know from the Government where that money is coming from. Who is to provide it? Whose responsibility will it be? If local authorities are hamstrung with the block grant, we shall not have the initiative, imagination and drive which are necessary to bring into being the recommendations of the Royal Commission.
Since this may be a shortened debate, I have cut down many of the things I wished to say, because I know that some of my hon. Friends wish to take part.
§ Mr. William Ross (Kilmarnock)
My hon. Friend says that it may be a shortened debate. Is it not the rule that, if a debate is interrupted in these circumstances, the amount of time lost is automatically made up to us afterwards?
§ Miss Herbison
Yes, I know that, but there are sometimes difficulties because people who want to take part in the debate find it impossible to do so after ten o'clock. It is for that reason that I have attempted to deal with what I thought was important. I did not feel 272 it my duty, as did the Secretary of State, to go into every aspect of the Bill. I felt that we could do that in Committee. I wanted to show where, in general, we are in agreement, where we disagree and where we feel that improvements can be made.
We certainly welcome the Bill, since it could be a great step forward in alleviating much of the misery that is experienced not only by the people who suffer from mental illness, but also by many of their families. If all of us in the House—not only the back benchers and the front benchers on this side, but the back benchers and front benchers on the Government side—enter into the Committee stage with a desire to improve the Bill, when it leaves the House it will be fit to meet the needs which so many of us believe must be met and which the Royal Commission certainly recommended should be met.
§ 5.18 p.m.
§ Mr. Forbes Hendry (Aberdeenshire, West)
This is the first time I have had the honour to address the House. I therefore crave the indulgence usually accorded to a maiden speaker. I also crave forgiveness for speaking while suffering from a cold in the head. I ask to be forgiven because I regard this subject as of the greatest importance and as completely free from controversy.
This is a long and obscure Bill and, as the hon. Member for Lanarkshire, North (Miss Herbison) said, it may contain in its body bones of contention. But these are matters to be dealt with in Committee and do not affect the principle of the Bill, which is completely free from controversy.
Stripped of all its verbiage and administrative detail, the Bill does two things. First, it sweeps away a mass of ancient legislation dating back to 1811 and substitutes new thinking, new ideas and a completely new approach to mental health. It is very difficult for the public to understand exactly what that new approach is. I confess that, until very recently, I had very little idea myself of what modern methods of treatment and modern drugs can do for mental illness. It is now recognised that mental pain is very largely a cause of mental disease. Mental pain can be as real as the pain of childbirth or the pain of appendicitis.
273 When a woman is to have a baby, she consults her doctor. The doctor calls in the specialist and, ultimately, without formality, the woman goes to a nursing home, has her baby, returns home and is happy. If a person is suffering from appendicitis, he consults his doctor, he goes into the nursing home without formality, has the pain removed, and goes home happy. Up to now, however, if a person has been suffering mental anguish as real as any physical pain he has either had to be certified and taken away or he has had to sign a formal document to say that he is mad and wants to be detained.
That is old-fashioned thinking. It is what we have had for the last hundred years. The position is now completely different, and the Bill asks that that person should be in the same position as anyone suffering from any physical illness. As my right hon. Friend has said, the kernel of the Bill is in Clause 23, which provides that any person in need of medical treatment for mental disease may be treated in a hospital or a nursing home without any formality whatever. That is the whole spirit of the Bill. We should all support it and make sure, too, that the public understand the position.
Perhaps I can best illustrate my point by telling the House what is happening at Kingseat Hospital in my constituency. It has 750 beds and, although it may seem incredible, 550 people go into it each year and almost as many come out of it cured. That is a tremendous proportion of success. I had no idea of the magnitude of the success in such hospitals until I looked into the facts relating to this one.
I should like to give an example. A woman had been looking after her old mother for many years. The mother was querulous and difficult. The girl had a tremendous sense of duty and, instead of looking after her own interests and going out with boys and girls of her own generation, she looked after her mother. If she felt inclined to go out, she would ask her mother if she could do so, and the mother would say, in the difficult way that some old people do, "Of course you can go out. I won't really have a heart attack while you are out of the house."
274 Many a time, the wretched girl thought in her inmost mind that it would be a good thing if her mother died. When the old lady died from purely natural causes—heart failure—the girl got into a panic. She suffered unbearable anguish and felt that the only way to atone for her wicked thoughts was to commit suicide. She tried several times to commit suicide and had ultimately to be certified. By means of psychiatric treatment and modern drugs she was cured in a very short time and once more given a proper sense of perspective. All this happened many years ago. That woman now has a husband and a family and is a useful and happy citizen because of her treatment but the House must remember that she was a certified patient.
Last week, I saw a boy who had committed a petty misdemeanour. That had prayed on his mind so much that he was under the delusion that he was dead and in hell, and he suffered all the agonies of hell. Ten days after his admission, that boy found it almost impossible to believe that he had been under that delusion. In a week or two he will be back at work, a perfectly useful citizen. If the success at Kingseat Hospital is multiplied by that achieved in all the specialist hospitals, the value of the work will be seen to be beyond estimation.
The unfortunate fact is that both the woman and the boy to whom I have just referred were certified cases. There is no doubt that a hundred years ago they would have been in padded cells, and would not have been cured. Similar patients are being treated and cured but have to undergo all the indignity of either certification or the signing of an admission that they are mad and want to be detained. The Bill seeks to sweep all that away. I beg the House to give it an unopposed Second Reading and to leave discussion of the administrative details until later.
Finally, I should like to pay a tribute to the doctors and nurses who are making all this possible. I am sorry to say that they are at present the poor relations of their profession, and only the education of the public will end that. In Kingseat Hospital, the physician superintendent, Dr. Stewart, is carrying on work started by his father, and he has produced this tremendous success.
275 The matron, Miss Cooper, is a devoted and dedicated woman. As an attractive girl of 16 or 17 years of age she trained as a secretary and discovered, quite by accident, how mental cases were treated. She was quite certain that she knew how to treat them, and had the patience, the skill and the devotion to give up everything for this work. She is now running that hospital, handling a devoted staff, and producing these great results. It is proper that I should say that so that the public should know the sort of thing that goes on. The public and we as their representatives should give the doctors and nurses all the support possible in their work. I ask the House, I implore the House, to give the Bill an undivided Second Reading.
§ 5.25 p.m.
§ Mr. William Hamilton (Fife, West)
It is my very pleasant duty to congratulate the hon. Member for Aberdeenshire, West (Mr. Hendry) on getting over his first hurdle so admirably. He spoke in apologetic terms about his cold: I should like to hear his voice when he has not got a cold—it would compete with some on this side, very nearly. He showed every sign of being an asset to his party, provided he does not obey the Whips too rigidly. If he takes part in the Standing Committee proceedings irrespective of what his Whips say, we on this side will be all the happier. We look forward very much to seeing and hearing him in Committee and in the House on future occasions.
