Mental Health Services

HC Deb 08 December 1998 vol 322 cc145-58 3.30 pm

The Secretary of State for Health (Mr. Frank Dobson)

I should like to make a statement on the Government's proposals to modernise the mental health services as part of our drive to ensure that we enter the new century and new millennium with health and social services that are modern and dependable.

Last year we published our proposals for radical reform of the national health service, and last week we did the same for social services. The strategy document we are publishing today brings together our proposals for far-reaching changes and improvements in the treatment and care which both services provide for people who are mentally ill. We are doing that to emphasise that mental health is not some marginal responsibility of the NHS and local social services—far from it: it must be at the heart of both. That is because mental health is not an obscure minority concern. It is just as important as physical illness and the two can be closely interlinked.

Mental illness is as common as asthma: it affects as many as one in six adults at any one time. It ranges from high levels of anxiety or deep depression to severe and enduring illnesses, such as schizophrenia, which affect one person in a hundred. Mental illness is extremely disturbing to sufferers and their families. It can leave people without insight into the consequences of their actions, which is very frightening; in addition, mental illness is little understood. Those factors combine so that mental illness carries a stigma. In turn, the stigma frightens sufferers and their families, and can lead to people postponing getting the treatment they need.

Partly because of that, mental illness does not get the prompt, effective and sympathetic attention it both deserves and needs. As a result, people who are mentally ill, their carers and the professional staff responsible for their welfare have suffered from ineffective practices, an outdated legal framework and lack of resources. We want to deal with all those aspects to bring about a dramatic change for the better in the treatment and care of all those who are mentally ill. In particular, we want to make sure that proper attention is given to the disturbing growth in the number of young people who are mentally ill, and to the particular needs of certain ethnic groups.

Most people who suffer mental illness are vulnerable people who pose no threat to anyone but themselves. Their condition may make it hard for them to keep a family together or hold down a job, but their behaviour is mild and inoffensive. Most of them are not getting all the low-intensity support they need. That is partly due to the fact that confidence in the whole system is in crisis, mainly because it is not coping with the small minority of mentally ill people who are a nuisance or a danger both to themselves and to others. That is where the policy of care in the community has failed: its failure to deal effectively with the most severe cases has dealt a blow to all mental health efforts and lost the confidence of the public.

Discharging people from hospitals brought benefits for some, but it has left many vulnerable people who find it difficult to cope. Others have become a danger to themselves and a nuisance to others. Too many have been left wandering the streets and sleeping rough, and a small but significant minority have become a danger to the public as well as to themselves. That cannot go on, so we are putting in place a new strategy to tackle the problems faced by patients, professionals and public alike. We have to take steps to tackle the most extreme manifestations of mental illness, because if we do not, the other people who are mentally ill will not get the attention they deserve and need.

That is why we must bring the law on mental health up to date. That law was formulated at a time when most mentally ill patients were treated in hospitals, so it now reflects the practices of a bygone age and must be modernised to cope with the problems of today. At present, some people who would once have been left locked up in a hospital are fine living in the community; others are only safe providing they take their medication. However, some of those who can become a danger to themselves and others refuse to comply with the treatment they need. That cannot be allowed to go on, which is why I have set up a review of the law on mental health. We need a law that works in a crisis, not one that fails in a crisis.

Similarly, there is a small group of people with an untreatable psychiatric disorder, which makes them dangerous. At present, neither law nor practice are geared to cope with them. They cannot be taken into a mental hospital if they will not respond to treatment, and they cannot be put in prison unless they have committed an offence. If they are sent to prison, they can be a danger upon their release. Therefore, the Home Secretary and I are considering proposals to create a new form of renewable detention for people with a severe personality disorder who are considered to pose a grave risk to the public.

That raises all sorts of ethical and practical problems, but we are convinced that the safety of the public must be the prime concern. People whose mental illness poses a threat to others constitute a very small minority, but we must be able to deal with them. Their illness is often an even bigger threat to them, and our new system should be better both for them and for the public.

