§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chapman.]11.45 pm
§ Mr. Bowen Wells (Hertford and Stortford)
I want to bring to the attention of the House the sad case of my constituent Mr. Peter Newman, and to the hopelessness of that gentleman's situation. I do so with a view to drawing attention to what I think is a gap in the provision for people suffering from the mental illness of which Peter Newman is a victim. Let me begin by referring to some points in Peter Newman's recent history. Because of the shortage of time, I shall leave out quite a lot of detail.
I am glad to see the Parliamentary Under-Secretary of State in his place. I have received from him many sensitive, generous and kind letters about this difficult case. I know very well that he will treat it with great seriousness and will try to find an answer. I am glad to see my hon. Friend the Member for Macclesfield (Mr. Winterton) also in his place. My hon. Friend the Member for Ealing, North (Mr. Greenway) wished to be mentioned in the context of this case, as it involves a person who, in layman's language, is suffering from schizophrenia. Mr. Peter Newman has never been positively diagnosed as schizophrenic, although a social worker once admitted to his mother, quietly and without commitment, that he had been diagnosed as paranoid with psychotic phases.
One of the key points that I want to draw to the attention of the House is that psychiatrists cannot truly identify, and will not designate, Peter Newman as suffering from any real or recognisable mental illness that could be treated under the Mental Health Acts of 1959 and 1983. In my view, that is one of the gaps in the provision.
Peter Newman has made two attempts to commit suicide. One of these occurred in July 1986, when he was a patient at Long Grove long-stay hospital. The fact that he had been sectioned to be there shows that he suffers from a very serious mental illness. He threw himself from a top-floor window and suffered very serious brain damage. His mother and family took a great deal of time to bring him round and restore him to some kind of normal health. In 1987, he was transferred to a hospital nearer his home—the Princess Alexandra—but he escaped and threw himself from the multi-storey car park, inflicting very serious physical damage on himself. Peter Newman is clearly very determined to commit suicide, and is thus a serious danger to himself.
It is not that many of the authorities have not made some provision for Peter. It is not that they have not been very worried indeed about him and have not tried to diagnose the problem and treat it in some way. Indeed, he spent a year, at the expense of the North East Thames regional health authority, in an extremely costly and excellent hospital—St. Andrews in Northampton. The authorities have done a great deal to try to treat him. Peter Newman released himself from St. Andrews and had to be brought back, after which he finally released himself into society. That was only to pick a fight with his brother when he returned to Hertford, and the Hertford magistrates committed him to Pentonville prison, just before Christmas 1990. All of us concerned with the case were relieved that he was there, because at least he was safe 771 there. The prison authorities put him straight into the hospital wing, where he remained for the whole of his three months' confinement.
On his release, in January this year, there was no place for him to go. Therefore, I made arrangements with my hon. Friend the Member for Ealing, Acton (Sir G. Young). the Minister for Housing and Planning, for him to be given addresses of hostels in London. The prison had given him a list of hostels dated 1988, so it was well out of date. He found hostel accommodation. A few weeks later, he broke into Buckingham palace and was arrested by the police. They did not charge him, because they recognised that he was suffering from a mental illness, but instead they took him back to the hostel.
He was then found riding on the outside of trains in the Southern region, arrested again and taken back to the hostel. He was last seen walking among fast-moving traffic in Edmonton, arrested, not charged, and taken by the police to where he is now, Hackney hospital. Two doctors sectioned him under section 2 of the Mental Health Act 1983, to be detained for a 28-day assessment order. He cannot release himself from that hospital.
I fear that, when he is released, Peter Newman will be released into a world in which there is no provision for him, and he cannot be treated or taken care of. During the time that he was in Northampton, all of us concerned in the case were worried about what would happen to him when he came out. I wrote to the district health authority and to the social services department of the Hertfordshire county council. It is worth reading their replies to me, because they are supposed to take care of him.