The right hon. Gentleman the Secretary of State for Scotland was not making his maiden speech, but his speech made quite a change. It was extremely conciliatory and augured well for the Committee stage. Speaking for myself, I am not at all sure that I relish the kind of atmosphere we shall probably get in Committee—I would much prefer the other atmosphere—but I suppose that we shall have to try to accommodate ourselves to it. It will depend a great deal on the right hon. Gentleman's attitude. His words are very often different from his deeds. We shall have to see whether his performance in Committee matches his words.
There is nothing more heartbreaking than to go into a home where one of the inhabitants is either mentally deficient or mentally ill. I had that very distressing 276 experience in Thornton during the last General Election. I went to a house where I saw a boy of 15 years. To look at him, one would have thought there was nothing wrong with him. He appeared to have great potentialities, but before I had been in that home very long his mother broke down completely.
The facts were that the boy was mentally retarded and one could see the parents shrinking away from an admission of what, I fear, is often the truth. The mother had tried to get the boy into a home because, as one of the reports rightly stated, one of the damnable features is the effect that this kind of thing has on the home environment and on the happiness of the family. The family was being almost destroyed by the very presence of the child. The mother deeply loved her child, as mothers invariably do in these circumstances. I did my level best to get the child taken away for his own good and for that of the parents, but I very much regret that because of the lack of accommodation there is no immediate prospect of the child getting out of that home. This is the extremely human issue that we must face.
Viewed in that context, the Bill is no more than a milestone on a very long road. I hope that we do not approach the problem from the viewpoint of complacency, that this is an administrative Measure dealing with the administrative problems and that the rest can be left to the initiative and imagination of local authorities. When it comes down to hard facts, it is money and resources that will be needed if we are to make any impact on the problem.
My hon. Friend the Member for Lanarkshire, North (Miss Herbison) was quite right in saying that the inauguration of the National Health Service has played a tremendous part in bringing us to this stage. Had we not had the National Health Service, I doubt very much whether we would have had this legislation today. It is made possible only through the resources that have been made available and by the more humanitarian and enlightened approach of the community to this problem, coupled with the enormous increase in medical knowledge and, not least, the part played by the B.B.C., the television services and 277 the Press in bringing to the public a more acute awareness of the problem in our midst.
Far too often in the past, we have found difficulty in finding time in the House of Commons to provide for minorities. When faced with a minority problem where not many votes are to be obtained—we are all vote-conscious—it is extremely difficult to get the House to focus its attention on a group which is not voluble and which has no pressure group to bring its problem to the House. We tend to sweep it under the carpet and to forget about it. One of the tests of our civilisation is the way that we bring the problems of minorities before the House. To that extent, today's Bill is an important landmark.
We congratulate ourselves on what has happened in the past, and I have seen it claimed that the record of Scotland in mental health over recent years—indeed, over the generations—compares favourably with the record of any other country. I am in no position to contradict that, but it is no ground for complacency. If we are the best, it does not say much for the others.
When I read some of the remarks of the Sub-Committee of the Standing Medical Advisory Committee in the Mental Deficiency (Scotland) Report for 1957, there is certainly no room for sitting back and thinking that all is well. All is far from well. One could quote paragraph after paragraph in that Report to show what I regard as a damning indictment of the neglect to which this service has been subjected, particularly in the years between the wars. In the 'twenties and the 'thirties, there was very little new building, with the result, as the Report makes clear, that after the war, with the scarcity of resources, there was an extremely difficult task to make up the leeway and to make any advance. Nevertheless, advance was made, perhaps not very dramatically, but it was an advance, not only in physical material provision, but in the attitude of the public.
Although my hon. Friend the Member for Lanarkshire, North said that a stigma still attaches to mental deficiency and mental illness, there has been a good deal of progress in the last several years. One of the results of this has been, so the Secretary of State said, that four 278 out of every five patients now enter mental institutions voluntarily. This compares with a figure of about 32 per cent. just before the war. This is a measure of the improved education of the public. Nevertheless, having said that, there is a great deal more yet to be done.
The educational process must go on, not least among local authorities. The Bill emphasises the increasing part that must be played by local authorities and voluntary organisations, most of whose members are laymen, all depending upon the education that they receive in this sphere from the experts. That is why we must give the local authorities every encouragement and the wherewithal to get on with what so many of them desire to do. It is no good voicing ardent aspirations unless we give them the means of carrying them out. This will be a practical point that we are bound to meet in Committee.
One realises, as my hon. Friend said, that there comes a point when we must decide whether certain activities of local authorities shall be mandatory or permissive. It is a difficult question to decide. I see the force of the arguments that were used by one of the committees that because resources vary so much from one authority to another, discretion should be allowed to the Secretary of State. On the other hand, there is a growing desire for uniformity of standards—of high standards. Precisely because of that, the Government are under an obligation to underpin and support the resources of those authorities which are not sufficiently wealthy to do themselves with their own resources what they would like to do.
We must recognise—we might as well be blunt—that there are some authorities with the resources but unwilling to carry out their duties as long as they are permissive. It is these laggard authorities whom we must get behind and say, "You are failing the community. If you fail them, we will step in and compel you to do what is your duty."
If I might refer further to what my hon. Friend said about the lack of psychiatric social workers and people of that description, clinical psychologists and so on, I should like to know what plans the Government have in mind for increasing the number of trained personnel in these fields. I hope the Joint Under-Secretary of State will not seek 279 refuge in the argument that this lies outside the ambit of the Bill, that it is more or less a legal administrative instrument and that the rest is dealt with within the terms of the National Health Service. I hope that he will give us some ground for hoping that we shall not fail because of lack of resources, either financial or personnel.
I should also be very glad if he would give us some information on the question of old people now being admitted into mental hospitals. I do not know what the latest figures are, but certainly the last few years have given us grounds for nothing but alarm at the number of old people going into mental hospitals. I have figures here for 1956, which I am certain will be improved upon now.
§ Mr. Hamilton
We shall be interested to hear from the hon. Gentleman at the end of the debate. In 1956, of the 2,000 patients who went into mental hospitals, 70 per cent. were over 65. The reason for that is precisely the inadequate provision of other accommodation for them. This again pinpoints the need for additional resources to be provided. I had intended to quote the paragraphs in the Report of this Mental Deficiency Sub-Committee, but it is there for everybody to see. It is the equivalent of the Devlin Commission's Report, and I hope that the Government will not treat it with the scant respect with which they treated the Devlin Report on Nyasaland.
