Community Care (Rights to Mental Health Services) (Hansard, 24 January 1995)

§ Ms Tessa Jowell (Dulwich)

I beg to move, That leave be given to bring in a Bill to provide for comprehensive services for persons referred to specialist psychiatric services or discharged from hospital following treatment for mental disorder and for connected purposes. The Bill would give enforceable rights to care and support to mentally ill people in the community. It would also establish national standards for the provision of services and care. Mentally ill people still live at the margins of our society. For too long, our concern and the public resources it represents have been as marginal. We have all had our reasons for that failure.

Professor Kathleen Jones put it well when she said: to the politician community care is a useful piece of rhetoric; to the sociologist it is a stick to beat institutional care with; to the Civil Servant it is a cheap alternative to institutional care which can pass to the local authority for action or inaction. To the visionary it is a dream of a new society in which people really do care. To the Social Services Department it is a nightmare of heightened public expectation and inadequate resources to meet them. Those words are as relevant today as when they were first written 20 years ago, and that is the problem.

There is now unquestioned and universal agreement about what makes care in the community work—agreement that was validated by research in the mid-1960s, and confirmed by numerous studies since then and by the experience of mentally ill people themselves during the past 30 years. The essential elements of community care are stable accommodation, the support of a named key worker, day care and access to crisis services that are available 24 hours a day and not—as, unfortunately, is still too often the case—only from 9 to 5.

Shamefully, whether a person secures the services that he needs, when he needs them and for as long as he needs them, still depends on a geographical lottery. The level, range and quality of provision varies enormously from one district to another. Eligibility varies. Is it any wonder that mentally ill people desperate for help just get lost, sometimes with tragic consequences?

When treatment was provided in large, distant hospitals, society could and did ignore the injustices and, sometimes, even the brutality that that caused. Patients were denied privacy and their own clothing; even false teeth were handed out before meals by charge nurses. But that time has long since passed, and no one seriously proposes a return to policies abandoned by public and professional consent a generation ago.

Today's challenge, which cannot be bucked, is to bring the essential elements of care once found in mental hospitals to every person who stands in need of them. The risk posed by recent tragedies is that public confidence will falter just when the Government and Parliament must be made to face that challenge and deliver a policy that works for all. How can confidence be restored in a policy that depends on the one hand on public acceptance and support, and on the other on the actions and decisions of countless doctors, nurses, social workers and other professionals?

What is needed is a system for care and treatment that can meet the twin concerns of public safety and the need to ensure that individuals are given appropriate and reliable help while living their lives in the community 144 rather than in a hospital ward. Our present legal framework for mental health is out of date; the legislation is hospital-based, and fails to take account of the fact that 90 per cent. of care is now provided in the community. Indeed, our mental health laws work against the very aims of community care, becoming more and more discredited as tragic cases highlight their glaring limitations.

Parliament created that inadequate legal framework, and it is now Parliament's responsibility to change it. In the House, we can legislate for a system within which the various rights and duties combine to provide a safer and more effective service for the mentally ill person, his relatives and the public. We can render more accountable those—from Ministers to individual practitioners—whom society has entrusted with the task of getting the policy to work.

What is needed to inspire both professional and public confidence is nothing less than root-and-branch reform—not tinkering with the details of the present law as the Government propose, or offering some paper-thin charter, which will be the next desperate idea. Numerous inquiry reports have emphasised that people can simply be lost by the services that should be helping them. Only last week, one such report—produced by a committee headed by Sir Louis Blom-Cooper—termed the Mental Health Act 1983 obsolete. The Health Service Journal, adding its voice, said that the "outmoded" Mental Health Act is "inadequate" and needs replacing.

My Bill offers a new legal framework. It will impose clear duties on health authorities, national health service trusts and social services authorities to assess and keep under regular review the needs which a person might have for the full range of medical treatment, social care and practical assistance required for life in the community. It will require the Government to establish and enforce minimum standards of community care provision throughout the country, with corresponding responsibility to ensure that those having to meet those standards have the funds with which to do so.

The Bill will define new duties which make health and social work professionals, and the authorities which employ them, accountable to those patients with whom they work and to the public for the decisions which they make on their behalf. Above all, it will for the first time give those who must rely on our health and social care system clear rights to receive the services which they need to have a decent chance of something better than just surviving in the community.

My Bill has the support of every major organisation concerned with the care and support of mentally ill people. Its principles are supported by MIND, the Royal College of Psychiatrists, the Royal College of Nursing, the Mental Health Foundation, the Association of Metropolitan Authorities, the Association of County Councils, the National Association of Health Authorities and Trusts, the Association of Community Health Councils for England and Wales, Survivors Speak Out, the patients' organisation, and Unison, the health service trade union.

The Bill also has extensive cross-party support within the House. I hope that it will be given an unopposed First reading by the House and that, in time, its much-needed proposals may find their place in legislation.

Question put and agreed to.

145 Bill ordered to be brought in by Ms Tessa Jowell, Ms Janet Anderson, Ms Jean Corston, Ms Angela Eagle, Ms Liz Lynne, Mr. Ken Purchase, Mr. Alan Howarth, Mr. Michael Clapham, Mrs. Gwyneth Dunwoody, Mr. Geoffrey Hoon, Ms Estelle Morris, and Mr. Roger Sims.