HL Deb 13 July 1966 vol 276 cc117-96

2.36 p.m.

LORD GRENFELL rose to draw attention to the working of the Mental Health Act 1959, with special reference to the care and education of children and adolescents; and to move for Papers. The noble Lord said: My Lords, in 1962 we had a debate on the workings of the Mental Health Act 1959, and during that debate I spoke on the progress made by local authorities in implementing the permissive powers given them under the Act regarding the care and education of mentally subnormal children. In that speech I was greatly assisted by a survey made by the National Society for Mentally Handicapped Children, and they have again given me reports which have been most helpful.

Prior to putting before your Lordships the evidence I have received, I should like to say a few words about the requirements of a family of a child of tender years. When a mentally handicapped child is born, the family are in desperate need of help. It is one of those things which are always very sad when they happen to someone else, but never seem to happen to on self. I have the greatest sympathy with general practitioners and consultants who have to diagnose and then tell the family the news that they have a subnormal child. Diagnosis is not always easy, and frequently parents have been put off by vague terms, and passed from doctor to doctor, until, in the end, they lose all faith in the medical profession, which is disastrous.

I am convinced that the best way to deal with this situation is for Her Majesty's Government to set up diagnostic centres, fully equipped to deal with the many disabilities in small children, to which the medical practitioner can refer any child which appears to be backward in any way. There are many tests which can be done, and in some cases a disability diagnosed early can be corrected. I am sure that these centres would be welcomed by the medical profession, and they would, I know, be of infinite assistance to the families who are now left in doubt about the future of their children. Attached to these centres should be counselling services, staffed by social workers and almoners who could explain to the family their rights under the law, and also advise them on the special care needed for their child. In nearly every case parents will face the future if they know what that future is: it is the fear of the unknown which causes such unhappiness and bewilderment. The National Society for Mentally Handicapped Children has set up a counselling service, and hopes to extend it. This service has been so successful that there can be no doubt that the State should follow up this pioneering effort for the good of all.

My Lords, I cannot pass on without mentioning the urgent requirement of all backward children to be tested for deafness as a matter of routine. This could take place in these centres. To-day there are children being diagnosed as mentally subnormal when in fact they are merely deaf. This can be disastrous to the family and to the future of the child. I asked an Unstarred Question in your Lordships' House regarding the education of children who suffer from the dual handicap of mental subnormality and deafness. I received a sympathetic Answer, and I hope that Her Majesty's Government will again study that speech and consider whether anything can be done for these children who are so very difficult to place in deaf schools, and who, in spite of their deaf aids, are in most cases completely lost in special training schools.

The South-West Metropolitan Regional Board, under, if I may say so, the very able chairmanship of the noble Viscount, Lord Addison, has asked hospital management committees to do a survey of children who would benefit by deaf training, and we are doing this. The real point is that training must, in my opinion, be continuous, and not just for one or two sessions a week. It would appear from this that accommodation should be residential, as the catchment area will be wide. Whether the teaching should be in hospitals or in the deaf schools already situated in the country is a matter for consideration by the Government.

May I now turn to the care of the child prior to school age? The local authorities have been empowered by the Act to set up special care units for the care of severely subnormal children on a day basis in order to give the mother some respite for shopping and recreation. These special care units are sadly lacking, and it appears to me that it should be possible for hospitals to co-operate with local authorities in setting up these units within the hospital grounds. Although in many cases land is at a premium, it is often possible to find a small piece of land within hospital grounds which could be used for this purpose, and hence achieve a necessary service, and at the same time save money. The staffing and costs should be a matter of arrangement between the hospital and local authority. Day hospitals are common knowledge for the mentally ill, and in my opinion this excellent provision should be extended to the severely subnormal child whose family would benefit so greatly by this assistance.

There are so many points which I wish to make in this debate that I have decided not to quote all the evidence I have received on the care and training of the mentally subnormal by the local authorities; otherwise, my speech would be far too long. But I propose to quote a few examples to show that, although the progress made in many parts of the country has been spectacular, there are some areas where there is still a grave lack of services. It is hard to understand why some local authorities are excellent, while others seem to have very little sense of responsibility in providing the minimum facilities for the care and training of these children. I fully realise the difficulties in rural areas, where long distances make the collection of children to one centre difficult; but it is not only in these areas that facilities are lacking, and in many rural areas difficulties have been wonderfully overcome.

May I now quote a few reports which will illustrate the points I have made? I shall then draw a conclusion which I trust will be carefully considered by Her Majesty's Government. In giving these reports I must state that they were drawn up earlier this year, and there may have been changes, but I believe them to be reasonably correct. With regard to the best establishments, one could go into any Lancashire or Cheshire training centre or hostel and find that everything is just what one would desire. Similarly, Manchester and Salford are both farseeing in their outlook and practical in their address to this work. With regard to authorities which have limited budgets and yet are making outstanding efforts, one could cite Flintshire, in North Wales. which for some years now has had both junior and senior training centres operating, and also hostels. All these are in fine buildings, well suited to their purpose, some newly built and some adapted and with a drive second to none anywhere in the country.

Monmouthshire is an outstanding example of the best kind of local-authority provision for the young mentally handicapped child. In this county at all baby clinics instructions are given that any baby who is slow in developing—that is, in walking, feeding, et cetera—should be referred to the mentally handicapped diagnostic clinic for examination. That is one point which I brought out earlier in my speech, which I hope will be noted, as it is most desirable that these things should be extended. In addition, health visitors, who visit all babies periodically for some years after birth, are instructed to report any child with a suspicious mental handicap to these clinics. The backward babies' clinics are well known in Monmouth-shire and hospital child specialists refer any suspect cases direct to the clinics for diagnosis. If a child is found to be mentally retarded he can be admitted from the age of two years to training centres and subsequently given six graded classes of instruction as in a normal school. When the child reaches the age of five years an official diagnosis of mental subnormality is made and reported to the education committee, and the child is then normally excluded from entering school.

Radnorshire is an authority that has not provided any facilities whatsoever for mentally subnormal children. It is intended that children from this county should attend a training centre at present being built in Brecon. However, no hostel accommodation is planned for this centre, which would make it virtually impossible for some of the children in Radnorshire to attend the centre at Brecon. In Huntingdon and Peterborough there are two junior training centres—one at Peterborough and one at Huntingdon—the latter being purpose-built, with a hostel and one bed to provide for short-term care. There are no adult centres, sheltered workshops, special care units, crèches or hostels for adults.

The authority provides a club for the mentally handicapped in the Broadway Club, Peterborough, which is also used for the elderly. It appears to be the policy of this authority, or at least of the health committee, never to pay for short-term care. Since the hospital waiting list is so long, this means that in fact short-term care is never available and families with helpless or extremely difficult children never have relief of any kind. Until the new hospital is opened, a child can be on the waiting list for ten years without even the relief of short-term care.

The St. Ives Society of the National Society for Mentally Handicapped Children were originally running the training centre now replaced by the new Huntingdon centre. This St. Ives Society now have a new building of their own where they run a club for adults and a crèche. It will be seen from the above that the local societies are still carrying out a great deal of the work which we would expect the authorities to undertake. In Barnsley County Borough there is an old wooden building with a corrugated roof which at present accommodates forty juniors and twenty-three adults. There is no leisure space and the building is quite inapproriate for the for the purpose. It appears that there is little hope of this building being replaced by 1971, but the council have obtained authority and a site for an adult training centre for eighty adults by that date.