In the House last week, we had a startling figure given to us of the money that we have given to private industry and agriculture between 1951 and 1959. A sum of £2,311 million has been given in the last eight years in the form of outright subsidy or grants to private enterprise in this country, and we are now discussing a Bill which will fail or succeed on the amount of money that we devote to this field. One could spend a few minutes on the sums of money which we have granted in this Parliament to, as I think, much less worthy causes than we are now discussing.
If the Government will give us some hope that the resources will be available, we can go into the Committee stage in the atmosphere which the Secretary of State indicated. It may be that if he 280 can give us that assurance, we will have a happy time in the Committee. Nobody will be happier than I to have that assurance, but if we do not get it, I can adapt myself to the other conditions just as well. I give the Bill a qualified welcome. At the moment, it is pretty much of a blank cheque, and we want to know how it is to be filled in before we give it our wholehearted support.
§ 5.45 p.m.
§ Sir James Henderson-Stewart (Fife, East)
I thought the hon. Member for Fife, West (Mr. W. Hamilton) was also going to make a maiden speech, as he began by cooing like a dove; but he proceeded to make a most penetrating, eloquent and in parts moving speech, and I myself was very much impressed by it. I find myself in large part in agreement with what he has been saying, as indeed I was with the speech made by the hon. Lady the Member for Lanarkshire, North (Miss Herbison).
On an occasion like this, most of us, I imagine, inwardly have the same desires and feelings. I think it is probably true that this is an infinitely better Bill than the one introduced for England and Wales some time ago. Most people who are knowledgable on this matter seem to take that view. If that be true, the credit is due to our own Scottish people—the Committees which drew up these two Reports, the Department of Health, our own officers and the Board of Control. All these are our own Scottish people who have devoted a great deal of pains and trouble to this work, and who deserve credit. I think the Government will also be entitled to some share of credit because they had to put all this into legislative form.
I do not think that we should forget that the Royal Commission produced a Report which our Scottish Committee examined with great sympathy, and many parts of which it found agreeable. In fact, much of what is found in these two Reports is drawn from the Royal Commission, and we might as well recognise that and pay our tribute to that body too.
There are two main topics that I have in mind. As the hon. Member for Fife, West has said, this is one of those matters which touch people's hearts. I suppose that what we are discussing tonight is the oldest and perhaps the 281 saddest of all the ailments that affect mankind, and it is natural, therefore, that as time goes on we should be making progress, changing our attitudes and so on. That is what we have to do here.
The first change that we seem to be making is in the alteration of the name of the Board of Control, which is now to be known as the Mental Welfare Board. I think that is wise, because, as the hon. Lady said, there was a slight dual interest in this matter, and it is better that this newly-constructed body should concentrate its attention upon the care of the actual patients rather than upon broader administrative matters. Therefore, I am glad that we have made this change, which I think will be very much to the good.
If I may turn to another matter, at the one end of the scale of the mentally disturbed we have these unfortunate people, who are a danger not only to themselves but to the public at large. These people have to be locked up—we know that—and locked up in conditions of supreme security. We have to recognise that that has to be done, because the public need that protection. The experience we have had in the last two or three years of men escaping from these institutions in England, with the furore that resulted and the anxiety created in the locality, is such that the Government simply have to take note of it. Therefore, I hope that these new State hospitals, as they are to be called, will be places of real security, so that, while everything proper is done for the inmates, the interests of people outside will always remain one of the major concerns of the Government.
I am, however, concerned principally about Part II of the Bill. Unless we can make Part II work, unless we can ensure that local authorities in all their departments work closely together in an integrated fashion and with enthusiasm, we shall not make a success of the Bill at all. The hon. Lady the Member for Lanarkshire, North, was critical, naturally—I do not object—of the proposal to make a change in the integration of functions of the health and education departments of our local authorities. Is she right about that? She has, I know, great experience, but our own Scottish Committee looked into the matter and came to the conclusion that there was a 282 lack of integration among our Scottish departments and it was not altogether good that they should all be separate.
There is, I think, a paragraph on page 11 of the Second Dunlop Report on Mental Health Legislation in Scotland which brings out that very point. While I do not wish to dogmatise, I believe that there is a case for the view expressed by the Committee that there should be closer integration, even if it means abandoning some of the old associations with this or that committee. I have an open mind about it.
The hon. Lady referred also to the question whether there should be duties or powers laid upon local authorities. She quoted the Report of the Royal Commission which came down fairly solidly on the side of duties. Our Scottish Committee did not do that. If we are to pay any attention to the advice of our advisers, we must note that the Dunlop Committee, admittedly after some hesitation but nevertheless finally, came down on the side of saying that it would be better on the whole if local authorities were given powers only, it being understood that the Secretary of State would always be behind to impose duties whenever be thought it right.
Again, I invite the hon. Lady to consider whether that may be a better answer than the advice which she ventured to give to the House. I understand very well what the hon. Member for Fife, West meant when he spoke about the various nature of local authorities, at different stages of advance, and so on. Local authorities are not all the same. What they seek to do is not the same. To regard them all as one and the same and equal is not, in my view, practicable. There is, therefore, something to be said for the proposal in the Bill to leave these matters as powers rather than duties.
I come now to consider the position of old people. It is really heartbreaking to go into one of the great mental hospitals, such as the one we have in Fife, and see there the scores and scores of old people, some of whom have been in for years, not because they are all mentally defective so much as because they have nowhere else to go. I am told that in the Fife Mental Hospital 40 per cent. of the inmates are old people like that. I know that the figure 283 may not be so high everywhere, but that is the information I have in respect of Fife.
It cannot be right that the mental hospital should be the only place where that kind of old man or old woman can go. I am, therefore, strongly of the view that we must do what the Committee itself recognised as necessary, namely, build up what are called hostels for old people outside mental institutions. This is, of course, another geriatric problem. I do not know whether we in Fife are more troubled about it than the authorities in other places, but as the hon. Member for Fife, West and I know full well, the problem of caring for elderly people in that part of Scotland is a source of constant anxiety to us. I would go a long way to urge the Government not only to impose duties, but to give local authorities the funds to make an exceptional advance in the matter.
During the election campaign, we were all confronted with the problem of the old-age pension. I suppose that most of us would have been only too glad to be able to say, "Yes, we will double it". Unfortunately, we could not. But here is something which all parties can agree about. Here is something which the House would be unanimous about. Let this be our contribution towards meeting the needs of the old people. Let us give them a chance to spend the last days of their lives in reasonable comfort outside mental homes. That is the simple plea I make.
