HC Deb 12 May 1967 vol 746 cc1911-27

1.0 p.m.

Mr. T. L. Iremonger (Ilford)

The House has just been debating collective madness and the scant hopes we have of doing something to combat it. I shall talk about individual madness, and I think that the House has rather more hope of coping with that.

I thank the Minister of Health for being here. I know how much this means to him, and I acknowledge that one of the doctors about whom I shall speak is a personal friend of his of long standing, and that there is a great mutual respect between them.

This matter means a great deal to me, because there are in my constituency two of the greatest of our mental hospitals, as they used to be called, Claybury and Goodmayes. Schizophrenics form a major proportion of their patients. I do not like the word "schizophrenia". I think that it is a bit of medical hog-wash and dog-Greek with no scientific basis to it. The Minister and I know that the word applies to people who are mad, suffering from an incurable and devastating illness. Freudian analysis is not a remedy for this class of patient. But there is new thought that a cure lies in changing the chemistry of the brain by chemicals taken as medicine.

My purpose is simply to ask the Minister to refer this new and hopeful medicine, this new method of treating schizophenia, to the Medical Research Council for investigation. I have here an article reprinted from the International Journal of Neuropsychiatry of May-June, 1966, Vol. 2, No. 3, entitled: The Effect Of Nicotinic Acid On The Frequency And Duration Of Re-Hospitalization Of Schizophrenic Patients; A Controlled Comparison Study". It is by Dr. Abraham Hoffer, Ph.D., M.D., who is Director of Psychiatric Research, Psychiatric Services Branch, Department of Public Health, Province of Saskatchewan (located at University Hospital, Saskatoon), and Associate Research Professor (Psychiatry), College of Medicine, University of Saskatchewan. He is also the author with Dr. Humphry Osmond, to whom I shall also refer, of a book called "How to live with Schizophrenia", published in this country by Johnson Publications, with a foreword by the hon. Member for Woolwich, East (Mr. Mayhew).

Dr. Humphry Osmond is the Director of the Bureau of Research in Neurology and Psychiatry at the New Jersey Neuro-psychiatric Institute at Princeton, New Jersey. The book is therefore by the leading sponsors of the theory that the cause of schizophrenia is biochemical. The authors believe that it is due to changes in body chemistry, and that we are on the verge of a break-through similar to that in treating diabetes by insulin.

Dr. Hoffer and Dr. Osmond began to use nicotinic acid for the treatment of schizophrenia as far back as 1952. In fact, it has been more thoroughly studied than any chemical therapeutic agent in psychiatry, excluding, possibly, insulin coma. They have follow-ups going back to 1952 which give evidence of cure rates of 75 per cent. compared with control rates of 25 per cent. They claim to have met every obligation of research and to have completed three double blind controlled studies as well as many other similar investigations.

In a letter to me of 8th November, 1966, since receiving which I have been trying unceasingly to raise this matter in the House, Dr. Hoffer writes: What has troubled us is the reluctance of our colleagues to use the treatment. This would be understandable if it was dangerous, but, in fact, it is much safer than any tranquillizer. With tranquillizers there is a very large literature which shows the following dangers—