Our mental health strategy goes much wider than that, and there are huge developments in both policy and practice. We will put in place a national service framework, which will spell out for every part of the country the range of services that are needed to treat and care for the mentally ill and how best to deliver them. We are being advised about that by an external reference group chaired by Professor Graham Thornicroft from the Maudsley hospital. I thank him and his colleagues for their work in that area.

In the meantime, we are getting on with the improvements that are unarguably needed. There is a pressing need in some parts of the country for more mental health beds and for 24-hour services to be available. We want the services that are provided to be safe, sound and supportive: safe to protect the public and the most vulnerable patients; sound to ensure that patients get the best and most appropriate care and attention; and supportive by working with the patients, users, carers and local communities to help mentally ill people live as independent lives as possible. The strategy works best when patients and carers are involved in shaping services to meet local needs.

Those services, which back up informal carers, will be provided by the national health service, social services and voluntary bodies. All must work together to ensure that people who are mentally ill get well-organised and unified treatment. Proposals in the forthcoming national health service Bill and Local Government Bill will promote that policy.

This year, the planning guidance issued to the national health service was issued as joint guidance to the health service and social services to emphasise the need for them to work together. The National Institute for Clinical Excellence, which we shall establish, will issue clear and authoritative guidance on the most effective drugs and therapies for use in treating mental as well as physical illnesses.

At the same time that those general improvements are being made to the NHS, we are going ahead with much better support for patients and carers. The measures include: access to NHS Direct 24 hours a day; 24-hour crisis teams to respond in emergencies; more mental health beds of the right sort, in the right place; more hostels and supported housing; home treatment teams; and improved mental health training for GPs and others responsible for providing primary care. Other new developments in the NHS, including health action zones and the obligation on health authorities to prepare and implement health improvement programmes, will contribute to improving mental health treatment and care.

I would like to pay a particular tribute to all those who care for people with a mental illness. A great deal of that caring is done by parents, children, friends and neighbours. It is also done by dedicated professional staff. Their work can be very stressful and is sometimes dangerous. We owe them a great debt. They must deal, day after day, with the consequences of policy failures, shortcomings in the law and a lack of resources.

What needs to be done will clearly cost money. Last week, I announced that we had found an extra £185 million to invest in mental health services provided by council social services. Today, I can announce that that sum will be more than matched by our extra investment in national health service mental health services, which will total £510 million over the next three years. That adds up to about £700 million extra investment in mental health services over the next three years on top of the £3 billion already going in.

All that is investment for change. The Government and the public will expect that extra investment to make a discernible difference and help people across the range of mental health needs. At the end of three years, we expect there to be more 24-hour staffed beds, more secure beds, access to new drugs, assertive outreach teams where they are most needed, more day and respite care, more supported accommodation and improved services for children and adolescents.

All those and many more services will make sure that when people have a mental illness, they and their families can turn to top quality professionals to provide the best possible treatment and care in a system that is safe and sound for patients and the public.

Miss Ann Widdecombe (Maidstone and The Weald)

I am grateful to the right hon. Gentleman for his courtesy in letting me have an advance copy of his statement and for ensuring that on this occasion, it reached me in good time. I have questions about his proposals which I hope he will be able to answer today, but if he cannot, perhaps he will write to me.

First, will the Secretary of State confirm that the view of the profession is that care in the community has been an overwhelming success and that only a small number of inappropriate discharges have caused justifiable concern among the public?

Will the right hon. Gentleman confirm that a major factor in patients defaulting on medication is the rationing of the latest atypical anti-psychotics? Will he give an assurance that community treatment orders will not be invoked until the patient has been given access to all appropriate medication, even if that medication costs more than that currently being used? Will he ensure that guidance from NICE on the prescribing of medication for patients with mental illness does not assume that all patients should start on the older, less satisfactory medication? If NICE recognises a drug as effective, will he ensure that it is always available on the NHS?