I welcome the Bill and I hope to be able in Committee to play my part in improving it, particularly in Part II which seems to me to hold out the greatest hope.
§ 5.52 p.m.
§ Mr. Bruce Millan (Glasgow, Craigton)
The Secretary of State, in introducing the Bill, said that it was largely a piece of codifying legislation. Anyone who has tried to pick his way through the existing legislation on mental health will not disagree about the need to introduce a Measure to make the present situation a good deal clearer than it is.
Many of the matters to which the right hon. Gentleman referred and many of the provisions of the Bill itself are extremely important from the point of view of civil liberty. In particular, there 284 is the procedure for certification and the procedure for discharge. It seems to me that in that part of the Bill, at least, we have a system of procedure which, in the view of most people, will provide a great deal of protection for the patient, the position of relatives, guardians and so forth, and also from the point of view of the community itself. There may be certain defects in the provisions which deal with certification, but I imagine that the House as a whole will accept the spirit in which that part of the Bill has been drafted and, if minor Amendments are required to improve it, they will, no doubt, be readily made in Committee.
Apart from those provisions to which I have just referred, the great importance of which we all appreciate, there are certain other provisions which some of us regard as of even greater importance. In paragraph 2 of the Explanatory and Financial Memorandum, it is said:The Bill does not involve any substantial new net charges upon central or local funds".This indicates something which certain hon. Members on this side, at least, are disturbed about and, judging from what the hon. Member for Fife, East (Sir J. Henderson-Stewart) said, it disturbs some hon. Members opposite also.
The implication of that paragraph in the Memorandum is that the general arrangements for dealing with mental illness in Scotland are quite satisfactory at this time. We on this side of the House, I think, would take objection to that suggestion. As a matter of fact, reading the various Reports of the Scottish Health Services Council and other bodies which have considered the matter during the last few years, no one could come to the conclusion that the general facilities for dealing with mental illness and deficiency in Scotland are anything like adequate.
We are, therefore, concerned lest Clause 7 of the Bill should give a wide range of powers to local authorities without making the exercise of those powers mandatory. There may be certain administrative difficulties—we all recognise that—in making the powers mandatory, since local authorities are of different sizes and have different resources; but it is very important that the powers which are laid down by Clause 7 should be exercised to the full. In view of the history of the treatment of mental health in Scotland during the last twenty or 285 thirty years, I do not believe that many people will be satisfied with a Clause which gives permissive powers which are to become mandatory only at the direction of the Secretary of State. Therefore, we shall want to strengthen the Clause to ensure that, despite the administrative difficulties, all concerned play their parts to the fullest possible extent.
My hon. Friend the Member for Fife, West (Mr. W. Hamilton), mentioned a matter which I think is of very considerable importance, namely, the shortage of accommodation for mental defectives in Scotland. The Scottish Health Services Council Sub-Committee which reported on Mental Deficiency in Scotland in 1957 had something to say about this matter. It estimated that probably there were about 40,000 defectives in Scotland. One would hope that that is an exaggeration, but that estimate was based on the best evidence available to the Sub-Committee at that time. The total number of certified mental defectives was only 7,853, but it was estimated that there was a shortage of accommodation for at least 5,000 mental defectives.
It is very important that there should be adequate accommodation for mental defectives. It is not by any means true that every mental defective requires institutional care, but it is important that those who require it should have it available to them. It is important From the point of view of the patient himself and it is in the interests of the community. As my hon. Friend the Member for Fife, West said, it is also Important from the point of view of the patient's family. Although the question of accommodation is not directly relevant to the Bill in that it is a National Health Service responsibility, it is nevertheless to be hoped that the Minister who winds up the debate for the Government will be able to set our minds at rest to some extent about the shortage of accommodation.
Apart from the question of accommodation, directly related to the matter is the question of discharge. I must join in the congratulations to the hon. Member for Aberdeenshire, West (Mr. Hendry) on his maiden speech. He mentioned the remarkable success of many mental hospitals with the mentally ill. Many, perhaps the majority, of mentally ill patients are short-term 286 patients, but that is by no means true of mental defectives who are certified and sent to mental deficiency institutions.
There is what is to me an appalling paragraph in the Report to which I have already referred, paragraph 30, which deals with discharge from mental deficiency institutions: It reads:The discharge rate (including discharge on licence) varies greatly between different institutions and this cannot be accounted for solely by differences in the types and grades of the inmates. In three large institutions, each dealing with similar types of defectives, the proportions of patients on licence on a given date were 11 per cent., 3 per cent., and 1½7 per cent.; for all institutions the percentage on licence varies from 19 per cent. to 1 per cent.It seems to me that there is something very wrong if that is the position.
This is a matter of supreme importance from the point of view of the community. One of the great difficulties which we have encountered in getting a sane attitude towards mental illness is the prejudice among people that there is a permanency about mental illness and deficiency. That is the major factor which contributes to the sense of hopelessness which many people feel who find themselves confronted with it in their family. It is important—it is being increasingly realised—that people should know that mental illness very often is of short-term duration. I think that it is equally important that people should know that mental deficiency can be treated to some extent and that it is possible to ameliorate the condition at least to the extent that many people suffering from mental deficiency and needing institutional care can be brought back into the ordinary life of the community within perhaps a comparatively short time, or, in difficult cases, after a longer period. The prospect of some sort of amelioration of their condition is often good.
If some mental deficiency institutions in Scotland are able to discharge a comparatively large proportion of their patients after a period of care and treatment and others are not able to do so, it seems to me that a good deal of investigation is required, and we should ensure that institutions which are falling behind are brought up to the standards of the rest.
I should like to mention another point in connection with discharge from mental deficiency institutions. It also applies to 287 the discharge of the mentally ill. I hope that we might hear something on this matter from the Minister who replies to the debate this evening. One of the things which is most needed to make the rate of discharge as high as possible is an intermediary stage between the patient being in hospital and his return to the community. The Second Report of the Committee of the Scottish Health Services Council on Mental Health Legislation in 1959 recommended that powers should be granted to regional hospital boards for the establishment of hostels as an intermediary step between the hospital and the return of the patient to the community.
There is no specific mention of this in the Bill. Perhaps this is excusable, but I wonder whether the right hon. Gentleman can tell us whether the powers granted to local authorities under Clause 7 are sufficiently wide to enable them to build hostels for the treatment of discharged mentally ill and mentally defective patients. I hope that the powers are wide enough. If they are, that will bring us to the question of the need to make the powers mandatory, and also, as has been said, it will bring us to the question of the Government having to face the fact that, before the mentally ill in Scotland can be properly treated, we shall have to spend a good deal more money.