  1. (1) Sudden deaths—due to changes in vessels around the heart.
  2. (2) Purple pigmentation all over the body leading to blindness and irreversible Parkinson tremor.
  3. (3) Malignant diabetes.
  4. (4) Liver damage.
  5. (5) Dangerous blood diseases.
I am not against tranquillizers and I could not practise psychiatry without them, but they seldom cure by themselves. Chronic patients on high doses of tranquillizers very often become worse and worse even though their social behaviour remains tolerable. In a recent study in the U.S.A. of schizophrenic Veterans on discharge, only 10 per cent. were able to hold jobs. I have on my list 104 chronic schizophrenics (average of ten years' illness). Nearly 90 are fully employed, but all are on nicotinic acid. The United States is moving very quickly into nicotinic acid therapy with nearly 100 institutions using it. The National Institution of Mental Health (an agency of the United States Government) is sponsoring several controlled studies. But England seems singularly disinterested in a problem which must cost you millions of £s and untold human suffering. Dr. Hoffer says there that the United States is moving very quickly into the sphere of Government-controlled study. There is also private initiative under way, and I have here the special first issue, dated Fall, 1966, of Schizophrenia, the news letter of the American Schizophrenia Foundation, which is now about three years old. The news letter explains the Foundation's purpose thus: Schizophrenia … creates prolonged and unbearable suffering for 2,000,000 North Americans and their families. The American Schizophrenia Foundation seeks cure and prevention of this widespread disease through intensified biological research. … (In time, the A.S.F. hopes to be in a position to recommend to doctors and to the public the most advanced and effective biological treatments for schizophrenia.) I think that the House would be interested to know the sort of men who back this idea. Their names are set out inside the news letter. Among those on the Scientific Advisory Board are the Professor of Neurophysiology and Biochemistry, Centre for Brain Research, University of Rochester, New York; Director of Research in Clinical Physiology, McLean Hospital, Waverly, Massachusetts; Emeritus Professor of Medicine, Mayo Foundation, Chicago; Director, Psychiatric Research, State Department of Mental Health, Chicago; Chief, Psychosomatic Service, Veterans Administration Hospital, Los Angeles; Professor of Neurology, University of Illinois, College of Medicine; Chairman, Department of Psychiatry and Neurology, Tulane University, School of Medicine, New Orleans; Executive Director, Worcester Foundation for Experimental Biology, Shrewsbury, Massachusetts; Director of Research, Rockland State Hospital, Orangeburg, New York; Professor of Psychiatry, McGill University, Montreal; Medical Director, Hollywood Psychiatriac Hospital, New Westminster, British Columbia; Hill Professor of Neuropharmacology, University of Minnesota Medical School; and Alexander Agassiz Professor of Zoology, Harvard. A real bunch of cranks and quacks!

I think that it is to our shame that I should have to read that list. I do not know why reading that list makes me so terribly angry. I think that it is that I am ashamed that in our country we should need to be pushed to make a comparative effort of imagination and thought. Perhaps it is just because I smell here the smell of something that I think I hate more than anything else in the world. It is the smell of the sons of Martha who rule—and the sons of Mary who rue—in this cruel world.

I hope that the Minister will take note of what is being done and of who is doing it, where they are doing it—and where they are not doing it.

What are our men doing about it? Why does not the Minister get them to do it? I hope that I am rebuking him unjustly and that he will be able to tell me that all is now well. For this debate is about thousands of English families here and now; mothers and fathers in anguish and perplexity and shame because of their children who have become inexplicably odious, terrible and alien to them; husbands whose wives have become things of horror to them; and wives where husbands have become hateful and intolerable to them. This is a possibility of hope for all of them and for the wretched sufferers themselves.

The House must ask why we do not do something here to make sure that this still only half-understood magic of chemistry can be the miraculous cure that we hardly dare to dream of. After all, insulin treatment and electric shock treatment were discovered only by accident. Why do we not see what is in this, and why does not the Minister tell the Medical Research Council that it must investigate this?

Let us consider for a moment the results that we have before us in Dr. Hoffer's own records. These cover five years and four separate groups of patients treated by four psychiatrists. Let us compare the results obtained under a nicotinic acid treatment regime with the results obtained under other regimes.

Dr. Hoffer says in the journal from which I quoted: The tables are self-explanatory". The tables cover the results obtained by the four psychiatrists whose patients were examined, and in respect of each group of patients the figures are given for those under nicotine and those not beneath the following headings: the number of patients; the number of patients re-admitted; the number of re-admissions—the right hon. Gentleman the Minister and my hon. Friend the Member for Essex, South-East (Mr. Braine) will know that those are subtly but importantly distinct things; the total number of days in hospital for all patients, admissions and re-admissions; the total number of days divided by the total number of patients, which gives us the critical figure for each group of patients to compare the figures for other groups; the number of patients remaining in hospital some years afterwards; and, finally, the number of suicides.

