MENTAL HOSPITALS (CHILDREN'S ACCOMMODATION) (Hansard, 22 January 1970)

§ Mr. F. P. Crowder (Ruislip, Northwood)

The matter which I wish to raise this evening is the shortage of suitable accommodation for children in mental hospitals. I am interested to see that the hon. Lady who has just replied for the Government in the previous debate has been replaced by no less a person than her husband, the Joint Under-Secretary of State for Health and Social Security. I congratulate the hon. Gentleman. At one time I was in a similar family position, because I was a Member of the House for about nine years, from 1950 to 1959, when my father was also a Member, so in a sense I think we can say that this is a family parliamentary occasion.

On 1st December, a Monday, when the newspapers are rather short of copy, there appeared an alarming report, in banner headlines, on the front page of the Daily Mail. It described the case of a boy aged 7 who was locked in a mental hospital with 2,500 adults. That boy lived in my constituency, and for obvious reasons I shall not mention his name, or the name of his parents. I personally dealt with that case, and as a result of my intervention, and with the assistance of the Minister, the boy was moved to a children's hospital.

In view of the alarming disclosures in the Daily Mail, I gave notice that I would apply for an Adjournment debate so as to raise the whole question of the serious shortage of accommodation for patients of this kind and, if he thinks it necessary, to ask the Minister to hold a public inquiry.

There is grave public disquiet as a result of this investigation and report by the Daily Mail. There is no question of their being any political differences in the matter between the Minister and myself. The hon. Gentleman has done me the kindness and courtesy of discussing the whole matter in some detail with me, but in view of this report I think that you, Mr. Speaker, would be 852 the first to agree that the public would want to know what the true situation is in regard to these matters.

Unfortunately, what I have to say does not apply only to this case. In the case which I am raising, of which the Minister has full knowledge, what happened was that this boy of 7 was locked in this mental hospital. He was left there for about seven weeks among 2,500 patients, and he was put there without his adoptive parents' previous knowledge or consent. For 53 days he was constantly guarded by male nurses to protect him from grown-up patients. He was kept under lock and key at times in a small side room off a ward filled with more than 30 severely disturbed men.

At the end of the day, after my intervention, I received a very happy letter from the mother, who thanked me for what I had done, and said: I am very pleased to be able to write and let you know that —the boy has now been admitted to the Park Hospital for Children at Oxford. He was transferred on Friday, 19th September. My correspondent went on to refer to a letter of 24th September—and I think in all fairness it must be said that this was due to a misunderstanding—in which the Minister at the time said that he understood that the consultant at Hillingdon Hospital had explained to the parents concerned the need to transfer the boy to a psychiatric hospital, and that arrangements were made with a local authority social worker who, he understood, invited the parents to accompany the boy when he took him to the hospital.

That was a grave mistake on the part of the Ministry. The parents were never invited to accompany the boy, and they were never informed, which is singularly unfortunate, but, as one knows, the dead hand of bureaucracy occasionally fails, even in matters of this seriousness This is not the only case. The boy is back home, after successful treatment at the hospital which I mentioned and he is now almost 100 per cent. well.

But what worries me is a letter I have received as a result of the publicity on this matter—I have shown it to the Minister—from a woman who used to be a constituent of mine. The letter was 853 dated only a few days later, 14th December. She wrote that, as a result of what she had read in the local paper, the Ruislip and Northwood Gazette, she was surprised that this should happen after 20 years or more. Her son of 11 was sent to St. Bernard's—that is the mental institution which I have described—and stayed in a ward with 40 men. When he was sent there, hysteria was diagnosed. He was there, she says, from 8th July to 20th December, 1948. She said that, after she and her husband had been before a committee, the boy was allowed home, but had to return to this ward of adults for one night a week. This was as long ago as 1948. This woman naturally wrote to me, since I had raised this matter, wondering how similar mistakes and conditions could come about after all these years.