I should like to turn to a matter about which I am in some doubt and which probably causes confusion among other people, namely, the treatment of mentally defective children of school age, between 5 and 16. It was recommended in the Second Report of the Committee of the Scottish Health Services Council that there should be some transfer of responsibility from local education authorities to local health authorities. Where, under existing legislation, an education authority had been operating occupational centres, these centres should be transferred to the jurisdiction of local health authorities.
I naturally expected, and I think that there was a general expectation, that the Mental Health Bill would provide for that transfer of responsibility. I may have misread the Clauses dealing with this matter, but, so far as I can see, the Bill does not change the position 288 with regard to the question of responsibility. I have the impression that my hon. Friend the Member for Lanarkshire, North (Miss Herbison) and the hon. Member for Fife, East implied that there had been some transfer of responsibility. If it is not proposed that there should be a transfer of responsibility, I am glad to say that I agree, and I think that that is not only the opinion, naturally, of education authorities but the opinion of some of the people most directly concerned, particularly the Association of Parents of Mentally Handicapped Children. I will be very pleased to hear that no change is contemplated in the Bill.
That represents a victory to those who feel that the education authorities are the right people to deal with mentally deficient children from the age of 5 to 16 years, except in the special case of those who are neither educable nor trainable because of associated physical handicaps or because they are too seriously affected mentally or for some other reason.
If it is true that, with that exception, education authorities are still to be responsible for the training and education of mentally defective children from the age of 5 to 16, it is perhaps opportune to put in a plea for the treatment of children beyond the age of 16 years. It is obvious that mentally defective children at 16, by definition, have a mental age considerably lower than that, and if it is a good thing that ordinary children should have education at least up to the age of 16 it is obviously absolutely essential that if mentally defective children are to be trained reasonably at all they should have training beyond the age of 16.
The figures for occupation centres up to the age of 16 are bad enough, but the figures for training centres beyond that age are absolutely disgraceful. There are at the moment 48 junior centres, apart from special schools, with almost 1,400 children attending them in Scotland. The number of senior centres for those over 16 is only 14 and the number in attendance is only 339. This is a situation which all hon. Members must find quite unsatisfactory. I hope that every encouragement will be given to local authorities to get on with this work, not only with the junior education centres but particularly with the senior 289 centres, and also industrial training centres, because I do not think that there is even one such industrial centre in Scotland at present.
These are some of the reasons, incidentally, why we feel that Clause 7 should be strengthened. No provision at all is made for the high-grade mental defectives who, with a good deal of training, might be able to find some kind of perhaps restricted employment in various occupations. A great amount of work still remains to be done and, whatever its virtues, the Bill needs strengthening in many respects. I hope that when in Committee we on this side of the House come to move Amendments which will have that effect, we shall have co-operation from the Government.
§ 6.12 p.m.
§ Sir Thomas Moore (Ayr)
This problem of mental ill-health has always seemed to me one of the most difficult questions that face our doctors and our social workers. What is it? Where did it spring from? Why are there so many imprecise forms of it? These are some of the questions. For instance, I have a constituent who is no longer young but who was a young man when he was sent to Broadmoor twenty years ago. He writes perfectly normal and intelligent letters. He discusses topical matters with interest and alertness. He is pleasant in his manner and almost mild and apparently he thinks coherently. Yet successive Home Secretaries, including the right hon. Member for South Shields (Mr. Ede), conscientious, humane men, have refused time after time to allow that man to be released. Each in turn, at my request, has had the man independently examined by doctors and psychiatrists and, in turn, the result has been the same. He has not been allowed out of Broadmoor.
I have wondered at times whether there was something deficient in the treatment of these patients or whether the nurses were of the right type. Fairly recently I have had some encouragement in that view from an experience in my constituency. There is a mental home there which, according to time-honoured custom, is one of the places which I visit during a General Election campaign. Up to fairly recently I was allowed to speak only to the nurses. It seemed that the other inmates, perhaps, would not fully appreciate the wisdom of my remarks.
§ Sir T. Moore
The other inmates seemed to me to be in some degree segregated. I am speaking, of course, of a few years ago and not of the last General Election. The place was then called an asylum. A stigma is attached to anyone who has been in an asylum and to anyone who has been certified, as we all know, but it has always seemed to me a great pity that such a kindly word as "asylum" should suffer such a nasty reputation as it now has through being associated with mental defectives.
All this is very different today. There is a new superintendent in that place and it bears a new name. It is now called a "home". Not only have these changes taken place, but there is something far more important in that there has been an entire change of atmosphere, which is beyond description. One receives a happy carefree impression not only from seeing the attractive, well laid out grounds but from seeing the expressions on the patients' faces. Visitors are welcome and a free mixing of patients, nurses and visitors seems to be the order of the day. It is now a pleasant place to visit whereas before it was rather forbidding.
These are some of the reasons why I welcome the Bill. I believe that it will do a great deal to expand, develop and perpetuate this change which has been sc marked in the one mental home of which I have been personally aware. It was George Bernard Shaw who first publicly familiarised the British people with a word with which we were perfectly familiar privately and it is in order not to risk the displeasure of the Chair that I quote Bernard Shaw in applying that word as an adjective before "good" to describe this Bill.
The Bill contains three or four outstanding Clauses which I think will appeal to the public. Clauses 24 and 27 control the admission of a person to a mental home and Clause 39 contains controls over detention. We have had many cases in the last few years of men and women who have spent almost all the best years of their lives in such institutions as these when they were apparently perfectly normal people. We must, 291 therefore, ensure that there are—and indeed there are—definite ordinances in the Bill which make it perfectly clear that the greatest care will be taken before a person is either admitted to a home or detained there. There is one Clause which is especially important because it provides adequate machinery for ensuring the discharge, when cured, of people previously mentally defective.
The Bill is full of safeguards which within my recollection have not existed previously. For example, I welcome the right of appeal to the sheriff. This will give the public more confidence in the administration of the Bill when it becomes an Act than almost anything else.
There is the establishment of the Mental Welfare Board to take the place of the Control Board. This is also a step in the right direction because of the psychological effect of the word "control" compared with the term "mental welfare". The Board will have an important function to carry out, and much will depend on the quality and character of its members. Of course, the Secretary of State for Scotland and his assistants are fully aware of those necessary factors. Clause 95 deals with ill treatment or neglect, although none of us would like to think that this would take place in any of our mental homes. Clauses 96 and 97 are endeavours to safeguard the sexual health of patients.
For all those reasons, I welcome the Bill. It is a great step forward along a most difficult path, and I hope it will have a non-turbulent career during the Committee stage, although I gather that there are some threats to the contrary.