I think that I have said enough to show you the great differences in the care given to the mentally subnormal, and I now draw my conclusions before moving to other subjects. I am convinced that the time has come when Her Majesty's Government must make a survey of the care and education of the mentally subnormal, and lay down minimum standards which must be complied with. It is the statutory duty of all parents to send their children to school, but if there is no adequate school for them to go to, how on earth can parents comply with this requirement? We have abandoned the word "ineducable" and substituted the words "unable to benefit from a normal education". It is up to Her Majesty's Government to ensure that an education is given to these children which will benefit them in their future life, and relieve their families of a bitter and frustrating experience which is unfortunately the lot of so many.

My Lords, may I, for a few minutes, turn to the teachers of the mentally subnormal? We cannot expect to recruit really good teachers unless we pay them a reasonable salary. We cannot accept in this day and age that this is a vocation and hence teachers should accept a greatly reduced remuneration. In some ways the teaching requires more skill than that required in normal schools. The teacher must be a saint and a psychiatrist with a large degree of firmness. He or she has to deal with a class of varying intelligence, some of whom will be non-communicating, and many of whom will be highly disturbed in one way or another. The teacher must be able to switch from one subject to another at short notice as the pupils, with their limited intelligence, can benefit from only a short period on any subject and may need a complete change to something like a percussion band.

I can assure your Lordships that the whole future of these children's lives depends on their early training, and it is not easy to find the right people and this is the reason why: the scales of remuneration do not compare favourably with those of normal schools. In making these comparisons I have taken assistant supervisors in both hospital and local authority schools, and assistant teachers in normal schools under the Burnham Scale, as these posts seem to correspond with each other in seniority. The pay in the case of assistant teachers in hospital schools is £575 to £765 over eight years, while in local authority schools it is £545 to £765 over the same period. In both cases it is £70 a year less if unqualified. There is one difference in that local authority schools get twelve weeks' holiday but hospital schools get only three weeks, as laid down by the Ministry of Health, and anything further is at the discretion of the hospital management committee, the average being two weeks, making five weeks in all.

Let us now compare this with Burnham Scale assistant teachers. They get with three years' training £750 to £1,400 over 14 years, and if unqualified£520 to £730 over 7 years. In addition to this, if they are working in a special school, such as an educationally subnormal or a hospital school, they get another £120 a year, and if they do a year's course in teaching the blind or deaf another £50 a year, bringing the possible scale up to £920 to£1,570 for the trained teacher. If we sum this up, we find that a qualified assistant supervisor gets a maximum of £765 and cannot advance any further, and if in a hospital school gets only five weeks' holiday. A Burnham Scale teacher can reach £1,570 over 14 years with twelve weeks' holiday. My Lords, is it any wonder that it is hard to find the best teachers for the mentally subnormal?

I find that the London Borough of Greenwich was advertising in the Federation of Association of Mental Health Workers' leaflet for an assistant supervisor starting at £735 and rising to £960. This shows that they consider that the normal rate as laid down is not adequate to fill the post. It is vital that teachers should not only be paid adequately but also be trained in the special skills required to get the best out of the children. Great strides have been made by the Council for Teachers of the Mentally Handicapped set up by the Ministry of Health, on which I am privileged to serve, in setting up courses in universities and technical colleges on the pattern pioneered by the National Association for Mental Health, who continue to do wonderful work in this field. In this context I should like to record, with the deepest regret, the death of Lady Adrian, the late Chairman of the Council, who did so much for the mentally handicapped. It is essential that the salaries of teachers should be carefully considered in relation to the importance of their work in bringing the children up to a standard which will make them useful members of the community rather than a permanent liability to the State.

May I turn now to hospitals, and on this subject, as Chairman of the Fountain and Carshalton Group of Hospitals, my experience is limited to hospitals for mentally subnormal children, with the exception of Queen Mary's Hospital for Children, Carshalton, which is the only comprehensive hospital with patients both long stay and acute on the pædiatric side, and long stay on the subnormal side. This is a wonderful concept, furthering the efforts of us all to integrate the mentally handicapped into the life of the community, and I hope that in years to come this idea will spread and hence the segregation of the mentally subnormal will be ended and all nurses will automatically be trained in both forms of nursing as a matter of course.

Here, my Lords, may I pay my very sincere tribute to all nursing staff, and especially those who nurse so devotedly the very severely subnormal? In so many cases there can be no word of thanks to these nurses as the patients are non-communicating. The work is hard, and as I visit the wards I come away with a great sense of admiration and gratitude for the wonderful service these men and women are giving. I believe that all of us would like to honour the nursing profession in whatever branch of nursing they are, and I feel that it would not only be right but also a great morale raiser if a few more nurses, both male and female, with long devoted service were put forward for decorations in the Honours Lists. I know full well how this would be appreciated, not only by the recipient but by the whole hospital in which the recipient was working. In the Birthday Honours there were decorations for four matrons and two ward sisters, and I was delighted to see it, but I think that a certain number of nominations could be allocated to the Regional Hospital Boards for really deserving cases among the more junior ranks who have given a life time of service to the care of the sick.

My Lords, I turn now for a moment to the administration of hospitals. We have been told that it is proposed to spend£1,000 million on the Health Service over the next ten years, and this certainly appears to be a large sum, but if it is broken down it will be found to be totally inadequate if our hospitals are to be brought up to the standard required to give a good service to the community. Without being in any way extravagant, I could spend£250,000 tomorrow on Queen Mary's, Carshalton, alone, and I know there are many more hospitals in the same circumstances.

It is essential that money should be found for the hospitals, and I am convinced that the time has come when we should consider a National Lottery the proceeds of which go exclusively to hospitals. There will inevitably be some that would object to this as an extension of gambling, but I am certain that the vast majority of people would rather have a little "flutter" on behalf of a good cause than let the money go to outside sources. Gambling has come to stay in this country so let us channel the proceeds into the cause of humanity as is done in other countries.

My Lords, before I close may I put one more suggestion to Her Majesty's Government? I can say from personal experience that there can be little doubt that a child brought up in the home with all the love and care of the family does much better than one in hospital or institution; and in saying this I am not in any way insinuating that the child in hospital or institution does not get loving care, because I know it does. But the family background will in nearly every case be the best solution. The published average weekly cost of severely subnormal children in hospital throughout this country is£10 5s. 4d. per head. It will be obvious that the cost to the parents of a subnormal child cared for in the home is greater than that of a normal child, quite apart from the mental stress. There is more laundry, and a modicum of help is desirable if the mother is to have any personal liberty at all, and in many cases special feeding is required.

We all wish to keep the mentally subnormal out of hospital if we can, not only for their own sakes, but also in order to keep the beds for those who are so severely affected that they need hospital care. I believe that Her Majesty's Government should consider a scheme to pay a small sum in the form of maintenance to the families of mentally subnormal children, until they reach school age, who are willing to look after them in the home. Perhaps the right amount would be the equivalent of that paid to foster mothers, which I believe to be something between£4 and£5 per week. I am convinced that this scheme would in the end save money and shorten the waiting lists for admission to hospitals, which are still, I fear, long.

My Lords, finally, may I appeal to all noble Lords to assist so far as possible the work being done in their own areas for the mentally handicapped. I pray that I may be spared for many years to fight the cause of families who are so sadly afflicted, and of children who through no fault of their own are unable to rise to the heights of other members of the community. Over the last twenty years great strides have been made, but we have not yet reached our goal and ensured that no family of a mentally handicapped child can feel that they have been forgotten by their fellow men. My Lords, I beg to move for Papers.

3.4 p.m.