Will the Secretary of State commission a study on the real costs to our health service of providing the latest anti-psychotic medication, compared with providing in-patient treatment? Will he state what consultation he has had with those involved with all aspects of mental health, and what are the results of that consultation?

Will the right hon. Gentleman clarify the position of personality-disordered patients in relation to the Mental Health Act 1983 and state what discussions he has had with the Royal College of Psychiatrists regarding the prospects for treatment of those individuals?

Will the Secretary of State clarify the role of the Under-Secretary of State for Health, the hon. Member for Barrow and Furness (Mr. Hutton), in consulting the mental health charities and what reception he has had from those discussions? Is it true that the hon. Gentleman greatly offended the charity MIND with ill-advised comments about enforced treatment?

Will the right hon. Gentleman confirm that care in the community has been in existence since the closure of Victorian-style asylums in the 1950s? Will he confirm that the policy of community treatment orders has caused concern among psychiatric nurses? What steps is he taking to ensure that their fears are not realised?

Will the right hon. Gentleman confirm that the number of dangerously mentally ill patients, from whom the public need protection, accounts for a small proportion of the total population of mentally ill people?

What estimate has the Secretary of State made of the number of new in-patient beds that will be necessary if community treatment orders are not to prove utterly unworkable? How many of those beds will be provided in mixed-sex wards? What is his policy on mixed-sex wards for the mentally ill?

When will the Mental Health Act 1983 be replaced? [Interruption.] I think that some Labour Members do not understand the workings of the Act. Is it not the case that to implement community treatment orders a new mental health Act will be required? Why, in that case, has the Secretary of State failed to win time for one in the Queen's Speech? If mental health is such a priority for him, why could not time have been found in this year's Queen's Speech for a new mental health Act? Can the right hon. Gentleman confirm—I hope that he will—that there will be no enforced medication for patients outside NHS premises?

Mr. Dobson

I cannot really thank the right hon. Lady for her welcome for what we are proposing. She asked me to confirm that the psychiatric profession's view is that care in the community was a success. It is my job to say what my views are. The right hon. Lady can find out from the profession what its views are. I think that it failed.

We are seeking the views of the various professionals involved in this matter, but some of the shortcomings in the present arrangements arise from the things that some of the professionals have got wrong in the past and, in my opinion, from their adherence to an over-optimistic view of the likely product of care in the community carried to extremes.

NICE will have the clear job of looking at new treatments and new pharmaceutical products, and advising on whether they are sound and should be widely used in the NHS. If they should, they will be funded.

I am afraid that I cannot read my notes. What was the right hon. Lady's fifth question? I am happy to take a hint.

Madam Speaker

Perhaps the right hon. Gentleman will continue. I am sure that it will come to him eventually.

Mr. Dobson

What we have been saying all along is that we want to consult the people who have been involved in these matters but, in view of the track record of some of them, we will have to look carefully at what they say and not necessarily directly accept their advice. Some of them have been responsible for some of the things that have gone wrong. There is a new arrangement in hand and they will have to become accustomed to it, as will the people at MIND who did not like the Under-Secretary of State for Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), giving them an outline of what we intend to do.

I heard someone from MIND on the radio this morning and she apparently shares the right hon. Lady's view that there is really nothing wrong. I have seldom heard such a defence of the status quo as was apparent in the right hon. Lady's questions. She emphasised that the policy of care in the community has been in place for a long time. Indeed it has, and it has had time to show whether it works—it has shown that it has not worked. One cannot claim success for a policy that fails the most difficult cases, and that is certainly what has happened with care in the community.

We believe that the law needs to be changed to enable community treatment orders to be introduced; that is one of the reasons why we need to change the law. As I said in my statement, I recognise—it is fairly clear—that the dangerously mentally ill are a small minority. However, I have also emphasised that, until we sort out the crisis that they have created, proper attention will not be given to the other people who need help with their mental health.

We are not looking for national totals for beds. We are conducting a survey of all beds in the NHS to find out what is needed in each area so that we can identify what sort of beds are required. The fact that there is a surplus of beds in Norwich is of no consequence to those facing a shortage of beds in Bristol.