§ 6.22 p.m.
§ Mrs. Judith Hart (Lanark)
I join with my hon. Friends on this side of the House in welcoming the Bill simply because it represents an up-to-date concept of mental health, of the treatment of mental ill-health, and particularly because it represents a modern idea of individual liberty. Whatever one's state of mind may be, the Bill represents the fact that whether an individual be mentally fit or ill, whether he be highly intelligent of mentally defective, he has the same rights as other citizens to the protection of society. This is one of its Mat important aspects.
292 I shall direct my attention to Part II, which interests many of us. This part of the Bill relates to the functions and powers of mental authorities. It is true to say, I think, that the new powers given by the Bill are small. There is the power to provide residential accommodation, which is important, and there is also the power to ascertain mental deficiency among children under the age of 5 in categories hitherto not covered. There are other powers, but, by and large, I think it is true to say that most of the necessary powers for a local authority to give community care to the mentally ill and the mentally defective in its areas already exist under present legislation.
For instance, if we take the National Health Service (Scotland) Act, 1947, we find that a wide range of powers are given there for the care of the mentally disordered in the community. There are powers to make domiciliary visits and to take after-care measures in order to look after those discharged from mental institutions, mental hospitals and so on. There are powers for advising and supervising the mentally disordered in their own homes, whether they be mentally deficient or mentally ill. There are powers for the provision of diagnostic and advisory clinics. There are powers for setting up a mental health committee or sub-committee, and there are powers for the appointment of welfare workers to carry out all the domiciliary duties for which powers already exist. There is the power for an education authority to provide child guidance, and it is not purely for the purpose of education but also for the purpose of diagnosing, advising and treating those children in the community who are mentally or emotionally disordered, thus laying a foundation for the prevention of mental illness.
What is happening with these existing powers? When we look at the situation as we find it today there is a clear indication that three things have been occurring in the years since the end of the war. Let us limit ourselves to those years in which public knowledge and awareness of mental health and mental illness, and the way it should be treated, has been progressing rapidly on all fronts.
We find that not enough money has been spent on providing the things for which powers exist already under the 293 National Health Service Act. We find that not enough attention has been paid to staffing the services which are to administer the existing duties. I am glad that the Secretary of State for Scotland has come into the Chamber because I am going to say something to him, through you, of course, Mr. Speaker. I am sorry to say that we have seen in the last fifteen years, and over the last ten years particularly, a failure on the part of the Scottish Office and the Government sufficiently to impress upon local authorities their obligations and the need for them to do a great deal more than they have been doing.
I now turn in detail to one or two of the measures I have mentioned. It seems to me logical and natural that only where there is a mental health committee or sub-committee appointed within a local authority shall we get the job of community care carried out really effectively. We shall then get the people who are interested in carrying out the task. We shall gather together people with knowledge and experience and so have a better chance of doing the job well. Although powers exist already for this to be done, what do we find when we look at the figures? We find that out of 143 county councils and county boroughs in England and Wales 119 have appointed mental health committees or sub-committees, but that out of 49 county councils and large burghs in Scotland only one has so far appointed a special committee to deal with mental health.
This measure of appointing a special mental health committee was recommended as long ago as 1946 by the Russell Committee, which, it would seem, envisaged a composite committee composed of the interests of welfare, health and education. There are various ways in which its recommendation could have been carried out, but there has been far too little exhortation coming from the Secretary of State to induce local authorities to appreciate their responsibilities to do this work.
Again, let us look at diagnostic clinics, for which powers already exist. The sub-committee of the Standing Medical Advisory Committee stated in its Report in 1947 that a proper system of mental deficiency clinics, which would diagnose and advise and give some supervision, would be a most effective method of 294 reducing the numbers of mental defectives confined to institutions. That would be a tremendous help in keeping the mentally disordered in the community, and, socially desirable as that is, it is also economically desirable, because the more we can cut down the cost of providing residential accommodation, the more money we shall have to spare for doing many other necessary things.
What did the sub-committee say? It criticised the delay in organising and developing. What advice has been coming from the Scottish Office within the last few years to local authorities on this question? Have the Government endeavoured to impress on local authorities what they can do to improve conditions to meet the modern requirements of a good mental health service?
The Russell Committee, reporting in 1946, said that it had considered mental deficiency clinics, and recommended not only that they should exist but that they should exist on a broad basis, and that after-care and rehabilitation should be carried out through them with the assistance of psychiatric social workers.
I now turn to another less directly connected, but infinitely important, aspect—child guidance clinics. Those which exist and which are the responsibility of regional hospital boards are doing a wonderful job. There is a child guidance clinic attached to the Royal Hospital for Sick Children in Glasgow. It is primarily a research clinic. There is the Nôtre Dame Clinic in Glasgow, and also a clinic in Edinburgh. One can find many child guidance clinics attached to regional hospital boards, but they cannot pretend even to begin to meet the needs of the community.
Too little has been done by local education authorities to provide child guidance clinics. We may find local education authorities which have set up child guidance clinics. They may seem to be working very well, but when one looks into them one finds that there is no consultant psychiatrist and no psychiatric social worker attached to the staff. The clinic consists largely of educational psychologists who are being used to further the educational requirements of the community rather than give attention to the mental health aspect of a child's upbringing. When a child of five, six or 295 seven starts developing an emotional disturbance to a degree that makes his mother go to the doctor to ask for advice, it may be that there is a child whose educational progress will be retarded by his emotional difficulties, and to that extent the educational psychologist at the child guidance clinic is justified. It must be realised, however, and this is much more important, that here there is an incipient mentally ill child and the provision on an adequate scale of properly staffed child guidance clinics throughout Scotland would be the finest and most positive single measure that one could take actively and positively to promote mental health in the community. I hope that the Secretary of State for Scotland will remedy some of the inadequacies of the Department of Health for Scotland and exhort local authorities to do what I am suggesting.
There are other aspects of community care. Apart from the mental defectives which have been mentioned, we know that in 1957 over 9,000 mentally disordered people were discharged from hospital. Some of them had recovered, but not all of them. Some of them had partially recovered. Some of them had made very little progress. The majority had done extremely well and made rapid progress to a good state of health, but even they needed care. They needed after-care. They needed supervision. Let us think of this in human terms. They needed to be put into the right job with the right kind of employer. They needed a family who understood their problems. They needed integration into community life again. A great deal needed to be done by way of domiciliary care even for those patients who had made remarkable progress while they were in hospital. For the others who had made either partial progress or very little progress there was a need for after-care, and the provision of advice at home was even more necessary.