My Lords, I am pleased that the noble Lord, Lord Grenfell, has put down this Motion on the Order Paper to-day. I do not propose to follow him entirely in regard to the training and teaching of the mentally handicapped child. I should like to begin by going one step further, and to come to the training of the young mentally ill person for some kind of trade or industry, because I think that at the present time, with modern industrial development, there is far more possibility than hitherto of bringing the psychologically handicapped person into the normal run of the world. This would not only be of benefit to the patient or the person himself, but also to the benefit of the community and of industry.

There are one or two particular types of mental disease which are peculiarly suitable for training at the present time. With the growing mechanisation and simplification of some parts of industry, there are now coming into being a large number of what one might call purely stereotyped jobs which the mentally normal worker may find rather difficult to do, because of the strain of doing this stereotyped work, but which some of those suffering from forms of mental disease, in particular those suffering from various forms of schizophrenia, as it is called, can do extremely well. That, I think, is partly because there has been a great deal of improvement in the treatment of these patients in hospital, so that many of their more trying signs and symptoms can be coped with. Indeed, it looks as though there is a great deal of evidence coming along now that much of these trying signs and symptoms have been due to the fact that the patient was taken away and locked up.

So one would like to see more of what I think has already started, certainly in one or two hospitals in this country and in some foreign countries, particularly I think in Denmark. I have in mind schemes under which workshops are attached to mental hospitals, where there can be trained staff, rather on the lines suggested by the noble Lord, Lord Grenfell, to supervise the training of the mentally sick people, and where there would be no earnings rule imposed upon them, so that, provided the work which was turned out was reasonably good and up to standard, they would get the rate for the job in the ordinary way. Supposing one were to get that occurring, there is no reason why the patients should not have their money to spend. In this way they could be encouraged, particularly the younger ones, to spend money on clothes, cameras, bicycles, and so on; and this would tend to bring them more and more into a normal kind of world, rather than leave them in the difficult world in which, up to the present time, they have been kept.

If we are going to do this kind of work on any scale, there will have to be a greater amount of liaison, co-operation and integration between the work of the local authorities, should the patient be discharged from one of these hospitals. There would be no reason at all, if the patient was a satisfactory worker, why he should not have a start. But there must be a great deal of linking between the local authority and the Regional Hospital Board or the management committee—the hospital authority in general. One has found in the past that there has been some difficulty in regard to handing over records and notes from one side to the other. I think that is one thing that we have to break down in order to obtain a perfect sense of co-operation and freedom between the two.


My Lords, before the noble Lord leaves that subject, is he aware of what has been done at Richard Thomas and Baldwin's factory at Scunthorpe, where mentally handicapped people are operating blast furnaces successfully? It is a most magnificent piece of work.


That is exactly the kind of thing one wants to see going on more and more throughout the country. I am grateful to the noble Lord for drawing attention to that particular example, for I am sure that if such work can be carried out in one place it can be repeated in a great many more. The fact that that example has been mentioned by the noble Lord, Lord Taylor, should encourage more people to go in for the same kind of thing.

I should like to take advantage of the general terms of Lord Grenfell's Motion and say a few words about elderly people and their problems because, from the Ministry point of view, they are similar to the younger people to whom the noble Lord's Motion specifically refers. I do not think I shall stray too far from the terms of the Motion, and I trust that your Lordships will give me your indulgence to say a few words on this subject.

The passing of the Mental Health Act 1959 made an enormous change in the position of all the age groups coming under its ambit, because the doors of the mental hospitals were at last opened. These hospitals were no longer places to which one sent people, particularly the elderly suffering from degrees of senility or senile dementia, so that they could be locked up and put away. In those days, if one found a thing that one did not like, one shut it up and put it away and then forgot all about it. The same thing happened with mentally defective children and mentally decayed old folk.

These big hospitals, however, are extremely unsuitable for patients of all kinds, whether young, middle-aged or old. Generally, they are not in the centres of population, but are kept some distance away; and although the patients, whether children or the old, receive a certain amount of care and attention, they are more or less cut off from their families, and from their friends and visitors. In this sphere it is extremely important, both for the young and for the old, that contacts with home life should be kept up. They provide one of the few links which the old have with the world, and if the link is broken it leads, in many cases, to a rapid rate of deterioration which probably need not have occurred. The same consideration applies to young people. Therefore, I consider that patients, old or young, should not go into mental hospitals unless they have some kind of disease for which treatment is possible. In the case of the elderly, they should not go to mental hospitals unless they suffer from some depressive condition for which mental treatment is possible and desirable, or from some kind of persecution feeling, which again is not uncommon, and for which some kind of treatment is possible. In short, I believe that nobody should go into a mental hospital at present unless he has a disease which requires proper, skilled treatment.

If this does occur, there needs to be a very close working ararngement and co-operation between the physician in charge of the geriatric department—and this would apply to pædiatric wards and to normal adult wards—and the physician in charge of the psychiatric department. One wants to bring these two branches of the profession as closely together as possible, rather than keep them apart as separate entities. Indeed, some authorities in the geriatric field think there is value in creating special psycho-geriatric departments for patients. I am not at all sure that that is necessary. It may be necessary in some cases, but it seems to me that it is a way of coining a new word, making something new out of something which is not necessarily so—a not uncommon trait, I am afraid, in my profession. I think the noble Lord, Lord Taylor, will agree that we rather like to make up new words from time to time.

Those are some of the points I should like to bring out. They have a bearing on mentally sick patients, whether they be young or old. There is one point I would mention in relation to treatment. If one is going to have wards in general hospitals where mentally deranged or mentally disturbed patients are going to be taken into care, then it is of great advantage if some of the nursing staff have received special training in the care of people suffering from mental diseases. They will not be so surprised and perplexed by the curious things which mentally deranged patients can do. I should like to see people being moved from the mental hospitals, and the mental hospitals gradually being run down and made part of the general hospitals, providing that there is a sufficent number of nursing staff trained in this work to look after them.

The local authorities have a very big part to play in the care of mentally sick people, both young and old. The old get transferred or placed in a variety of accommodation, some of which in some authorities can be extremely good and in other authorities, as in the case of children's accommodation, it can be extremely bad. When one visits institutions of this type one sees that they were built in the old days of the Poor Law, probably at the end of the 19th century. The authorities have done a great deal to improve them and make them more comfortable, but all their efforts cannot make them up to date. Therefore, one would like to see some change in this direction as soon as possible. One point which has always struck me when dealing with elderly, senile types is that it is extremely important that local authorities should arrange for them to be given some simple physiotherapy and simple occupational therapy. There was one place in which I was involved where we managed to provide physiotherapy, but it was merely because somebody came along and did it on a voluntary basis in their spare time. The effect was quite startling. One would like to see forms of treatment for these patients, just as for mentally handicapped children.

There is, after all, a great deal in common between the care of mentally handicapped children and the care of mentally handicapped elderly. The only difference is that the elderly have not so long to live, whereas the children have a long time to live and therefore need more special care taken of them. The greatest improvement can be achieved by a far closer co-operation than there has been in the past between physicians in charge of psychiatric departments and physicians in charge of general departments, and with the officers of the local authorities whose job it is to care for these people when they go back to the community. Therefore, I would support the noble Lord in what he has said, although I approach the matter from a rather different point of view.

3.20 p.m.


My Lords, the noble Lord, Lord Amulree, and I are old comrades in debates of this kind. I would join with him in thanking my noble friend Lord Grenfell for moving his Motion and giving us the opportunity to have this debate this afternoon. I should also like to express my admiration for the tremendous wealth of detail in my noble friend's speech. He has made a very large number of suggestions, some large and some small, but all of which, I think, are seriously deserving of consideration. I certainly cannot comment on all of them, but I shall, of course, try in my speech to make some observations about some of them.