The chairman of the health authority said:The latest information I have had is that Peter Newman is due to be released at the end of next week and I have to confirm that following the Forensic Psychiatrist's report, Peter Newman will not be the responsibility of the Health Service.I understand that he would therefore be the responsibility of the Social Services who, as you know, had provided a place for him in one of their homes but he walked out from it. They have no authority to force him to stay. I am sure that Mr. Laming"—the director of social services in Hertfordshire county council—has replied to you in a similar manner and that due to his history, the Local Council representatives will be visiting him prior to his discharge concerning his housing. This action is in line with the recommendations made in the Case Conference held on 15 November 1990.The social services director, Mr. Herbert Laming, said:By all means, take up the case of Peter Newman, since it illustrates extremely well the difficulties which are being faced by Social Services Departments when they are being asked to provide services for people who either refuse to accept what is offered to them, or behave in ways that ensure failure of the placement, or need services which can only be provided by other agencies.In Peter Newman's case, we have had the experience in the past that we have found residential homes which were prepared to offer him a place, only for him to refuse to accept. We have tried to accommodate him in the residential homes run by the County Council for people with mental health problems, but his behaviour could not be contained in this setting. More recently, his propensity for violent behaviour resulted in the prison sentence he is currently serving.Of the residential resources approached on Peter's behalf by our staff, only two expressed a willingness to consider him. One is Kneesworth House, which is a private hospital, and if they were to admit him, his place would have to be paid for by the local Health Authority (as they have done on a previous occasion when Peter was admitted to St. Andrews, a similar hospital). The second offer to consider Peter came 772 from a residential home in Devon, whose charges are in the region of £20,000 to £40,000 per annum … The sponsorship budget available to the Department is fully committed and I regret that we are therefore unable to provide funding for such a placement.Therefore, neither the health nor the social services authorities in Hertfordshire provide a place for Peter to go. I sought a place for him from those responsible for the homeless, but found that there was no local authority provision for people in his position, so there was no question of his being offered such accommodation.
That means that Peter is left to wander aimlessly and hopelessly in London without treatment. Authorities cannot detain him to provide him with the 24-hour care that he needs or prevent him from releasing himself. He needs to be restrained and to have his liberty curtailed, yet there is no way to do so under the current Mental Health Acts.
Care can be provided by the health and social services and by homelessness offices as well as by the police and the prison service. Indeed, many mentally ill people, like Peter, are accustomed to being accommodated in their hospitals, which are the only places where they can be put. Great responsibility lies with the psychiatric services and the mental health commissioners.
At the suggestion of my hon. Friend the Minister, I went to see the mental health commissioner, Professor Evelyn Murphy. At present, it is the fashion to try not to keep anyone in detention if one can possibly avoid it. Although that is laudable and I understand it, it has resulted in a grey area. People are not positively identified as suffering from a mental illness under the definition of the Act, yet by any normal person's judgment, and certainly in the judgment of their family, they are clearly not acting in their own interests. They are vulnerable and a danger to themselves as well as to their community and family.
Mrs. Newman has concluded that her son is lost. He will either kill himself or somebody else. Only in the latter case will his problem be solved by a long-term prison sentence, which he will probably serve in the mental hospital wing of a prison. That is unacceptable, and we cannot allow this to continue.
I call on my hon. Friend the Minister to set up urgently a committee of experts to make recommendations on how people in Peter's condition can be detained, treated and given long-term security under restraint. If necessary, the committee should make recommendations to alter the Mental Health Acts 1959 and 1983 to permit that to happen.
Secondly, I ask my hon. Friend to provide suitable accommodation as a halfway house. Perhaps such people could be identified not as mentally ill under the 1983 Act, but as sufficiently mentally ill that they cannot look after themselves and need to be looked after. I also call on my hon. Friend to meet with me psychiatric consultants and to ask them to examine the position and to make recommendations for alternatives to current practice and definitions of mental illness, so that people in Peter's position can be treated and detained, as I am sure the whole community would wish them to be.
§ Mr. Nicholas Winterton (Macclesfield)
I am grateful to my hon. Friend the Member for Hertford and Stortford (Mr. Wells) for allowing me the opportunity to contribute 773 to this important, albeit short, debate. I do so for a number of reasons—not least Mrs. Newman, my hon. Friend's constituent, who wrote to me about her son's case. I am particularly interested because of my membership of the Select Committee on Health.