We want to eliminate mixed-sex wards. I have twice stepped in to prevent health trusts from following the policy of the previous Government and trying to create more mixed-sex wards. I will not tolerate such wards and they will be eliminated.

The right hon. Lady asked about the provision of legislative time in order to do these things. If she can sort out the Tory party's policy on the House of Lords so that we know whether it will obstruct the passage of our measures during this Session, perhaps we could introduce the legislation for which she apparently yearns.

Mr. David Hinchliffe (Wakefield)

I warmly welcome many of the points made by my right hon. Friend the Secretary of State. I welcome also the Government's recognition that serious problems are facing a minority within the community.

I find myself in some difficulty because I agreed with the first point made by the right hon. Member for Maidstone and The Weald (Miss Widdecombe) about community care being a success for many thousands of people. There are many thousands, who do not make news headlines, who are better off cared for in the community as a consequence of the community care policy. At the same time, I accept that there have been some very serious failures and tragedies that should be addressed, and my right hon. Friend is right to address them.

I say that in the context of regretting the view of some people that there was a golden age of the lunatic asylum; there was not. I am old enough to remember the Stanley Royd hospital in my constituency and other long-stay psychiatric hospitals, which left a great deal to be desired. I welcome my right hon. Friend's points in that context.

I press my right hon. Friend on two specific points. First—I am particularly concerned about this—does he recognise the urgency of the reform of mental health laws? As he has said, these laws reflect the old asylum system rather than the reality of today's care in the community. We desperately need laws that underpin the work of those who are doing a valiant job in helping people to be cared for in the community.

Secondly—it will not be a surprise to my right hon. Friend—bearing in mind the number of failures that have occurred through a lack of inter-agency working, is it not about time that we addressed seriously the issue of a single community care authority?

Mr. Dobson

First, I shall answer my hon. Friend's final question. He has a great depth of professional and personal knowledge of these matters. I believe that there would still be boundaries wherever we drew the line. I am not in favour of having joint social services and national health service provision. I am sometimes told that such a system works brilliantly in Northern Ireland, while others tell me that it does not.

One of the greatest problems was that the old institutions were awful. In many instances, they were absolutely vile places. It is right that they have been closed down and that people have been moved out. The problem is that some people have been moved out without adequate provision being made for them, either in law or in terms of the services that are available to them. The Victorians may have built great lunatic asylums so that people were out of sight and out of mind; under the previous Government, people were turned out of hospital and off the books, but we can no longer tolerate that sort of thing. We must ensure that people are properly looked after.

My hon. Friend has made the point that I make whenever I speak on these matters, which is that only a small minority of people are a danger to others. However, there are a huge number who are endangered by not being properly looked after when they are walking the streets. In future, people in both those categories need to be properly looked after, and that is what we intend to do.

Mr. Simon Hughes (Southwark, North and Bermondsey)

First, will the Government accept our welcome for their intention to make mental health a greater priority for the national health service? In particular, we welcome the commitment to assertive outreach, early intervention and 24-hour services, whether they are drop-in services or admission into hospital beds for those who need that provision—and at present, often cannot have it. We join the Secretary of State in his tribute to those who care for the mentally ill, especially psychiatric nurses, community psychiatric nurses and psychiatric social workers, who are often in the front line undertaking extraordinarily difficult jobs.

Will the Government reflect, however, and consider whether it would be better as a policy not to be tough on care in the community, but tough in providing the resources for that care? Is it not the case that many of the problems that have made the front pages of the tabloid newspapers have been caused by overstretched teams not being able to provide such care, rather by people being out in the community and being cared for?

Is the Secretary of State able to tell us the number of beds that he estimates we need to open? More importantly, does not he accept that we are desperately short of psychiatric nurses, community psychiatric nurses and psychiatrists? How many more of these people will be engaged as a result of the resources that he is announcing today?