Dr. Hoffer says: Patients on nicotinic acid in all the groups were better off. In the House one cannot possibly read figures, but a glance shows that this is undeniably so. They have fewer re-admissions, fewer days in hospital, fewer patients in hospital on the target follow-up date and did not have any suicides. The results are so strikingly different that no statistical tests are required. The data in the summary tables "shows that 346 schizophrenics occupied 54,491 days in hospital during nine years after their first treatment, i.e., they occupied 149 bed-years, or the equivalent of 16.5 beds per year for the entire nine years. The smaller groups of 128 schizophrenics given nicotinic acid occupied a bed for 7,422 days or 2.2 beds per year for the nine years. So the figures, in broad comparative terms, are 16 bad and 2 good. In other words, one could say, broadly, that this nicotine treatment is as eight times as effective as any other.

The most dramatic conclusion that Dr. Hoffer comes to, in my view, is when he says: Chronic patients given nicotinic acid did not respond as well as the acute ones but they were better off than the others who did not have nicotinic acid. He said that the data had: reinforced earlier observations that nicotinic acid did not benefit chronic schizophrenic patients as much as acute patients. However, recently I have been surprised by a large number of these chronic cases who have begun to recover. Even though they had not responded for the first few years they were able to survive in the community and I was able to keep them on medication with nicotinic acid. After seven years they have begun to recover and many are nearly well. He concludes: This data … leaves no room for doubt. Nicotinic acid used as described greatly improves the outcome of schizophrenia which is still a very grave illness. When a medication as free of toxicity as nicotinic acid can produce such a marked improvement in recovery of schizophrenic patients, there can be no valid reason for depriving these patients of bettering their chances of recovery. The House must sympathise with the right hon. Gentleman. As a layman among members of a great and ancient profession he may feel a little diffident about pressing any ideas that he may have, even with such medical evidence. When I last raised the matter by way of Parliamentary Question, the right hon. Gentleman, to do him justice, bravely stood up to a verv nasty little sneer from one of his hon. Friends, and the House was behind him. But we must ask him to do better still. He really should have the medical profession's blessing. I say that on sound authority, because Claude Bernard, the great physiologist, discussing the ethics of medical experiment—this is what this is about—nine centuries ago said: Those remedies that can only do harm are forbidden. Those that involve no foreseeable harm to the patient are innocent and therefore permissible. Those that may do good are obligatory. In fact, it is an ethical obligation upon the medical profession to experiment with this treatment. The nicotinic acid treatment of schizophrenia comes into the obligatory class; it may do good, it is harmless.

If the Medical Research Council does not trust the statistical evidence at present available, it must try its own experiments. However, when the Hoffer and Osmond data were presented in Oslo at the N.A.T.O. Brain Function Conference the scientists there agreed that it was indisputable that something happened to those who got nicotinic acid treatment, Instead of spending years in hospital they spent months.

There are only two other possible deductions to be made from the Hoffer and Osmond data. The first is that Hoffer and Osmond cooked the books. But they are open to inspection. The second is that the air in Saskatchewan is particularly good for schizophrenia. But other schizophrenic patients did just as badly there as they have done anywhere else.

If nicotinic acid treatment turns out to be proved effective—as it seems almost bound to be—we in this country, if we have lagged behind because of the stubborn resistance of the medical profession, and we in this House in particular, will have a shameful responsibility for all the suffering that will have taken place in the lost years. If there is scepticism about the evidence, the patients in Saskatchewan are available with all their records—10 million cards—nine hours' travel from this House. The House must ask the Minister why he does not take advantage of the open invitation to send his experts to Saskatchewan and investigate the evidence.

Luckily for their patients, more and more doctors are going there themselves and using this simple medicine. The doctors are puzzled, amazed, astonished and gratified by the results, and their patients and their patients' families are delighted and thankful.