I have other letters in very much the same terms. One reads: You may have seen some of the tragic letters and articles recently in the press, raising the whole unsatisfactory question of … emotionally disturbed children. There are some schools and units (though not nearly enough) for children up to the age of 11 or 12 years of age, but after that if they still need medical help, despite their educational level and progress there is nothing but the Adult Subnormality Hospital. I appeal to you, to try to understand the concern of mothers everywhere for the terrible plight of many of these misplaced children", whom she described as "outcast lambs". She continued: The Daily Mail has quoted figures indicating that there are at least 1,000 of these children in such hospitals throughout the country. I must stress that I have not been able to check that figure, and I invite the Minister to correct it if it is wrong: I dare not place too much reliance on it. We have seen only today in the reports from Biafra, the extravagance of which the press is guilty on occasion, and we must be careful—although in a case of this sort, they do a public service in drawing attention to something which I know is of great concern to many families with children who are not 100 per cert. mentally well. The writer says that anything which can be done to bridge this gap would be of the greatest assistance.

If a child of tender years is emotionally upset to the point of hysteria, is upsetting other children in the hospital 854 where he is being looked after and if it is thought by the authorities concerned that he is in need of mental treatment, there is virtually a vacuum; there is nowhere for him to go except to an adult hospital like St. Bernard's.

How many children are at present involved or are likely to be potentially involved I do not know. That is why, as a non-political issue, I have raised this matter tonight. I have no doubt that the Minister, who has given the most careful and sympathetic consideration to my arguments and ideas on this subject, will, I am sure, be able to enlighten the House.

§ The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)

I am grateful to the hon. and learned Member for Ruislip—Northwood (Mr. Crowder) for raising the question of hospital provision for mentally disordered children. As hon. Members will be aware, there has been publicity in recent weeks, to which the hon. and learned Gentleman referred, about one or two instances where children have had to be admitted temporarily to adult wards in mental illness hospitals.

It is important to get this matter into perspective and I am grateful for this opportunity to do so. The hon. and learned Gentleman also mentioned accommodation for the mentally subnormal, and my remarks will cover this problem as well—those unfortunate children who are born with defects which are perhaps not treatable, but which warrant care, attention and training, rather than youngsters who have mental illnesses.

Before dealing with these two major topics, I will comment on the case which the hon. and learned Gentleman specially mentioned. This is a case about which he was in contact with my Department long before there was any publicity in the national Press or other media. This boy had a tendency to aggressive behaviour which made treatment difficult. He was admitted to the psychiatric hospital nearest to his home as a temporary measure, until somewhere more suitable could be found for him.

It is a matter for regret that he stayed in the adult hospital for so long. Hon. Members will be pleased to have heard 855 from the hon. and learned Member for Ruislip-Northwood—I confirm what he said—that a place was found for him in a special children's unit, where he did very well indeed. My last information is that the boy is now back at his own home and is being treated as an out-patient.

All hon. Members must have heartfelt sympathy with the problems of mentally disturbed children, their families and those who care for them. The family setting is all-important, and whenever possible it is the practice to treat these children in their own homes. Most children with emotional disturbances attend child guidance clinics run by local education authorities or hospitals. Some attend special classes; others, whose disturbance is more severe, attend day or residential special schools or other schools catering for maladjusted pupils.

Admission to hospital is a last resort for the comparatively few who cannot be adequate treated elsewhere. For this small proportion of mentally disordered children it is our policy to provide special children's units. Much the same considerations apply to adolescents.

The question of scale is important. My right hon. Friend the Secretary of State recently had a special survey made to find the numbers of children and adolescents in hospitals for mental illness. This has shown that on the date selected, 7th January this year, there were 263 children up to the age of 12 and 506 adolescents between 12 and 17 resident in these hospitals. The survey also showed that of these only four children and 288 adolescents of the ages in question were in adult wards.

Taking the age group up to 12—the age that spans the case about which the hon. and learned Gentleman is concerned—there were 263 children being treated. Of those 263, only 4, due to circumstances of a temporary nature, were in adult wards, while 259 were in special children's units. These figures put the problem into perspective. I think hon. Members will agree with me that, at least so far as children are concerned, these results are not too discouraging.