It is exactly four years and one week since your Lordships' House last debated the working of the Mental Health Act, then at the initiative of the late Lord Feversham. Some of us who took part on that occasion have been speaking, or will be speaking, this afternoon, but I fancy that all of us will be conscious that we miss Lord Feversham's exceptional knowledge and humane approach to these matters. Although the 1959 Mental Health Act clarified and slightly extended the powers of the local authorities, it is principally concerned with the procedures for detention and compulsory admission to hospitals. During this last week-end I re-read the 1962 debate, and I found that, on the whole, with the exception of the noble Baroness, Lady Wootton of Abinger, and myself, those who spoke concentrated on standards of provision, care, education and training of the mentally disordered. Admittedly, at that time the Act had been in operation for only a very short time, just a matter of months, but, on the whole, all those who commented on it seemed to think that in practice it was a good Act. That was certainly my view then, as it still is to-day, and I do not have any suggestions to make for amending the Act. But I shall be interested to hear whether any other noble Lords and Ladies who speak this afternoon have any.

In the course of the 1962 debate some fears were expressed about the increase since the inception of the Act in the number of readmissions to psychiatric hospitals. But I think this increase was largely due to new ideas about medical treatment and there was no reason to suspect something sinister such as encouragement by the Act of superficial assessment of patients or of inadequate treatment. Since then, of course, the number of re-admissions to hospital has gone on growing every year. There were something like 80,000, I think, in 1964as against about 56,000 in 1960. That is a pretty sharp rate of increase, but I do not myself think that it is sufficient to give cause for alarm. It may be that the noble Lord, Lord Champion, will wish to say something about this in his speech. If he does not, we probably can take it that he agrees with me that there is no cause for alarm.

I am sorry that we are not going to be treated to the benefit of the wisdom of the noble Baroness, Lady Wootton of Abinger, this afternoon. I mentioned this to her before this debate, because in the 1962 debate she made some very penetrating observations about the tendency—which I think she considered to be a regrettable tendency—on the part of both public opinion and the law to widen the concept of mental disorder. Particularly she suggested that, although very few psychopaths compulsorily detained under Part IV of the Act had been kept in hospital for more than a very short time, nevertheless it might be safer and wiser if all diagnosed psychopaths were dealt with under Part V of the Act instead of Part IV, and so came before the courts of law.

I did not give the noble Lord, Lord Champion, any notice that I was going to talk about this subject, and I do not expect him to be able to give me an answer this afternoon. But I think it would be very interesting if we were able to know how many diagnosed psycopaths, compulsorily admitted to hospital under Part IV, have, since the inception of the Act, been detained for more than six months, and how many for less than six months. The point of that is that one does not want eccentric people to be compulsorily admitted to hospital just because they are eccentric and nothing else, any more than one wants the plain "bad hats" to escape the due processes of law by being compulsorily admitted to hospital as psychopaths under Part IV of the Act.

May I come on now to the question of hospital provision for the mentally disordered? In May of this year the Minister of Health presented to Parliament Command Paper 3000, which is a Blue Book containing a revision of The Hospital Plan for England and Wales which was first published in January, 1962, and which I had the pleasure of introducing to your Lordships in a debate in this House on February 14, 1962. We were originally promised this revision before the end of last year, and we have waited for it a long time. There is a lot that I could say about it, and may do one day, but this afternoon, obviously, I must confine myself to the bearing which it has upon mental health.

There are two points about it which I welcome without reservation. The first is that it is still the intention to base the Hospital Service of the future on a network of district general hospitals which will include units for active psychiatric and geriatric treatment. This seems to me a good thing, not only because it will help to end the invidious distinction between mental and physical illness, and encourage the recognition that both types of illness are equally susceptible to appropriate treatment, but also because eventually it will—if I may put it like this—speed up the running down of the largest old-fashioned mental hospitals, about which the noble Lord, Lord Amulree, just spoke and whose views on this matter I very much share.

Secondly, I am very glad (I have discovered this from reading this Blue Book) that the Minister considers that there is no reason, at any rate at the moment, to doubt that the need for mental illness beds will fall to 1.8 per thousand of population by about 1975. This forecast, which was based on a statistical exercise, was embodied in the 1962 Hospital Plan and it came in for quite a lot of criticism. Some people said that it was just a bit of financial cheeseparing by a mean Government. Others said that, even if it were an accurate forecast, it ought not to have been announced because it was likely to be bad for the morale of those who worked in mental hospitals. For my part, I am glad that the forecast still stands, because it is yet another guarantee of the eventual redundancy and disuse of our old and very large mental hospitals

It is very easy to wax eloquently indignant—and many professional writers on the subject do—about these old institutions: the sweetly cloying smell, the starkness, the overcrowding, the atmosphere redolent of outmoded ideas and so on. Fortunately, these institutions which we call mental hospitals are devotedly served by high-minded, though often frustrated, people—and nobody can be happy about them. But they do present a formidably expensive problem, and it is no good pretending otherwise. That is one reason why I am saddened by the revised Hospital Plan.

May I consider some of the things in it? It says: The expectations of the original Plan could not possibly have been fulfilled. My Lords, I do not accept that. What I am prepared to accept is that the expectations of the original Plan cannot now possibly be fulfilled, which is a very different matter. The Blue Book also says: A somewhat greater provision of resources over the coming years has been assumed in revising the programme than in the original Hospital Plan"— and my noble friend Lord Grenfell, I think it was, referred to that. My Lords, that is so, but I do not for a moment think that this greater provision of resources is sufficient to make up for the decline in the purchasing power of the pound that has taken place in the last four years or for the decline in the purchasing power of the pound which is likely to take place in the years to come.

The Blue Book says that it may be misleading to set starting dates for building projects, and it does not set them. I personally would much rather set starting dates and miss them than not set them at all, for this reason, if for no other: that the publication of starting dates is an extremely good stick with which to beat the Treasury when the time comes for those starting dates to be implemented; and, again, published starting dates are a splendid spur to the planning staff—the architects, and so on—of the Regional Hospital Boards to get on with their work. Again—and this is the last quotation I want to make—the Blue Book says: It would hardly be appropriate to publish in this paper, and thus give an illusory permanence to, the detailed programmes as they now stand". What do those words mean? What they mean to me is that the Hospital Plan of 1962 has in 1966 been turned into a non-plan, into a pious hope by the political Party which has always believed in the importance of detailed planning. I do not blame the Minister of Health for this. The trouble is that the economic condition of the country is such that he is not allowed to enter into firm commitments at all.


My Lords, the noble Lord, Lord Newton, has based his case on an attack on the large mental hospitals. I think that is very unfair and very wrong, because in fact a great number of these large mental hospitals are extremely good institutions, first-class institutions; and I would say, as a generalisation, that any mental hospital in this country, any psychiatric hospital, with less than 1,000 beds will be found quite first-class, without rival throughout the world. It is the 2,000-bedders which are so awful, and they are the ones we aught to be tackling.


My Lords, it was the very large ones about which I was talking. I think there are too many of them. I do know quite a lot about them, and I ask the noble Lord to accept that I entirely agree that a lot of them are very well run; but I do not take back the general criticisms which I made earlier about those larger hospitals.

May I now leave the hospital side of the picture and come on to the community care of the mentally disordered? This is a phrase which a year ago the noble Lord, Lord Amulree, told us he did not like. It certainly is not an elegant phrase, I agree, but it is difficult to think of anything better with which to describe all the health and welfare services, both statutory and voluntary, which are available outside the hospitals. That was why that phrase was used in the title of the Blue Book published in 1963 which contained the long-term plans of the local health and welfare authorities. I noticed with some interest that in the title of the revised version of this Blue Book (Command Paper 3022), which was presented to Parliament only last month by the present Minister of Health, the same phrase is used. As I was one of the authors of the introductory chapters of the 1963 Blue Book, I have studied the revised version of June, 1966, with considerable interest and with some despondency.