In the past eight years, there has been a cut of about one sixth in the share of the NHS budget spent on mental health. Will the funds that have been cut be restored? Will the £700 million be £113 million a year for the next three years, or £233 million for the next three years? There are two ways of calculating £700 million, and one total is only half of the other.

Does the Secretary of State accept that—to protect the public and the mentally ill from homicides and, much more often, suicides involving the mentally ill—we need to have better ways of controlling the moment of discharge, often by including a lay element? Does he accept also that—rather than telling people that they will be taken back into hospital if they do not take their drugs, taking away their civil liberties—the test should simply be whether people are well enough to be in the community?

Mr. Dobson

That was a set of weasel words at the end of the hon. Gentleman's questions. It is not simply a matter of people taking their drugs. Day in and day out—

Mr. Hughes

But—

Mr. Dobson

If the hon. Gentleman will listen for a moment, I shall answer his question. Day in and day out, even in purpose-built, small units trying to provide 24-hour care for those who can go out into the community, if someone has a bad episode—is on the turn—those who are running the place cannot keep that person in if he or she is determined to go out. That is nothing to do with medication but is a practical problem. We have to change the law to deal with that practical problem, and that is what we shall do. We are increasing the amount of money available and the proportion of NHS and social services money spent on the mentally ill. We think that it is right to do that.

I am sorry that I did not follow the hon. Gentleman's arithmetical gymnastics, in which he seemed to disappear halfway up the sum that he originally mentioned.

There are more specialist psychiatric nurses in training, and we want to ensure that there are sufficient nurses and other staff available to do the job that needs to be done. It is certainly true that, across the United Kingdom, there are overstretched teams. To help them, we plan to change the law, to provide extra resources and to change the way in which they go about things. We believe that those three actions combined will lead to a very substantial improvement in the service for all those who are mentally ill.

Mr. John Gunnell (Morley and Rothwell)

Will my right hon. Friend ensure that, when it is recommended that a patient has electro-convulsive therapy, it will be certain that the hospital providing the therapy has up-to-date equipment and a technician or doctor trained in the use of that equipment, and that, if the patient has any uncertainty about accepting the treatment, the opinion of an independent second appointed doctor will be available before the treatment is provided?

Mr. Dobson

Anyone who is being treated in the national health service should be entitled to treatment using equipment that is sufficiently up to date to be safe and to do the job that it is intended to do, whether it is to treat patients for something that is physically or mentally wrong with them. It is certainly intended that all treatments should be administered by properly trained staff. There is royal college guidance on the matter, and it should be followed. If my hon. Friend feels that we have to follow up and augment the guidance with arrangements in the national health service, I should be happy to contemplate doing so. One of the reasons why we are giving responsibility for quality to the national health service is that we feel that current arrangements are not satisfactory.

Mr. Nicholas Winterton (Macclesfield)

I served on the Social Services Committee when it undertook a lengthy inquiry into adult mental illness and mental handicap. I warmly support the Secretary of State's statement. The recognition of the failings of care in the community for the more severely mentally ill is long overdue. In-patient hospital beds are required for that small minority. My constituency has experienced two or three tragic deaths as a result of the failure of the system. The Secretary of State made a statement some time ago that no further hospital beds would be closed in the mental health sector. Will he repeat that assurance and promise that resources will be available to provide the necessary facilities for those with severe mental illness, particularly the more extreme cases of schizophrenia?

Mr. Dobson

I thank the hon. Gentleman for his kind welcome for what I have said and for all the work that he did on the Select Committee, which he chaired with great distinction. On these issues, he sometimes appears to be more supportive of the present Government than he was of the previous one. I do not want to ruin his reputation with his colleagues. He developed a reputation for saying what he believed to be true, which is a good reputation to have anywhere, particularly in the House of Commons. I share his view that unless those who are in favour of care in the community are willing to recognise its failings, we shall not be able to address those failings and get on with the rest of the task.