I fully endorse what my hon. Friend has said. He has represented his constituent and his family positively and sensitively in a difficult area. He has highlighted one of the grave gaps in our policy on community care, with particular reference to the mentally ill—the category into which Peter Newman falls. Those people are dealt with inadequately under the current legislation, and the available accommodation is inadequate to deal with a case such as that of Peter Newman. He has spent a limited time in prison, but that is not the place for someone suffering from a mental illness.
My hon. Friend has asked for certain assurances and commitments from the Government. Those requests are in line with the views of the Select Committee on Social Services, which produced a report on mental illness and community care in the previous Session of Parliament. When my hon. Friend the Minister replies, I hope that he can tell me when his Department intend to reply to that report, which has an important bearing on the serious case that my hon. Friend has raised.
§ 12 midnight
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
As my hon. Friend the Member for Macclesfield (Mr. Winterton) said, the case raised by my hon. Friend the Member for Hertford and Stortford (Mr. Wells) illustrates the difficulties in the law and practice in the treatment of, and facilities for, mentally ill people. I congratulate my hon. Friend the Member for Hertford and Stortford on raising this matter.
My hon. Friend the Member for Macclesfield asked when the Government expect to respond to the Select Committee on Social Services report on arrangements for provision for the mentally ill. That response will be given shortly—it is reasonably imminent.
My hon. Friends will appreciate that I have some difficulty in responding to the specifics of the case raised tonight. My hon. Friend the Member for Hertford and Stortford has argued about the specific nature of the provisions and services available to his constituent. He will understand that those issues relate to an individual case and are bound by the normal duty of confidentiality which govern the relationship between a national health service patient and his clinical advisers.
My hon. Friend disagreed with the clinical assessment of Peter Newman, but I cannot enter into an argument about that. I am not a clinician and therefore I am unable to argue about whether the psychiatrist's clinical assessment was right or wrong. Even if I were able to decide on that assessment, it would be a confidential matter between the psychiatrist and the patient and not one that should be properly traded across the Floor of the House. I do not believe that it would be right for me to get involved in the specifics of the Peter Newman case. I can, however, talk about the arrangements which are made to treat that type of patient in general, and the Government's approach to that.
774 My hon. Friend said that Peter Newman "needs his liberty curtailed". That goes to the heart of the matter. The House must recognise—I know that my hon. Friend does—that to deny any citizen his liberty is a grade A civil rights issue. The subject does not lend itself to administrative finesse. Parliament has rightly insisted that it should be laid down in detail in statute law. If the suspicion grew that a clinician was playing fast and loose with the statutory definition of the circumstances in which liberty can be denied, he would be hauled up not merely for his clinical judgment but also on legal grounds. It is for Parliament alone to describe the circumstances in which any citizen of this country can be compulsorily denied his liberty or be subjected to compulsory clinical investigation.
The mere fact of mental illness does not remove from the citizen in all circumstances the right and ability to take decisions about his own life. Mental illness removes that right in some instances, but those circumstances are defined in the Mental Health Act 1983. If my hon. Friend wishes to argue that the statutory definition of the circumstances in which freedom can be removed needs to be extended or redefined, it is incumbent on him to propose draft amendments to the Mental Health Act to that end. Such amendments would prescribe the circumstances in which he thinks that liberty should be curtailed and which are not covered by the definitions to be found, most importantly, in section 3 of the Mental Health Act.
I put the ball back in the court of my hon. Friend the Member for Hertford and Stortford not merely as a debating point but because the issue has been regularly raised by those concerned about and interested in the subject. The Government have said that they are always open to proposals on how the law can be amended or refined, but we have not yet received detailed proposals showing precisely how the law is inadequate and how the grade A civil rights issue can be advanced.
It is not enough to take a particular case. There is an old saying that hard cases make bad law, so we need to define the circumstances——
§ Mr. Wells
It was precisely because the definitions in the Mental Health Act needed redefining that I asked my hon. Friend the Minister to help me and everyone concerned by establishing a committee of experts or a group to determine how we can alter the law to meet the gap in provision and in definition. Of course the liberty of the individual must be preserved, but not to the point of making vulnerable people walk the streets of London, without treatment, help or housing.