The original purpose of the 1963 Blue Book was twofold: first, to enable com- parisons to be made between the long-term plans of the individual authorities; and, secondly, to enable the Minister to comment upon the standards of provision envisaged not only by individual authorities but also by all the authorities as a whole. Now when one looks at the revised version (I hope the right reverend Prelates will not mind my talking about the "revised version" of this Blue Book) it is apparent that, although staff numbers have been improving in the last few years, in almost every case, and notably in the case of health visitors, mental health social workers and teachers in training centres, the targets have not been hit. This is a serious matter, but I do not propose to abuse the Government about it this afternoon, because I know well enough—too well, in fact—the problems of manpower in all spheres of the National Health Service.

On the other hand, I well recall the abuse that descended upon my head in the series of debates which we used to have in your Lordships' House about different manpower aspects of the National Health Service. The noble Baroness, Lady Summerskill, the noble Earl, Lord Longford, and the noble Lords, Lord Stonham and Lord Taylor, used to take it in turns to berate me about this particular shortage or that particular shortage. Sometimes they would all set about it together; and sometimes, for good measure, the noble Lord, Lord Amulree, would join in, too. I confess to your Lordships that I was sorely tempted to re-read those debates and to select some appropriate passages and epithets to hurl back this afternoon at the noble Lord, Lord Champion.


I never said anything.


No—and the trouble is that the noble Lord, Lord Champion, is just about the last person in the world at whom I should wish to hurl anything, let alone the past words of his noble friends. However, my Lords, if later speakers in this debate choose to take the Government to task about staffing shortages, that will be quite all right with me.

But even more serious than the staffing situation in the local authority field is the clear warning—and the language of the warning in the Blue Book is very strong indeed for a Government publication— that some local health and welfare authorities are not setting their sights anything like high enough, in the numbers, both of staff and of buildings, which they are planning to provide for the care of the mentally disordered. This point was extremely well emphasised, I thought, by my noble friend Lord Grenfell. He gave some interesting instances of this, and I could give more, but I think that both of us have by now said enough between us to bring this matter home. In a moment I want to come back again to this point, but before I do so there are just two other matters on which I should like to touch briefly.

The first is that I should like to pursue the suggestion of my noble friend, Lord Grenfell, about the need of counselling services for the parents of young, severely subnormal children. I do not see why these services should not be provided in ordinary children's welfare clinics or, if the clinics are not big enough, even in training centres. I recall seeing a session going on in a clinic in which there were a number of mothers of severely subnormal children and their children, and while the children were playing together the mothers, if they wished, were able to have private discussions with the medical officer in charge, who was fully qualified to give advice. The mothers also had the opportunity to give each other counsel, to talk about their own experiences, their own successes and failures. The doctor told me afterwards that these sessions were becoming a great success. I cannot see why the same sort of sessions should not take place all over the country. I hope that possibly there may have been some developments along those lines in recent years.

The other matter I should like to touch on is the vexed question of whether the time has come when severely subnormal children (that is to say, those trained in training centres) ought now to be trained in some sort of E.S.N. school, run by the local education authority rather than by the local health authority. I used to think, and say, that it did not very much matter where the training took place or who provided it, so long as the training was good and so long as the teachers were good. But one cannot ignore the fact that there is a growing body of informed opinion that the time has now come to make the change. I do not know whether the noble Lord, Lord Champion, would wish to say anything about the Government's thinking on this subject. I have not warned him that I was going to raise this point. My mind is still open on the question. The only thing that really matters, I think, is that what is best for the children should be done, and not what is best for the feelings and susceptibilities of their parents.

Finally, my Lords, I should like to offer two suggestions, which I hope are practical and comparatively easy suggestions, for helping to eliminate quality variation in the standards of local health and welfare authority provision for the mentally disordered. According to the Blue Book (Command 3022) the Minister is proposing that his officials should have discussions with the laggard authorities. That is probably as good a way as any of trying to deal with quantitative efficiencies—that is to say, of trying to improve those situations in which an authority is obviously not planning to have in the future enough staff or buildings. But what about the qualitative variations in the standards of provision as between authority and authority which, as we all know, exist?

My two suggestions are first that there should be set up a small mental health inspectorate on the lines of the inspectorate of schools. It could be quite small and therefore it would not have to be expensive. I think that that would contribute a great deal: that such men and women could do a great deal to iron out disparities in standards of provision. The second suggestion is that there should be another Parliamentary Secretary in the Ministry who is a Member of this House, who would concentrate on travelling round the country visiting hospitals and local authority establishments, and who would have the freedom to do so. In my opinion it is absolutely essential that when you have an enormous, centrally-run organisation like the Ministry of Health, which spends a tremendous amount of the taxpayers' money, the Ministers responsible should be able to get out and about and see what is going on on the ground. I am sure that the present Minister, Mr. Robinson, and his Parliamentary Secretary travel as much as they can; but it is only in the nature of things that two Ministers, both of whom are Members of the other place, cannot possibly do as much travelling and visiting as could three Ministers, one of whom is a Member of this House and who, therefore, enjoys much more freedom from the daily turmoil of Parliamentary activity.

When I was one of the Parliamentary Secretaries I did a great deal of visiting. It does not take long to learn to judge differences in quality of provision. If necessary one can have a quiet word in the ear of the chairman of the responsible committee, or even, perhaps, in the ear of the chairman of the council. That is something far easier for a Minister than for a civil servant, because the officials concerned normally deal with the medical officer of health. There are at the present time seven Ministers at the Foreign Office, five in the Home Office, the Board of Trade and the Department of Education and Science, and four in the Ministry of Housing. In the Ministry of Health there are just two. I think that something could and should be done about that.

I do not expect that the noble Lord, Lord Champion, will wish to say anything about either of these two suggestions, but I commend them to Her Majesty's Government as serious and practical suggestions which, if implemented, might make for a considerable improvement in the working of the Mental Health Act, which is something that all of us, wherever we sit in this House, want to see.

3.47 p.m.


My Lords, as is customary on these occasions, I ask for your indulgence. Over the years I have been fortunate enough to have considerable experience in listening, but to-day I have got my "L" plates up, and I am conscious of it. I am very grateful to the noble Lord, Lord Grenfell, for allowing me to bring to your Lordships' attention this afternoon the place of voluntary work in the mental health service, With the introduction of the National Health Service Act in 1946 it was thought by some that it covered everything and that there would be no place for the voluntary worker. But it soon became plain that this was not so because, as your Lordships may remember, the hospitals started forming their leagues of friends to provide for the patients amenities which were not covered by the National Health Service. We then had, thirteen years later, and have now, a Mental Health Act. I have read the Act carefully and I cannot find in it any real mention of the place of the voluntary worker yet to-day I think it is recognised that, without the help of these voluntary services, much of the mental health service could not continue. I must now declare my interest, again as is customary: I have all my life been connected with voluntary work of one kind or another and, of course, in particular with that of the British Red Cross Society.

My Lords, mental health concerns us all. We all have it; it is either good or bad and, with the stresses and strains and speed of modern life, the bad seems to have increased. Therefore I think it very important that it should be talked about openly as is any other form of illness; and this is what the noble Lord, Lord Newton, has just been saying. What is the best way of setting about securing mental health? Surely, by educating people about it and helping them to be less frightened about it. That is where voluntary societies come in; and, with your Lordships' permission, I should like to give just a few examples of what they are doing.