We do not want any loss of psychiatric beds that does not make sense. We have slowed the process of closure and have instituted an independent review, which is new. There may still be some cases in which moving people out of some of the remaining large hospitals is an appropriate response, but, as the hon. Gentleman says, if that is going to happen, the people must be moved to somewhere that is suited to their needs. I remember drawing the analogy when I was a shadow health spokesman a dozen or more years ago of looking at the old institutions as broken down motor coaches. What is needed is something approaching a custom-built vehicle for everyone who moves out. Sadly, a lot of them have been left to walk.

Audrey Wise (Preston)

I particularly welcome my right hon. Friend's reference to child and adolescent mental health services. I recommend that he ensures that his Department continues to keep an eye on that theme. When the Health Committee investigated the issue, it was concerned that neglect in childhood was worsening the situation for adult mental health. We were distressed to find that many of those engaged in child and adolescent mental health services felt that their service was a Cinderella of a Cinderella. I urge my right hon. Friend to keep his eye firmly on the issue for economic reasons as well as to ensure a good service.

Mr. Dobson

I thank my hon. Friend for what she has said and for her contribution to thinking on the issue. The strategy document refers to the views of the Select Committee on that. The services for children and adolescents are a neglected part of an already neglected service. We want to put that right.

Mr. Peter Brooke (Cities of London and Westminster)

I thank the Secretary of State for his statement. Will he accept it from me that I have heard the president of the Royal College of Psychiatry say within the Palace that although the present policy constitutes major problems for those on the streets of the Secretary of State's constituency and mine, it has worked a good deal better in rural and suburban areas? Does the Secretary of State further agree that it is important that we achieve, if possible, as much of a bipartisan policy as we can on so serious an issue, and that we all have a responsibility to build on the common ground of analysis and fact?

Mr. Dobson

I accept most of what the right hon. Gentleman, who represents the neighbouring constituency to mine, says, but nobody could accuse me of bringing politics into this afternoon's statement.

Dr. Lynne Jones (Birmingham, Selly Oak)

I commend my right hon. Friend on the sensitivity of his statement. One of my earliest recollections is visiting my father in what was known locally as the loony bin, and having my clothes prodded by elderly ladies who were dressed in clothes from the communal store and who looked like children. God forbid that we should ever return to those days of dehumanising institutionalisation. However, the principle of care in the community is not a failure; it is the inadequacy of its resourcing. Will my right hon. Friend assure the House that there will be sufficient well-trained staff with manageable case loads to provide care and support for the majority of mentally ill people who are not a threat to the community, and who for too long have suffered in silence either alone or, if they are lucky, with their families who are equally in despair? Will he ensure that sufferers and their carers are involved in the development of new services? Perhaps he could also consider establishing a mental health ombudsman to look at complaints across the boundaries of social services and health services which so often failed in the past?

Mr. Dobson

In relation to my hon. Friend's last point, the national health service ombudsman can deal with NHS issues and the local government ombudsman can deal with social services issues. There is nothing in law to prevent them from mounting a joint exercise in respect of issues at the boundary. I share her desire not to go back to the old institutions. The provision of care in the community certainly has been under-resourced, but it is not just a matter of under-resourcing. There was over-optimism among some of those concerned about the capacity of patients to cope outside institutions and a failure to provide the necessary back-up. The law is undoubtedly out of date and some of the practices have not been very sound. We are trying to address all three aspects. As I said in my statement, we want to work in collaboration with patients and carers in each locality because all the evidence is that when that is done effectively, it results in a better service for everyone and that is what we are after.

Mr. Dafydd Wigley (Caernarfon)

The Secretary of State will be aware that people suffering from learning difficulties—or mental handicap, as it was once known—sometimes need to take drugs in the community. Can he confirm that his statement does not apply in any way to those with learning difficulties, and that each case will be considered on its merits? Does his statement apply only to England or to Wales and Scotland as well?

Mr. Dobson

The statement applies to England alone. We are talking not about the treatment of people with learning difficulties, but about mental health.