However, hon. Members will ask themselves why any young people need be in adult wards. There are two different answers, one for children and one for adolescents. The child most likely to be 856 found in an adult ward—or a separate room off an adult ward—is probably one suffering from a violent behaviour disorder which can make him a very real danger to other children. Such a child cannot be treated while he lives at home, because his family cannot manage him. Indeed, he may pose a very real danger to other children in the family. He is probably also beyond the means of control available in a residential school.

On the other hand, for obvious reasons, it is difficult to place such a child in ordinary children's unit. Temporarily—until the right form of treatment is found for him and his condition improves—there may be nowhere for him to go except an adult ward. Adolescents present a somewhat different problem, although again, special units are usually desirable, as it is generally agreed that, although the special units are desirable, a proportion of adolescents are best placed in adult wards because of the particular features of their conditions. When they are so placed, the aim is, wherever possable, to group them with people of their own age.

I think that it will help if I provide a few more statistics. In 1964, regional hospital boards were asked to provide special units for children and for adolescents, separately, on a scale of 20–25 beds per million population. Progress in providing these has not been as rapid as we would have wished but we have to bear in mind that boards have many competing demands on their capital resources and many other urgent needs.

Nevertheless, progress has been made The position today is much better for children than for adolescents. There are now 36 special units, with about 600 beds, for children, and 17, with about 350 beds, for adolescents. So far as children are concerned, we seem to have enough beds in terms of numbers, though they are unequally spread over the country and some regions are much better off than others. There is probably a shortage of suitable provision for those with multiple handicaps—children who may have not only severe mental handicaps of one sort or another but perhaps an associated severe physical handicap.

We must see to it that these deficiencies are made good. Provision for adolescents, on the other hand, is still inadequate, 857 but I am glad to say that it is now accelerating; 150 beds were opened during the last 12 months and another 50 will, we expect, open during the course of the current year.

So far, I have talked about the question of the provision of care for the mentally ill child and adolescent. I turn now to the question of facilities for mentally subnormal, or, as we now prefer to call them, "handicapped" children. Here the problem is quite different. For one thing, the numbers requiring hospital care are much greater; for another, the problem of shortage of accommodation, which shows itself in different parts of the country, cannot readily be separated from the larger problem of the future of subnormality hospitals generally, and the shift of emphasis from hospital to local authority care, which is taking place at the present time.

There were at the end of 1968 about 7,000 mentally handicapped children under the age of 15 in hospital and local health authorities were caring for about 2,800 more children classified as mentally subnormal. Accurate estimates are difficult to make because diagnosis must be based on assessment of intelligence, retardation or abnormality in social behaviour, and identification cannot always in the nature of things be very precise, particularly where the handicap is relatively mild.

Accurate assessment of a patient at an early stage in his life is clearly of major importance. It is already well established that the assessment of physically handicapped children is a multidisciplinary exercise. The recent Report of the Committee on the Functions of the District General Hospital puts forward the view, for which the Committee says it has found considerable support, that the initial assessment and reassessment of the mentally handicapped should also be undertaken at the district general hospital by a multi-disciplinary team of psychiatrists, paediatricians, neurologists and other specialists concerned with associated handicaps. The provision required would need to be in children's departments and this will have some effect in relieving children's wards of subnormality hospitals.

My right hon. Friend the Secretary of State has said that this report will have 858 to be further considered in the light of the likely future pattern of community health and social services. The recommendations relating to the mentally handicapped will also be considered, together with many other views that have been expressed, by my right hon. Friend before he publishes the Statement of Policy on the Care of the Mentally Handicapped which he is now preparing.

I cannot at this stage commit him to a view on any particular aspect of what is clearly a complex and at the same time very urgent problem, but he has said that he takes the view that part of its solution lies in a great expansion of community services outside the hospitals.