All over the country voluntary societies are working with, and under, the local medical officer of health's department in various ways, such as in mental health education campaigns; visiting families who have had a pateint discharged from hospital to see how they are getting on and what supplementary services are needed; setting up clubs for the mentally sick to help them to return to normal life later; running weekly créches for mentally subnormal children. This relieves parents and gives them an opportunity to do their shopping or to do other jobs, while at the créche, through skilled play therapy, the children are taught so far as possible to deal with matters of their own toilet and feeding, and things like that.

Escorts are provided for adults, and also mentally retarded children to child guidance clinics. Beauty therapy inside the mental hospitals is provided in order to restore the self-confidence of women patients, and the London Association of the National Association of Special Education has asked for help in activities for mentally handicapped children. My Lords, may I just add about this that the aim and object of these activities is to try to give children something to do, so that they may feel they are contributing and are not all their lives on the receiving end. These are just a few examples of what the voluntary societies can do and are doing.

Much more help could be given if there were more volunteers, and surely with the coming of the shorter working week and increased leisure this is the moment for Her Majesty's Government to give a lead and encourage people to come forward to offer their services. But. my Lords, alas, far from giving a lead we get the selective employment tax. I welcome the fact that this tax is to be refunded; nevertheless, it still has to be collected and the money loaned free of interest to Her Majesty's Government. Voluntary societies are saving the taxpayer a great deal of money by providing many free services, and it is really most disappointing that this was forgotten and that their work was not recognised from the start by making it plain that this tax did not apply to them. That is why I felt it necessary to try to draw the attention of your Lordships to-day to the place of voluntary work in modern society.

3.53 p.m.


My Lords, it is my privilege to be the first to congratulate the noble Baroness, Lady Hylton-Foster, on her maiden speech—a speech of such warm humanity—to which we have just listened. I am sure we all look forward to hearing her on many future occasions. I should like also to thank the noble Lord, Lord Grenfell, for having brought forward this Motion. I am particularly interested, as I was a member of the Royal Commission which laid the foundation for the Mental Health Act. The noble Lord, Lord Grenfell, has given us a very comprehensive review of the whole subject, and I propose to deal only with some particular instances.

A great deal has been said already by noble Lords about the need for more activity on the part of local authorities in the foundation of community hostels to enable the mentally subnormal to go out into the community. Noble Lords may have seen only last Sunday the figures published in a letter in the Observer by the statistical information officer of the National Society for the Mentally Handicapped, in which he quoted the Minister of Health as saying that in eight years' time there would be 2,000 places in community hostels. Today there are 700 places. The letter went on to point out that there are now 30,000 children in hospital with a waiting list of 4,000, and clearly, a proportion of those will be suitable for training in such community hostels. One might point out also that we have an expanding population, so that inevitably these figures will increase.

One must draw the conclusion that not only are the present facilities inadequate but the plans for the necessary expansion of future facilities appear to be also inadequate. What this means in terms of human happiness will be clear to those who have had the privilege of seeing what can happen to these subnormal people when they go out and are trained, and find a job which they can do and realise that there is a place for them in the community. I think those who have seen such people before and after this will have been astonished that such a change has been possible.

I should like to say a little about the need for better education for those already in hospitals. This point has been touched on by noble Lords, particularly by the noble Lord, Lord Amulree. There are units in existence, about which I shall say something in a moment, for short-term training, but there is a comparative neglect of long-term education of patients in mental hospitals. As has already been said, there are a number of patients with schizophrenia who are capable of benefiting from education. There are brain-damaged, epileptic children who also could profit from some education and training. I believe it is the local education authority which has the power and the duty to provide this education for those needing a long-term stay in a mental hospital; and here again I believe that there is great need for developing this service. It is an expensive service—special training is needed for the teachers—but it contributes substantially to human happiness.

The short-term units are developing, but perhaps not quite quickly enough. They were the subject of a recommendation to hospital authorities by the Ministry of Health in a Memorandum in 1964. They are designed to provide for a wide variety of children. Some are mildly mentally subnormal. Others have normal intelligence but experience emotional difficulties. Some are mentally ill but are still able to receive educational training.

My Lords, such units, I believe, need to be especially built. It is not enough to try to make do by adapting some existing buildings. Such converted buildings severely limit the possibility of what can be achieved. The practical problems of the management of these difficult children call for specially designed buildings. Moreover, the work is extremely exacting, especially for the teachers and the nursing staff concerned, and they cannot be expected to undertake this work and remain at it if they have to struggle with bad physical conditions as well as with the natural problems involved in the work.

Then there is the rather small but very difficult problem of the intractable delinquent adolescent—a small minority but a considerable problem; and again there is no adequate provision for these. If two or three happen to get into an approved school it can call for a disproportionate amount of work from the staff and provide a very disruptive influence. The natural tendency is to call upon a psychiatrist. Unless there is evidence of mental illness or some disorder like epilepsy or some physical disease of the nervous system, there is little that a psychiatrist can do. There are a number of psychiatrists who feel that once a diagnosis has been made and serious illness excluded, these people constitute a social rather than a medical problem. I am not going now into the question of by what means they should be sent to an institution, but there is, certainly among psychiatrists, a feeling, first, that there is not enough provision for this difficult problem, and, secondly, that residential accommodation is required, and that there is a case for putting it under the Home Office rather than under the Ministry of Health.

Lastly, I must say a little about nursing. I should like to echo what the noble Lord, Lord Grenfell, said about the magnificent work done by those who nurse the mentally subnormal. I have known many of these devoted people. But one has to remember that it is increasingly hard nowadays to get staff for such hospitals and such patients. It is an odd and unexpected side effect of exiling policy that if you provide hostels and get back into the community the high-grade subnormals, who otherwise create a worse problem in your hospitals, so that hospitals are left with a larger proportion of the heavier cases, the lower-grade subnormals, there is less variety in the nursing and a heavier task for the nurses and doctors. This, however, clearly has to be faced.

I will not say much about conditions in the older mental hospitals, because the point has already been made. I would, however, emphasise the fact that we have to take into account the conditions in which the nurses work. The better the conditions, the more likely we are to get and retain nurses. At present we depend in these hospitals to a large extent upon nurses from overseas. We value their help very much, but we should clearly like to see far more of our own nurses going into this particular form of work. I should like to urge the need for better residential accommodation for nurses, particularly married nurses. They have to work, as the noble Lord, Lord Amulree, has said, in difficult conditions, sometimes away from major centres; and, therefore, all possible facilities, residential and otherwise, which can be provided should be provided and need to be provided if we are to maintain and retain the services of these nurses who have done such good work in the past and are doing it still.

4.3 p.m.


My Lords, I am glad that two Lords Spiritual are taking part in this debate, because the Church has always been deeply concerned about the maladjusted minority of our community, and must always continue to be thus concerned. We live at a time when it appears to be rather an amusing hobby to make it appear that the nation is going downhill rapidly and that our problems and failures are far more numerous than our successes and achievements. I believe this to be not only untrue but psychologically dangerous. Nowhere is this less true than in the field of the care for mental sub-normality, where there has been a quite remarkable advance in effective treatment of this problem during the past ten years.

Of course, we know that mental sub-normality is a major problem. Indeed, it has been estimated that one in every 100 persons in this country is mentally subnormal. But things have changed for the better in almost every single aspect of this problem. Advances have been made in research, in the training of qualified teachers, in the training of mentally subnormal children to take their full part in public life, and, not least, indeed almost most important, in the attitude of the public and of parents towards this tragic mental condition. In the four years from 1959 to 1963 the number of subnormal children and adults receiving training increased by just over 45 per cent.; and that number has gone up steadily since then. Current expenditure by local authorities on their mental health services rose during those years from less than£4 million to over£9,750,000, an increase of over 100 per cent.