When this treatment is eventually accepted here, what are hon. Members to say to their constituents and their constituents' relations who have been National Health Service patients and who have at last experienced these benefits? What shall we say to them when they ask, "Why did we not get this treatment before so that we might have been saved years of agony and suffering?" From the scientific point of view, there may not be very much hurry, but in human terms this is desperately urgent, because today, 12th May, and tomorrow, 13th May, between 50 and 70—let us say 60—young people will be becoming schizophrenic, will be becoming mad. Of these 60, in five years' time, in present terms, 20 will probably be well and sane and stay so; 20 will have recurring bouts of illness and madness, and 20 will be ill and mad and will probably stay so. It will not be quite 20 in each class, because six of them will have committed suicide. With the nicotinic acid treatment—according to the records—the picture could be thus: 45 would be well and stay so; 15 would have recurring illness and madness, and probably not more than 5 out of that 15 would be very ill. There would be no suicides. There has not been one suicide under the nicotinic acid treatment.

Unless this House insists that the Minister refers this treatment to the Medical Research Council for research and approval this transformation will not come about, and we shall have a terrible responsibility for our constituents, who will curse us. When the medical profession goes against the precepts of Claude Bernard, one of the fathers of modern medical practice—one of its own greatest men—for no good demonstrable reason at the cost of so much suffering, this House and the right hon. Gentleman, as the lay head of the medical profession, have a duty and a right to question the judgment of the medical profession.

It has been done before. Florence Nightingale did it with the help and blessing of politicians of her day—all honour to them. Queen Victoria did it, and she did not need the help and blessing of anyone. She did it in the matter of anæsthetics, which would have been delayed for up to a generation if Queen Victoria had not said, "Come off it, and get on with it" in the way that I am asking the Minister to do.

This treatment could revolutionise our National Health Service. It could make huge savings, by relieving the Service of 20 per cent. of its patients. It makes no demands whatsoever in terms of extra staff—nurses or doctors. It involves no extra capital cost. But the most important thing it could do would be to relieve and prevent a vast amount of human suffering. I hope that the Minister will wholeheartedly accept my plea to have this solution examined by the Medical Research Council. If he does not, he can accept my assurance that I shall harry him ceaselessly and mercilessly until he does.

1.33 p.m.

Mr. Bernard Braine (Essex, South-East)

I rise briefly to associate myself with the thoughtful and moving plea made by my hon. Friend. He has long been trying to ventilate this subject, and this morning not only did he address himself to it with humanity and understanding; he performed an extremely valuable service in focussing attention on the need for a break-through in the treatment of this most baffling, severe and socially crippling form of mental illness.

It is still not sufficiently appreciated in this country what a dreadful toll is taken by mental illness. About one-third of the beds provided by the National Health Service are occupied by the mentally ill. I understand that the latest figures that the Ministry has made available reveal that about 60,000 patients are in hospital suffering from schizophrenia alone. This amounts to 47 per cent. of all patients in hospitals who are mentally ill and, what is especially significant, 63 per cent. of those who have been in hospital for 11 years or more.

I understand that the distinguished Chief Medical Officer of the Ministry, commenting on these figures, has said that a method of preventing or curing this disease would have a profound effect on the need for hospital beds. One might add that it would bring enormous relief—as my hon. Friend made clear in his eloquent plea—to local authorities and a vast number of harassed families. Those of us who take an interest in health subjects have been enormously encouraged by the wonderful advances in medical skill, the use of new drugs, and above all, the change in public attitudes, since the passing of the Mental Health Act, 1959.

However, from my limited knowledge I understand that schizophrenia is vastly more serious than most other forms of mental illness. It is more difficult to treat in the community. The researches of one George Brown—not, I hasten to add, the Foreign Secretary—into schizophrenia, published in the British Journal of Psychiatiric Social Work—Vol. 7, in 1963—showed that because of the nature of this illness it is not always desirable to discharge a patient to his home, whereas over the whole field of mental illness we have been seeking to get people out of hospital as soon as possible and back into the community.