Mr. Martin Linton (Battersea)

Does my right hon. Friend accept that the provision of more mental health beds will be a great step towards ensuring that people who should be in hospital are not kept in hostels? That would be some reassurance for the colleagues and relatives of Jennifer Morrison, who was killed in a hostel in my constituency only two or three weeks ago, and, indeed, for the neighbours of the hostel. Although care in the community was a bipartisan policy, we cannot be totally uncritical of the previous Government, who, between the mid-1980s and mid-1990s, oversaw the closure of 50,000 to 60,000 beds in psychiatric hospitals without making care in the community a reality by ensuring that resources and the provision of hostels kept pace.

Mr. Dobson

I share my hon. Friend's proper concern for the relatives and friends of Jennifer Morrison, who—as we should always remember—died doing the job that we had asked her to do, in difficult and, as it turned out, fatal circumstances. The necessity is to provide services that are suited to the needs of each individual. A place in a hostel may be appropriate for some, whereas a place at home—provided that there is back-up—may be appropriate for others. In some cases, people should be held in secure accommodation. We must recognise the fact—some practitioners, I believe, do not like to recognise it—that people can move backwards and forwards across that spectrum; we are trying to ensure that we can respond sensitively and quickly to those changes.

Mr. David Faber (Westbury)

The right hon. Gentleman's statement and some of his subsequent replies will have a somewhat hollow ring for my constituents in Warminster, where we learned with dismay this weekend that the mental health unit in the local hospital would close. The hospital is not large, if I may use his word; it is a small community hospital that serves a rural area, and its future will be threatened by the closure of the unit. Is he aware that his refusals to meet local health workers to discuss the closure or to answer my questions on it in the House have been viewed at best as discourteous by those who work in the hospital and by those whose family members are being treated there? Given the nature of his statement, will he or one of his Ministers undertake to meet those health workers and local people as soon as possible?

Mr. Dobson

I am not aware of the current state of any closure proposals for the unit to which he refers. I may have to take a decision on it, but I do not know off hand whether that is the case. If I do have to take a decision, I am, as ever, willing to meet the elected Members for the area or to get one of my colleagues to do so.

Mrs. Alice Mahon (Halifax)

I warmly welcome the measures that my right hon. Friend has outlined. I have never understood the argument that it is better to sleep rough or languish in prison than to be given proper short-term asylum and appropriate treatment—if one of my loved ones was involved, I know which option I would prefer. Will he consider the tragedy of the high number of suicides among teenagers? Does he envisage special measures to deal with that vulnerable group?

Mr. Dobson

I thank my hon. Friend, too, for all her efforts on this issue over the years, in and around Halifax, in the House and in other places. The increase in the number of young people who commit suicide is one of the most disturbing aspects of our society. No one has a ready explanation for that increase or for the general increase in mental illness among children and young people, but we hope that the specific measures that we are taking—not only through mental health services, but through the education service—will help to tackle the problem. We also hope that the changes that we are proposing as a result of the Utting inquiry into children in care will help, especially as a much higher proportion of children in care are mentally ill and a higher proportion of them subsequently commit suicide. Until we have a better explanation for the problem, however, it is hard to do anything about it.

Rev. Martin Smyth (Belfast, South)

I welcome the statement. Along with my hon. Friend the Member for Macclesfield (Mr. Winterton), I served on the Social Services Committee, and we tabled an amendment—which was not accepted—pressing for secure units and places of asylum. Having said that, I must confess that the general plan of community care has worked tremendously well and, in parts of Northern Ireland, it has been going on for 40 years to good effect.

May I press the Secretary of State on the number of occupational therapists who are being recruited? There is still a great need for such people to help folk with mental illness. Is there a process of reaching out to the Department of Social Security? Recently, I had a constituency case where benefit for a schizophrenic person was reduced from including the major care component to a lower care component. As a result, her husband was not able to look after her and she was readmitted to hospital. Surely there should be greater cross-referencing between the different branches of the caring professions.