Old people are in another category. We have to recognise that, as we develop our physical health services in such a way that we extend life, we are up against the problem that while an old person may be fit physically he may be far from fit mentally.
I know of an old lady who at the moment is living with a family. She 296 is living with her daughter, her daughter's husband and their three children. She is mentally confused. She has reached the stage with which many of us are familiar, perhaps with members of our own family, that she dare not be left alone. One does not know what she might do. She might do something with the electricity plug or the gas tap, or with matches. She might do almost anything. She might walk out of the house and try and get on a bus. We know the problem that exists for that family.
That is typical of that kind of mental illness and disorder. It is not an individual problem but a family one. The worst aspect of the case is not the difficulties of the old lady herself but the difficulties that she is imposing on the young children in that family who cannot understand. As a result a very difficult atmosphere has been created. The family is trying to face the need for this old lady to go into a residential home. They do not like the idea of that happening. None of us likes the idea of it, but if there existed an occupation centre provided by the local authority to which this old lady could go during part of the day, many of the problems of that family would be solved and they could cope with the problem during the remainder of the day.
Psychoneurosis is known to all general practitioners in our modern communities. These cases legitimately qualify for the care and advice of the skilled psychiatric social worker. We also have the mentally defective people who are in these hospitals. What is happening about all these people in our society in Scotland today?
The sub-committee on mental deficiency said in 1957 that it found little evidence that these obligations about after-care were being fulfilled. Is that surprising? Can they be adequately fulfilled under the new Bill? Unless the Government are prepared to say that money will be devoted to training the workers who are needed, that money will be spent on providing the buildings which are needed and that local authorities will be given the assistance that they must have if they are to play their part in carrying out the powers given to them under the Bill and under previous legislation, no progress will be made.
297 Let me now consider the staffing position. When one looks either at the staffing position or at the finance, or at whatever aspect one likes, one finds that there are two kinds of local authorities. There are the local authorities who have good intentions and want to do their best to provide a good mental service in the community, but who are limited by lack of finance and staff. The other group consists of authorities in whose areas, unfortunately, one finds a state of primitive neglect of mental health. In those areas one can say that a state of bedlam exists for dealing with mental health.
There is no other aspect of medicine in which there is such a gap between knowledge and practice as there is in mental health. It is a gap which can be filled only if the Government are prepared to turn their attention to the need for fully trained staff to carry out the tasks given by the Bill to local authorities.
I come now to mental health workers and mental health medical officers. I understand that there are only two senior medical officers in Scotland engaged wholly in mental health with the highest salaries and prospects of promotion that those higher appointments involve. That is not enough if we are taking mental health seriously.
Much information has arisen from the discoveries of the Younghusband Committee about social workers; some of it related to Scotland. One of the facts which emerges from the Younghusband Report is that although there are said to be 118 welfare and mental welfare officers in the Scottish counties, when that figure is studied in detail it is found that 70 of them are also district clerks. Those of us who know how our district councils work know that if a district clerk is doing his work properly he has no time to be a mental welfare officer as well.
That is the kind of thing which makes a mockery of the whole position of our mental health services in Scotland. Taking those workers who are fully engaged in the mental health services, welfare workers of one kind or another, whether fully qualified or not, the Younghusband Report shows that those people of whom we are so desperately short are wasting a great deal of their time doing work which could be done by clerks, 42 per 298 cent. of their time being taken up by writing reports and letters, and that they have no cars for travelling and that we are, in fact, employing only half the number Which we say we are employing because half of their time is used not on mental welfare work but on unnecessary clerical work in the background.
The most disturbing fact of all is the position about psychiatric social workers. I am trained in sociology and, perhaps because of that, I should be one of the first to realise that I should never venture to undertake any social or mental case work without the two years' mental health training that a psychiatric social worker has. I remember that the Secretary of State said that this was a devoted army of workers. It is a devoted army, but this is the one subject above all others in which devotion cannot be substituted for skill, technique and training. One must know precisely what one is doing when one is dealing with an individual and with a family with an elaborate, complicated background of mental ill-health. One cannot afford to make mistakes.
One of the most dangerous signs at the moment—and I beg the right hon. Gentleman to make certain that this will not be allowed to happen and to assure me that it is not to happen—is that in order to make an effort to implement some of the new powers in the Bill, local authorities will gather together people without adequate training in order that they can say that they have people doing the job. That would be a dreadful thing and would do irreparable harm for the future.
I notice from a reply which I received today from the Secretary of State that five psychiatric social workers are now employed in Scotland. I understand that not all the five are fully qualified and trained psychiatric social workers. According to the Younghusband Report, a year or so ago there were only two psychiatric social workers in Scotland employed by local authorities on community care work. I have since discovered that neither of those is now employed on that work, both having left.
Here is a tragic situation. What is the answer to it? How are we to find the men and women with the highly 299 skilled technique which is necessary unless the Government spend money on training schemes and recruitment and are themselves sufficiently impressed with the importance of having this body of people to undertake the work of the mental health service?
I am very well aware that there is a certain background discussion—I think that dispute is too strong a word—about the rôle of the psychiatric social worker and the rôle of the health visitor. In at least one city in Scotland, Aberdeen, health visitors have been given a very comprehensive course on mental health education so that they can take some part in mental health welfare work.
I am sorry that my hon. and learned Friend the Member for Aberdeen, North (Mr. Hector Hughes) is not here. Aberdeen is, perhaps, one of the most progressive cities in Scotland in mental health work and community care, and has far more facilities than any other city in Scotland. For example—and here is something which other local authorities could well emulate—when it is dealing with children who come into care, children who have been deprived and neglected and among whom there is likely to be a very high incidence of mental disorder of some kind, the children are sent to a reception centre, which is fully staffed and which has a consultant psychiatrist, an educational psychologist, a warden, an assistant warden and a psychiatric social worker in attendance. The children stay at the Craigielea Reception Centre for up to two months so that a decision can be made in the light of all the knowledge about what is the best way of taking those children into care—whether they should go to foster parents or to some kind of home. That is the kind of approach which we need, so that infinite care can be taken with every individual who needs help in any of our community services.
Aberdeen is the first to recognise that the psychiatric social worker can do a skilled job in a way that even the health visitor trained in mental health can never do it. I think that the answer must be that health visitors who have been given a short course on mental health training can work only under the skilled supervision of fully trained psychiatric social workers.
300 I have heard, to my dismay, the suggestion that Glasgow and Edinburgh might give brief courses of two or three lectures to their health visitors and turn them out to do social case work in mental health. That would be dreadful, and I implore the Secretary of State to see not only that that kind of thing does not happen but that that suggestion is not taken seriously by any local authority in Scotland.