The sad truth is that, as far as we can judge, there is as yet no cure for this disease. It is fluctuating and it is chronic. So it is not surprising that the vast majority of sufferers—about 70 per cent.—have to be readmitted to hospital. Thus, the pressure on our hospital resources is very great.

What is more, because this disease attacks the young and the intelligent, its economic and social cost is incalculable. I suppose that we lose about 30 million working days a year from mental disorders of various kinds. Even if we were to find more effective means of transfer- ring people suffering from schizophrenia from hospital to the community we would probably do no more than shift the burden from the National Health Service to the patients themselves, to their families, and to the Supplementary Benefits Commission.

There are enormous gains to be had from any break-through in the prevention and treatment of this socially crippling disease. After listening carefully to everything that my hon. Friend has said, I would have thought that the case for intensifying research into this disease is unanswerable. I therefore add my voice to his in expressing the hope that the Minister will heed his eloquent plea.

1.37 p.m.

The Minister of Health (Mr. Kenneth Robinson)

I am glad that the hon. Member for Ilford, North (Mr. Iremonger) has chosen to raise the subject of schizophrenia. As has been said, the schizophrenic group of diseases is responsible for one of the largest categories of patients in our National Health Service hospitals at present. First, I want to say a word about the nature and scope of this disease. The term schizophrenia covers not one but several forms of mental illness. There are considerable differences in the clinical picture presented by the different forms of the disease, but all involve disorganisation of the patient's personality. This disorganisation primarily takes the form of interference with his thought processes and emotional make-up.

Some forms of schizophrenia may produce the wilder forms of behaviour, the hallucinations and bizarre notions which we associate with mental illness in its most extreme forms. There is also a progressive deterioration of personality which can result in chronic and persistent illness, and even, in the worst cases, a lifetime in hospital.

The disease seems to occur in all races and in all strata of society, although it is commoner among the poorer and less privileged. This is probably because it causes a downward drift towards unskilled work. In other words, its comparative frequency amongst the poorest sections of the community may well be the result of deterioration brought about by the disease itself.

It has been estimated that, in general, one's expectation of developing schizophrenia at some times during one's lifetime is between 0.4 per cent. and 0.8 per cent., the average being probably nearer the higher than the lower figure. We can roughly put the chances as around one in 150. In 1964 about 11,000 schizophrenic patients were admitted to hospital for the first time and there were about 25,000 admissions for second or further periods of treatment.

About 70 per cent. of all admissions for schizophrenia were readmissions. There were about 64,000 such patients in hospital at the end of 1964, and they occupied about 13.5 per cent. of all hospital beds.

The causes of the disease are still not certainly established, but they are generally thought to include inherited, psychological and biochemical factors, either singly or in combination. A great deal of research is being directed into the causes, and I want to say more about that in a moment.

Meantime, I will deal with the medical treatment. The development of treatment by physical methods over the last thirty years and the discovery and use of psychotropic drugs in the last decade have provided a range of rapid and successful treatments for mental illness, and a great deal can now be done to alleviate the symptoms of schizophrenia. This disease has provided one of the greatest changes from the past and it offers one of the greatest hopes for the future in the treatment of mental illness.

Modern treatment may combine the use of drugs, electro-convulsive therapy and psychological techniques. Now, in fact, treatment is so quick and effective that most schizophrenic patients admitted to hospital, particularly those diagnosed early, stay only a short time, and can then be treated as day or out-patients. Even for the older patients and the chronic schizophrenics, who may have been in hospital for years, much can be done through these new methods.

In the old days schizophrenia was the condition perhaps most liable to lead to a patient's life-long isolation behind the walls and bars of a mental hospital. Now, thanks to modern methods of treatment, this is a thing of the past, since most patients are kept in hospital for no more than six weeks.

The hon. Member for Ilford, North referred in some detail to the treatment of this disease by nicotinic acid, sometimes called treatment by Niacin, a proprietary form of nicotinic acid. I know of the experiments by Dr. Osmond and Dr. Hoffer in treating the disease in this way and I understand that they have published some impressive results, quotations from which the hon. Gentleman read.