Mr. Dobson

The hon. Gentleman's last point is valid, and we are looking at how we can provide a better package of care that includes money and direct help. We are trying to formulate that package, but it is rather difficult. If he has any further ideas, I will be happy to consider them.

Many therapists—not just occupational therapists—can make a contribution to helping people cope with living in the community, and we must try to make the system work as best we can. There was a time—it is still the case in certain circumstances now—when asylum was regarded as a good concept, and as a place of safety and security. However, the asylums became so disreputable that the concept suffered, and the bad reputation and stigma that attached to the word "asylum" have, to some extent, dominated much of the subsequent discourse on the matter. They have made some people reluctant to look at the idea of providing the secure care that is needed by some people.

Mr. Neil Gerrard (Walthamstow)

I welcome my right hon. Friend's statement, including what he said about the way in which the current system has failed a small number of desperately ill people. In my constituency, a young man, when seriously ill, murdered someone else. The most tragic part of the case was that his family had been trying desperately to get help for him and to get him into secure accommodation. They were not able to do so.

Does my right hon. Friend accept that if we bring in a new and renewable form of detention order, there may be some clear-cut cases but, with any such order, there will be difficult, borderline cases where decisions have to be made as to whether an order is brought in or not? What safeguards does he envisage for the bringing in of such orders? What protection will be provided to someone who might be subject to such an order?

Mr. Dobson

My hon. Friend rightly refers to the small number of what might be described as spectacular and awful failures, but the failure of the system went further than just the people who became a danger. There are many vulnerable people who are walking the streets and who are not getting the attention that they deserve. We should not forget them.

A renewable detention order raises deep and difficult ethical issues. I expect—although I cannot say, because we have asked some distinguished people to look at mental health law—that some form of protection for the individual will be recommended, relating both to people's clinical state and to their freedom as individuals. Both concepts will have to be brought to bear when decisions are made.

Dr. Evan Harris (Oxford, West and Abingdon)

I welcome much of what the Secretary of State has to say, but will he accept a sixth invitation to agree with the statement that he was wrong to describe community care as failing outright? That gives major concern to people who work in the area. May I invite him to agree that community care may have failed in a few areas for a few patients, but that generally when it has failed, it is because it has never been tried, as it has always been inadequately funded?

Does the Secretary of State accept that in Oxfordshire, with a mental health trust that is effectively in receivership, and with experience of the failures in the tragic Raus and Darren Carr cases, we would be concerned to learn that the extra money allocated to mental health will not compensate for the real-terms cut in funding that Oxfordshire social services received in the standard spending assessment announced last week?

Does the Secretary of State finally accept that rationing—the "R" word that dare not speak its name from the Government Front Bench—has applied in mental health, the Cinderella specialty, not only in the use or lack of use of new anti-psychotics, but in the provision of beds for the mentally ill near where their families live, and not miles away? Many of my constituents have had to go to Wales to visit their loved ones. Does he accept that rationing exists and that his funding could at least reduce the amount of rationing that occurs in this specialty?

Mr. Dobson

One or two people seem to think that a system that has led to an unacceptable number of homicides and suicides has been a success, but I am afraid that that is not my interpretation. I think that the system of care in the community failed as a totality, because it failed in the most difficult circumstances. One cannot claim success for an arrangement that fails in a crisis. I fully accept that it delivered for a substantial number of people—

Miss Widdecombe

Ah.

Mr. Dobson

The right hon. Lady reacts as though I had never said that before, but I said it in the statement. No doubt she was preparing at the time to jump up and announce that the system had been a success. The people who have committed suicide or killed others are not the only failures. All over the country there are vulnerable people who have not been properly looked after, and that cannot be regarded as a success.

We have just announced that we are putting an extra £700 million into mental health care, on top of the £3 billion already being spent. That is a big step forward, and it is disproportionately greater than the increase in spending on other aspects of health care. We are moving in the right direction. We may not be moving as fast as the hon. Member for Oxford, West and Abingdon (Dr. Harris) would like, but then again, we have to find the money, and he does not.