There is the difficulty, which we have to face, of enabling even the most progressive local authorities to understand that this is a very new idea and a new approach to mental health and to appreciate the rôles of the different specialist services in administering the mental health service. That is not easy for a person who becomes a member of a local authority, a person with a wide experience of many subjects, but whose experience does not touch—as, indeed, how should it—mental health work. It is here that the Secretary of State has his job to do. Here is a wonderful opportunity for the right hon. Gentleman to see that in the next four years Scotland makes the progress which it should have been making in the last ten.
It seems to me to be easy to introduce a much faster rate of progress with the Bill and to ask for a tremendous move forward over the whole range of mental health work so that these powers are translated into duties. I appreciate the difficulties about making the powers mandatory—the difficulties being the shortage of staff—but I support my hon. Friends who said that unless the powers were made mandatory it was unlikely that the step necessary to implement them would be taken.
Finally, I make one or two suggestions about filling the tremendous gap in the number of adequately trained social workers available and required to administer the service. We all realise that one can only talk of the service in terms of the individuals who are carrying it out. If we do not talk about the workers who are to carry out the service and the atmosphere of it we are talking just so much hot air. So let us direct our attention to the ways in which we can meet this challenge.
301 We must realise that the salaries and the status of the social workers in the sphere of mental health are not high enough to be an impressive inducement and to lead to an increase in recruitment. I think it true to say that in most cases these social workers engaged in local authority work would be lucky at the end of their careers to earn salaries exceeding £700 or £800 a year at the most. Generally, it will be found in any local a authority Which employs such people that the majority are earning about £600 a year. That is not enough.
To recognise the importance of the job they are doing, the highly skilled nature of their education and training and the need which we have for them, I suggest that their salaries and status should be at least comparable with those of many groups of teachers in Scotland. They are doing an equally important job. It must be the direct responsibility of the Government to provide training courses, not only for young people who may be induced to enter the service, but also in-training courses for men and women who already work on the fringe of welfare service in the local authorities, who are consumed by an interest in the work and who feel that they would like to take the training and become fully qualified workers.
I have been told of regrettable cases in Scotland within the last year or two when permission to take the mental health course at Edinburgh University, which would qualify a man to be a fully-trained psychiatric social worker, has been refused to somebody working for a local authority. Here was an opportunity for the local authority to acquire a worker with the training needed, but permission for him to have leave of absence for two years to take the training was refused. This man left the employ of the local authority to take the mental health course, but it is extremely doubtful whether he will go back to work for the same local authority.
There should be normal training courses on a vastly extended scale and training courses for people already in the service. Where are we to find some of the people we require? I suggest that the Minister should consider carefully the possibility of recruiting married women who have reached, or will soon 302 reach, middle age. The Younghusband Committee found that only forty-four married women were employed part-time in social work in the whole of Great Britain, yet this is a field in which it would be desirable that such women should be found employment. We want people who have lived balanced lives to administer the social services, particularly in connection with mental health, and the sphere of recruitment should be extended as far as possible. Here is a possible source of recruits, women whose children are at school, women who are no longer needed at home throughout the day and who, after having a short refresher course, could return to social work and do an extremely good job.
This is one of the most urgent challenges to our society, and unless we can face the challenge of promoting mental health in the same way as our ancestors in the last 100 years met the challenge to provide physical health we shall be a doomed community. We know all about the stresses and strains of modern life, and, indeed, we now diagnose as mental illness much of what would have been dismissed in past years. We now know that we must regard persons suffering from mental illnesses in the same way as people suffering from physical diseases and we realise that they can be cured if the will to do so exists. So I say let us welcome this Bill and ensure that its provisions are carried out by all local authorities in Scotland. Let us ensure—this is the most important aspect—that enough money is spent to enable this to be a Measure which will mean something in the history of Scotland, and that it will not merely be another piece of paper for the Statute Book.
Do not let us pretend that there is any shortage of finance by which help may be given to local authorities on a generous scale, but let us finance the positive promotion of mental health. As was said by my hon. Friend the Member for Fife, West (Mr. W. Hamilton), no one who has observed the way in which money is given or loaned to private enterprise in order to make a profit can doubt that if money can be found for that it can certainly be found, even by this Government, for this purpose. We cannot legislate for enthusiasm, and that, above all, is the quality needed for 303 this mental health service. I hope that the Secretary of State will be able to promote that enthusiasm throughout Scotland.
§ 6.57 p.m.
§ Mr. William Ross (Kilmarnock)
When we started our discussions on this Bill there seemed to be an atmosphere which presaged a changed attitude in the Scottish Standing Committee when eventually the Bill is discussed there. It seemed that we should have a Bill on which we were all agreed, and one which we could discuss without controversy.
It may well be that after hearing the last few speakers, the Secretary of State for Scotland may have detected a certain measure of concern that the financial provisions or the implications of this Bill might lead us once again, as always in the Scottish Standing Committee, into the paths of acute controversy. At any rate, if the right hon. Gentleman did not realise that following the speech of my hon. Friend the Member for Lanark (Mrs. Hart) he will appreciate that, although this Bill is well received by hon. Members on both sides of the House, its passage will not make any great difference to the actual problems of mental health, the actual treatment of mental health or the provision of the necessary facilities for dealing with it.
The right hon. Gentleman started his speech by saying that we were dealing with a Bill which consolidated Acts of Parliament relating to lunacy and mental deficiency ranging over about a century. He said that when he had gone into the matter he had entered a legal labyrinth 304 of archaic phrases, and that now we were to get rid of them. He will receive all the help in the world from hon. Members on this side of the House to get rid, not only of the old phrases, but of some which he has let slip.
I was interested to note that the right hon. Gentleman said we were to get rid of the term, "Her Majesty's pleasure". Looking quickly through the Bill, I notice that that phrase occurs at least twice. If the right hon. Gentleman examines the Bill during the enforced interval in this debate which we are to have shortly, he will see that it occurs in the Second Schedule and I think in Clause 64 in Part V of the Bill relating to the detention in hospital of those concerned in criminal cases. I hope, therefore, that when we discuss Clause 64 in the Scottish Standing Committee—that will probably be in three or four years'time—the right hon. Gentleman will appreciate that he has already prejudged the Clause and he will be able to accept an Amendment making a desirable change.
The complexity of the provisions will not be such as will discourage hon. Members from closely examining the Bill, because we appreciate its tremendous importance in relation to so many people in Scotland, not only people who are immediately—
§ It being Seven o'clock, and leave having been given to move the Adjournment of the House under Standing Order No. 9 (Adjournment on definite matter of urgent public importance), further Proceeding stood postponed.