However, I must repeat, as I am sure hon. Members will appreciate, that it is not for me to intervene in clinical matters, much less to advocate any particular form of treatment. It would be undesirable and, indeed, dangerous for the Minister of Health to try and assume this kind of responsibility. Psychiatrists in this country are, of course, aware of this form of treatment and, since Niacin is available under the National Health Service, there seems no reason why there should not be every opportunity for testing it here.

I am, however, advised that the work in this country has not so far produced results that support the claims quoted by the hon. Gentleman in respect of the treatment of schizophrenic patients by this method. However, I am sure that the Medical Research Council will take note of what has been said in the debate.

Mr. Iremonger

Can the right hon. Gentleman clarify my mind on this and explain exactly what his relationship is to the Medical Research Council and what its relationship is with the medical profession? For example, if I were in his place and able to do what he could do, what could I do feeling as I do about this subject?

Mr. Robinson

The hon. Gentleman would, I am afraid, probably feel very frustrated. I have no responsibility for the Medical Research Council. The Minister responsible to this House for its functions is my right hon. Friend the Secretary of State for Education and Science. The M.R.C. is the agency through which most medical research supported by Government grants is channelled, but clinical research is done in hospitals for which I have responsibility.

Mr. Iremonger

Supposing, then, the Minister were to say, "We spend £X million on schizophrenia. Let us take one hundredth part of that and give it for the pursuit of this treatment." Could the M.R.C. spit that out or would it have to do something with the money?

Mr. Robinson

I shall say something about research generally, and I think I shall be able to satisfy the hon. Gentleman that there is no financial barrier to the M.R.C. doing what it thinks fit in this matter.

Earlier, I mentioned the large number of readmissions which every year are more than twice the number of first admissions. Sometimes this is cited as criticism of current methods of care, but from what I have said the hon. Gentleman will realise that, far from being a confession of failure, these are a measure of the success of new forms of treatment, which have rendered unnecessary long continuous periods as an in-patient. Modern psychiatry considers it essential, wherever possible, to keep patients in touch with the community, with the friends, relatives and occupations which together make up the social framework in which the patients are rooted. Institutionalisation is the evil above all to be avoided. It is bound to lead to further deterioration of the personality, which always hinders and can, indeed, eventually prevent response to treatment.

Even a temporary return to normal life can be of help to the schizophrenic patient. When long-term treatment in hospital is necessary and the acute stage of the illness is over, rehabilitation through active social life and work is vital. Industrial therapy in particular, in which patients can carry out work on many different types of component for industrial firms, is being actively encouraged and the apathy and restlessness which used to be the hallmark of the long-term schizophrenic patient is fast disappearing. The aim today is to return patients to the community as well-equipped as possible to play their part.

But the return to the community raises its own problems. The difficulties faced by a patient in the community and the strains placed upon his family are very real. It is not an easy task to cope with a schizophrenic parent, husband or wife. There may be relapses, especially if the patient neglects to take his supportive drugs. But patients can be, and increasingly are, given the necessary support in the community by psychiatrists, family doctors, nurses and social workers, working as a team, often with the help of voluntary organisations.

Although community care is still in many areas in a relatively early stage of development, local authorities can offer a wide range of services. Psychiatric and other social workers can advise families on the problems they are likely to meet and keep in touch with the patient to make sure he continues to take the drugs prescribed. Residential accommodation may be provided for patients with no home or whose home is unsuitable. Sometimes this takes the form of specially approved lodgings, but local authorities are also providing more hostels of their own and by the end of 1965 there were 61 such hostels for the mentally ill, with 1,200 places—a three-fold increase over the previous three years. By 1976 it is hoped to have provided 259 hostels with almost 5,000 places. Many of the patients living in such hostels are schizophrenic.