Of course, we know that this increase is not universal, and the noble Lord, Lord Grenfell, has quite rightly called our attention to the wide disparity in the handling of this problem by different authorities. I am one of those who would strongly underline his plea that the Government should make a survey as soon as possible to ensure that every local authority is helped to be raised to at least a minimum standard below which they ought to be ashamed to go: because, alas! as has been pointed out by the noble Lord, there are authorities that are not doing nearly enough in this respect. Nevertheless, the fact remains that there has been, on the whole, a major advance during the past decade.

First, as I said earlier, there has been a remarkable advance in research. When the Mental Health Research Fund was founded, a little over a decade ago, the total money spent on mental health research was probably not more than£50,000 per year: the current psychiatric budget of the Medical Research Council is over£500,000. But, even so, it is necessary to get things into proportion. One Polaris submarine would finance all the research that has ever been done in this country or is likely to be done over the next decade. Nevertheless, despite the comparatively small amount of money raised for mental research, compared, shall I say, with the equally vitally important area of cancer research (none of us would want to see that lessened but all of us would want to see the other raised), there have been some remarkable successes, and diagnosis at birth of children suffering from certain serious diseases has led to complete cure. Even in the tragic field of Mongol children, through right diagnosis, the story has been one of partial success. It should not be forgotten that these advances alone would justify the amount of money spent in this all-important field of research into mental subnormality, and it should challenge the country to set aside a still higher proportion of its budget for this vitally important work.

Secondly, there has been considerable advance in the training of staff. The National Association for Mental Health has made an immense contribution to the pioneering training of teachers of the mentally subnormal. It is estimated that there are about seventeen courses for psychiatric social workers. There are possibilities of new types of courses in colleges of advanced technology; and I am led to understand that some of the new universities are interested in planning courses for psychiatric social workers. All of this, of course, is only the beginning of the beginning, but there are large numbers of people employed in teaching the mentally handicapped who have not had the opportunity to take a formal training. No praise can be too high for these people. I am very glad that the noble Baroness, Lady Hylton-Foster, who made her admirable maiden speech to-day, drew our attention to the important work that continues to be done by voluntary workers in this as in so many other fields.

Thirdly, there has been a marked advance in the adaptation of these mentally sub-normal children to the public life of the country. Ten years ago a high proportion of these mentally subnormal children were allowed to languish for long periods of time, and sometimes for life, in a hospital. To-day this situation is changing, and quite a high percentage, as we have heard from a recent speaker, are now being trained to take their part in industry. And even though in some cases little can be done to raise them above a low standard of educational ability, a great deal can be done in what is known as "socialization"—helping them to learn the rules of society so that when they emerge from their home or their training institution or hospital they are not considered odd, nor are they allowed to regard themselves as odd, for they have learned the rules and are able to comport themselves in such a way that they are no longer gazed at or treated as strange objects of wonder.

This advance in adaptation to public life must, of course, be accompanied by an equal adaptation by the public and by the parents of these mentally subnormal children. In this field a great deal of education still remains to be done, and if this debate has no other effect—and it will have many—one hopes that it will have an effect in this respect. For the public must be helped to adjust themselves to these children, or to adults with children's minds, so that the public no longer regard them as patients, treating them as diseased people, but learn the difficult art of coming alongside them, helping them to feel wanted, and to feel that they have a part to play in the public life of the nation. And of course this is particularly true of parents. We have all known parents who have been so shocked, bewildered, and even infuriated, by the arrival of a subnormal child that they have in some cases, disowned it, with tragic results (I heard only last week of a child who had died of a broken heart because its mother had disowned it at birth), or known parents who, quite a long time afterwards, are ashamed of their child. This attitude is, of course, tragic and disastrous.

At the other end of the scale there are parents who are sentimental and possessive, cosseting their mentally subnormal child and refusing to allow it to be trained and adapted to normal life. In my own city of Coventry, as in many, if not most, other areas of local authority, a child can be taken over for training almost at birth. Schools have been set up to deal with infants, juniors and seniors, so that they can pass in training from one school to another. Hospitals are also available for those who are unable at that moment to go to schools of training. It is an interesting fact that to-day in hospital only about 10 per cent of patients are certified: all the rest are voluntary patients. Here again, throughout the country one sees a quite remarkable success story (and I should not like it to be felt that there has not been success), for a high percentage, after five or six years of hard work by the staff, are helped to adjust themselves to life.

I want to say a further word about the part the ordinary citizen can play in helping the subnormal child to be readjusted to normal life. In an age of increasing specialisation, it is sometimes thought that only the expert (with a capital "E") can help to bring a solution to a problem, but in this particular sphere a good neighbour has an important part to play. It is possible that, in the automated world towards which we are moving, people may well have more time to learn the difficult art of being good neighbours. Of course, I hasten to add that the good neighbour and the mere enthusiast will never take the place of the skilled, trained, social worker. Nevertheless, it remains a fact that the neighbour who cares, and who has a little time to spare for a subnormal child, who interests that child in some hobby and takes time to ensure that the hobby is learnt through patient and unhurried example, repeating a few things again and again, until "the penny drops" is worth his or her weight in gold.

This good neighbourliness, which was a marked feature of the village—or, indeed, let us face it, of the old slum world which, thank God! is now disappearing—needs to be developed in the new tower blocks of flats and in the new affluent suburban life which is the background of so many people's lives to-day. At the moment, this good neighbourliness is normally to be found only among the more unusually responsible, religious or talented groups. Yet it needs to be inculcated from the earliest days among normal schoolchildren, so that they emerge from school with a sense of responsibility, shorn of all sentimentality, for those less well adjusted than themselves. This development of the good neighbour will not diminish the professional social worker's load; nor will it make the slightest difference to the present tragic shortage of trained teachers. But it can, as has been pointed out, make possible the step within community care, from care in the community, to care by the community. I would say a further word about the parents' part in the rehabilitation of mentally maladjusted children. It happens all too often, as I have already pointed out, that the mother and the mentally subnormal child are for the time being, at any rate after birth, incompatible, each upsetting the other, so that a vicious circle is set up. At that point it is advisable that parents should allow their children to be brought to a hospital, allowing the child time to settle down to the new life without too much parental visiting. Often this has a quite dramatic effect, with immediate improvement in things like toilet habits, excessive food fadism and restlessness. But once the child has settled down in hospital it is important that parents should begin once again to visit their child, otherwise the gap between child and parent will have become so wide that it will be very difficult to bridge.

To this end bodies like the Nuffield Provincial Hospitals Trust has built a parents' hostel attached to at least one hospital, consisting of flatlets in which the children can live with their parents for a few days, or even a week or two, during which time they are slowly introduced to, and absorbed into, hospital life. The mother can have periods of well-earned rest, mingled with visits to the hospital with increasing frequency. Thereafter, the hospital becomes a sort of family centre, where not only mothers are welcomed, but brothers and sisters, and even fathers. Furthermore, in this curative process brought about by the right relationship between the handicapped child and its family there is a place for the less mentally handicapped patient to look after the more severely subnormal patient. In the process of so doing the less severely handicapped patients are themselves greatly helped to be adjusted to life. They become "big sisters" or "big brothers", and in many cases the mental health of the "big sisters" has improved even more than that of the children whom they are looking after.

In all these ways the handicapped child to-day is being no longer regarded as incurable, a person to be ashamed of, a dead loss to the community. On the contrary, the mentally handicapped child is being regarded increasingly as a potential citizen of value to the community who, by the right treatment of trained workers, untrained good neighbours and family, can begin to play his part as a responsible citizen in the world tomorrow.