I need my hon. Friend's help. I do not have a research assistant to do the work. Neither I nor any hon. Member has the resources to do it. We need experts, and I am certainly no expert.
§ Mr. Dorrell
Indeed, but the difficulty with establishing a committee is that its terms of reference need to be clearly defined. Our minds are not closed on the subject, but the onus is on those who argue that the law is inadequate to describe the circumstances which they believe should be covered by the law——
§ Mr. Nicholas Winterton
Will the Minister accept that my hon. Friend the Member for Hertford and Stortford also requested that, pending any such committee being set up, he might seek to find appropriate accommodation for 775 Peter Newman? It will need to be accommodation with 24-hour care, treatment and supervision, because the man is mentally ill and requires such care, treatment and supervision. As my hon. Friend said, at present there is no suitable accommodation, there are no resources and there are no facilities to provide the necessary care for this vulnerable person.
§ Mr. Dorrell
My hon. Friend has neatly pre-empted my next remark.
I have dealt with the definition of circumstances in which we deny someone his liberty under the Mental Health Act. If an individual does not come within the terms of the Act as written—or even as amended, as a result of my hon. Friend's initiative—we must conclude that he has precisely the same right to refuse treatment for mental or any other illness as any of my hon. Friends, or any other citizen. We all have that important right to discharge ourselves from an NHS hospital, although it may not be in our best clinical interests. I would not wish to finesse or blur Mr. Newman's right to discharge himself from facilities that may indeed be in his best clinical interest, if he is not covered by the Act.
That, of course, increases the onus on us to ensure that provision is adequate, and that mentally ill people who are not subject to the section power accept that the available treatment meets their needs. It is to that aim that the major enhancement of the mental illness programme on which we have embarked is directed. The date of 1 April 1991 marks not only the general implementation of the NHS reforms, but the beginning of the implementation of a major programme of enhancement of mental health facilities within the NHS, initiated by my predecessor, my hon. Friend the Member for Kettering (Mr. Freeman).
On 1 April, five points in our mental illness programme begin to take effect. First, each health authority has been charged with the introduction of the care-programme approach to treatment provision for the mentally ill. For those who are under the care of a health authority. the authority is required to ensure an individually tailored care programme for each patient, which must name a key person who is responsible for ensuring that the health and social facilities described in the programme are made available to the individual who benefits. That is a major enhancement of the management of mental illness services.
776 Secondly, from 1 April we shall implement the mental illness specific grant, which will provide for total additional expenditure by social service departments of £30 million in the first year. Thirdly, we have announced the approval of capital allocations through the local government finance system, so that local authority social services departments not only have the specific grant to support their revenue expenditure, but have access to capital funds to ensure that the facilities are there on which the expenditure can be made.
Fourthly, we are continuing with the capital loans fund, which is designed to ensure that inappropriate, old-fashioned mental illness facilities are taken out of commission more quickly, and that the capital released thereby is used to provide more appropriate, effective care facilities within the community. Fifthly—perhaps as important as any other proposal, in the context of cases such as Peter Newman's—the next financial year will see physical expression of our programme for the homeless mentally ill in London, to ensure that, for those who slip through one net—and, to be honest, if we are providing for the majority of mentally ill people in the community, some will slip through—there is also a safety net to give them a staircase back into mainstream provision.
That programme adds up to £155 million of new money for mental illness services over the next three years. I do not think that anyone can doubt the Government's commitment to enhancing provision, precisely to meet the test that I described: that those who are not detained compulsorily under the Mental Health Act must have access to a range of provision that will cause them not to wish to discharge themselves voluntarily from provision that the law does not allow us to provide compulsorily.
I hope that my hon. Friends accept that we have clearly defined the circumstances in which provision should be compulsory. Those are very tightly drawn, properly in my view. If someone is not covered by such provision, it is incumbent on us to ensure that there is adequate voluntary provision, and to address that priority as well.
§ The motion having been made after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at fifteen minutes past Twelve o'clock.