The whole concept of the psychiatric hospital has had to change to fit the new patterns of treatment and care and one of our problems in providing for schizophrenic patients is our legacy of out-dated hospitals. Many were built in Victorian times to perform a mainly custodial function and are large, isolated and unsuitable for modern methods of treatment. In the course of time many will have to be abandoned, basically remodelled or replaced. The psychiatric hospital today needs close links with other hospitals in the neighbourhood, with the family doctors, the health and welfare services and the community at large. Geographical isolation is a special handicap, because it tends to separate clinical staff from professional colleagues elsewhere and to cut off patients from their friends and relatives. In planning the hospital building programme, therefore, we have laid particular emphasis on psychiatric units forming part of district general hospitals.

But planning the new pattern of psychiatric provision is one thing, achieving it another. We must face the fact that when the needs of other branches of the hospital service are so pressing, and resources are not unlimited, the new pattern will take many years to complete. This means inevitably that many existing hospitals—even some that are structurally outdated—will be needed for a long time to come. But it does not mean that we must be satisfied with obsolete facilities. Much can be done to improve even the oldest hospital. The Ministry of Health has been at pains to encourage this.

Unsatisfactory design can often be modified without radical reconstruction. Partitioning of large wards, the provision of false ceilings, new sanitation annexes, redecoration in modern style, up-to-date furniture, heating and lighting can make a world of difference to an old hospital and many improvements of this kind can be seen in psychiatric hospitals all over the country.

As I have told the House, research is mainly the responsibility of my right hon. Friend the Secretary of State for Education and Science but with his agreement I should like to say something about research into schizophrenia. An enormous amount of research is going on in different parts of the world into different aspects of this disease. In this country it is the policy of the Medical Research Council to do all it can to advance knowledge of the nature and treatment of this as of other mental disorders.

The Council has some 14 research units engaged in work relating to mental health and they are helped by two special advisory committees. Three Medical Research Council units are particularly concerned with the biochemical aspects of schizophrenia—the brain metabolism research unit, the neuro-psychiatric research unit and the unit for research on the clinical pathology of mental disorders. It is now generally accepted that the biochemical approach is the most promising. This line of attack, however, is not the only one and it is likely that social and psychiatric studies will throw further light on the disease.

Other Medical Research Council units such as the social psychiatry research unit, the clinical psychiatry research unit and the unit for research into the epidemiology of psychiatric illness are engaged on such studies.

Mr. Iremonger

Before the right hon. Gentleman leaves what he is saying about the biochemical aspect, as he knew that the debate was coining up, having had notice a long time ago, and having answered a Question in the House about it, can he say what questions about the nicotinic acid treatment he has put to the biochemical side of the Council's work? Has he asked whether there is interest in this approach, what the Council's unit is doing about it, what its thinking about it is and what provision has been made for it, or has it been completely ignored?

Mr. Robinson

It is not completely ignored. I was pointing out that there is a unit specifically charged by the Research Council with examining this aspect of this group of diseases. The hon. Gentleman put down a Question some weeks ago and I am sure that reference was made to the Council and that the Council consulted the unit before suggesting the answer which was given in the House. I was aware of the treatment and I can only repeat, as I said earlier, that so far there is no evidence from work in this country which would support the claims made. Obviously, that can only be a provisional conclusion.

Mr. Braine rose——

Mr. Robinson

I am sorry, but I do not have time to give way. I was specifically asked by Mr. Speaker to sit down at a quarter to two.

Expenditure by the Council on research into mental disorders and applied psychology rose from £250,000 in 1959 to £750,000 in 1965–66 and is expected to reach almost £900,000 in 1966–67. Further research work is being undertaken in a number of universities with support from the Council and from public funds allocated on the advice of the University Grants Committee; and in other centres financed from other sources, including voluntary bodies. There is also the Ministry of Health scheme for locally organised clinical research which includes mental health projects. In parallel with the Research Council's arrangements, this is designed to encourage local initiative in research and to cover projects which might not attract funds from other main sources.

This has been a useful debate and certainly to focus public attention on such problems as schizophrenia and its treatment can do nothing but good. The House and all who have at heart the welfare of the mentally sick will, I know, be grateful to the hon. Member for his initiative.