I can, however, mention some matters on which action has already been taken. My right hon. Friend has visited many hospitals for the mentally handicapped as I have done and has often declared himself dissatisfied with what he has seen—though I know that hospitals make a special effort in the case of children's accommodation. He has asked regional hospital boards to prepare programmes aimed at improving conditions in hospitals for the mentally handicapped. To assist them in this he has reallocated £1 million for capital improvements in 1970–71 and made available in the same year an extra £3 million for revenue expenditure. He has also given boards guidance on standards which they should aim to achieve through their improvement programmes. These cover space, size of children's wards, staffing, catering, personal clothing, and play and recreational facilities.

These, in many cases, as far as the handicapped are concerned, are some of the most important provisions that the hospitals can make. They are necessary to give immediate improvement in an underprivileged sector of the National Health Service while the long-term programme is being formed. We have also been giving attention to education and training. There is much useful progress to report on local health authority developments although the foundation of a new service is bound to take time and while local authority services are still developing there will necessarily be a continuing heavy burden on hospitals. Not only have local authorities had to provide hostels and training centres but 859 staff have had to be recruited and new forms of training established.

The overall picture shows encouraging progress. Hostels—which provide permanent homes for children in some cases and short-term relief to parents in others—are increasing in numbers. So are junior training centres and social work staff, who play such a vital rôle in keeping the handicapped child's family intact. We sometimes forget the effect of a handicapped child on other members of the family. As local authority provision increases the pressure on hospitals should be eased.

Many mentally handicapped patients who have been assessed accurately in early life can with suitable education and training be enabled to enjoy a useful life. The Government have, as the House knows, accepted in principle that the present statutory distinction made between those who can and those who cannot be educated in school should be abandoned, and that responsibility for the education of all mentally handicapped children should fall to the education service. Local health authorities will continue to provide adult training centres, and hospitals will arrange occupational or industrial training for their adult patients.

Clearly, a lot depends on our ability to add one way or another to the level of care available for the mentally handicapped outside hospitals. We know that there is a large number of children in large hospitals who might appropriately be cared for in smaller units nearer to their homes. Giving them a proper environment must be our first concern and I can assure the House that my right hon. Friend has this very much in mind. We must reserve more specialised hospital accommodation for those who need it because of the extent of their handicaps and the level of medical and nursing care they require. For the rest, our aim must be to give the children a home which is as like a normal family home as possible.

One of the things that is happening in medical advance is that more and more of these youngsters can survive to a much older age than previously, but requiring very intensive medical and nursing care. 860 This is an aim with which I am sure the House will wish to associate itself.

Finally, I should like to say a few words about a rather special category of very disturbed boys and girls who are being provided for outside the framework of the hospital service. These are severely disturbed children who, because of their acutely disruptive behaviour, cannot benefit greatly from treatment in psychiatric hospitals, but whose treatment needs cannot easily be met within the ordinary approved schools, children's homes or other existing establishments for children.

To meet the needs of these children my right hon. Friend the Secretary of State for the Home Department is using the powers conferred upon him by Section 64 of the Children and Young Persons Act, 1969, to establish three homes combining the care, control and treatment possibilities of a school, a children's home and a hospital, with a degree of security. The homes will provide for children who are in the care of local authorities but need facilities and services that are not available in the new system of community homes for which the Children and Young Persons Act, 1969, provides.

The homes will be mixed and will provide altogether places for about 100 boys and 100 girls, with a normal minimum age of 12 on admission. My right hon. Friend hopes that the first of these homes will come into use about the middle of this year.

This has been a brief survey of the main features of the present services for mentally ill and handicapped children and adolescents in our community. I hope that I have said enough to make it clear that, while we are encouraged by the progress made in recent years and look forward to more, we are in no way complacent and I recognise that in a civilised and compassionate society we must strive to improve these services further in every way we can. I can assure hon. Members that we regard psychiatric services for children as one of the highest priorities among the many demands of the National Health Service.