I would add one last word, my Lords. This work should be undertaken, not merely to make the mentally maladjusted and handicapped child into a responsible citizen, so that he can pull his weight in the nation's life, important though that is, but also because a child is a person, of immortal value and significance, no longer to be tucked away out of sight (and, therefore, too often out of mind), but loved and cared for, developed and trained, just because that child, like every other child, is of value to God and of immortal value in itself.

4.18 p.m.


My Lords, I hope that the right reverend Prelate will forgive me if I do not follow him in the excellent speech that he has just made. I should like to add my word of thanks to the noble Lord, Lord Grenfell, for having given us the opportunity of debating this most important subject. We know his own close interest in the welfare of the mentally handicapped and of the many years of devoted service he has given to this work, not only as treasurer of the National Society for Mentally Handicapped Children, but also for the Carshalton Group of Hospitals, which in itself is a highly specialised group, in many ways an example to the rest of the country. I should like to relate my remarks more particularly to the role of the voluntary bodies in the working of the Mental Health Act. Perhaps at this stage I may add my words of congratulation to the noble Baroness, Lady Hylton-Foster, on her excellent maiden speech, and particularly to congratulate her on having chosen this subject for her speech. She, too, referred particularly to the role of the voluntary bodies, and I think it is of help to survey their particular work more from the national angle.

As we all know, the whole approach to the problem of mental illness has changed radically during the last twenty years. The conception of the mentally sick person as someone quite apart, to be segregated from the rest of the community and condemned to virtual isolation behind locked doors, has now been entirely discarded, and the straitjacket and padded cell have almost taken their place with the thumbscrew and the rack as mediæval instruments of torture. Instead, mentally sick persons are now regarded as intimate members of our community, who need to be helped and healed and enabled to return to their homes at the earliest possible opportunity. They have assumed at last their rightful place in our sympathy and understanding. We have accepted their claim to be given sheltered work, to keep them fully occupied, both mentally and physically, and to be regarded as useful, self-respecting citizens.

Enormous advances have been made recently in the treatment of mental illness, especially by means of the new, valuable drugs, which can soothe their fears and allay their anxiety. Terms of opprobrium and contempt, such as "idiocy" and "lunacy" have now largely been eliminated and have given way to a new terminology which reflects no sense of shame on patients who are mentally ill. They are no longer incarcerated in asylums as outcasts from the community, but attend hospitals as out-patients, secure in the anchorage of their own families and their own homes. The asylums have now become almost completely out of date, as grim relics of the Victorian era. They stand condemned by the progress of medicine and the growth of human understanding. Perhaps even more striking is the community of interest which these patients find in helping one another. They are tending to be drawn away from introspection and self-pity towards a degree of extroversion and a realisation that they have become members of a wider community. All these new advances in the treatment of mental illness had to be given concrete form, and the Mental Health Act, 1959 repealed all our previous legal enactments and swept away most of our earlier misconceptions of these vast and urgent problems.

But if enormous advances have been registered in our treatment of the mentally sick, there is one aspect of mental illness which has lagged woefully behind. I refer to the treatment of our mentally handicapped children. To some extent this is inevitable. Where manifestations of mental handicap are apparent from birth or develop in early childhood, they cannot be expected to respond readily to treatment. That is where the factor of their prevention is so vastly important; and this leads us inevitably into the field of research. Grateful as we are for Government assistance in this direction, the hard fact remains that only 8 per cent. of the Medical Research Council's annual budget is directed towards research into mental disorders. There is no aspect of mental illness more agonising to a parent than the thought that so little is known about its causation and prevention, and I feel an enormous field is still open to us to make further advances in this direction.

On the other hand, one of the most heartening facts about our approach to this problem is the rapid growth of the many voluntary organisations now working in this field, and the great assistance that they are rendering to the Government, to the local authorities, and to the community at large. It is greatly to the credit of successive Governments that they have never ceased to pay their tributes on many occasions to the magnificent work done by these voluntary bodies. The latest tribute is to be found in the recent White Paper on The Development of Community Care (Command 3022), presented by the Minister of Health only last month, and one passage especially deserves quotation: Reference is made in the following paragraphs to the wide and varied contribution made by voluntary bodies of all kinds. These play an invaluable part, not only as pioneers of untried measures but as providers of essential services. The training of the mentally subnormal, the accommodation of the elderly, and the mentally or physically handicapped, the running of social clubs and centres for all these groups, and friendly visiting in the home, these are outstanding examples of the help that voluntary bodies can give and local authorities must, and do gladly, take account of that help in making their own plans. Of many voluntary organisations, I should like to make special reference to the work of two with which I am particularly acquainted. Foremost is the National Association for Mental Health, a pioneer body which has grown out of the early organisations, founded when this type of voluntary work was in its infancy. Its activities now range over the whole vast field of mental health. It recruits among its members doctors, research students, social scientists, mental health social workers and teachers of the mentally handicapped. As has already been said, it organises training courses to qualify teachers for the special work of teaching the mentally subnormal. It administers residential homes for elderly persons who need mental care. It issues an excellent periodical Mental Health; and it organises a special advisory service which is staffed by trained social workers who advise all who are faced with the problems of mental illness. It is linked with 54 local associations, carrying on its work in all parts of the country, and maintains the closest contact with mental health organisations all over the world. Naturally enough, it is handicapped severely by lack of funds and of suitable premises to carry out its beneficent work.

Secondly, there is the National Society for Mentally Handicapped Children, with which I happen to be closely connected. This is a vast organisation whose membership consists almost entirely of the parents of mentally handicapped children. It is a model organisation of its kind and serves as a guiding example to the movements for the welfare of mentally handicapped children in other countries. I have been amazed at the sacrifice and the devotion which these dedicated parents bring to bear in trying to help the problems of other parents similarly affected. From very small beginnings this national society has, in the short space of barely ten years, grown into a huge organisation comprising over 360 branches and with a membership of well over 30,000. It has launched out into pioneer ventures of industrial training centres, holiday homes, training schools for teachers, advisory bureaux and many other activities. These are fields also dealt with by Government agencies, by local authorities, by the National Association for Mental Health and other bodies.

But there is an especial merit that this similar work should be carried out on the initiative of the parents of mentally handicapped children themselves. Through their own deep personal involvement, they bring to bear a special sympathy and understanding which is a vital element in the progress of this work. It is work which cannot be done in the same way by other agencies. For example, those parents whose children are away in hospital are constantly urging that more humane influences should be brought to bear, that children should be treated as individuals, helped to evolve their own personalities, encouraged to wear their own distinctive clothes and to take a pride in their personal appearance; helped to utilise their leisure time in a creative way, given a chance to broaden their education, and to develop their latent artistic and individual skills. These parents are anxious to de-institutionalise these hospitals and to humanise them in every conceivable direction.

There is just one question I should like to put to my noble friend the Minister who is to reply, and upon his sympathetic understanding of this question a very great deal depends. Why is it that the saddest parents I meet are nearly always those whose mentally handicapped children are in hospital? If only those 30,000 children to whom reference has already been made, or even if only some of them who are really not hospital cases at all, could be taken out of hospital and placed in a few more specially-run homes and hostels, given better individual care and education and a deeper understanding! As has already been said, no praise can be too high for the present hospital staffs who struggle bravely, often under the most appallingly antiquated conditions. But everything is loaded against them—the buildings, the huge obsolete wards, the shortages of staff, the enormous amount of work and the poorness of the pay. We are all fully mindful of the difficulties. I merely wish to point out the long, long road we still have to travel and the vast amount of work that still remains to be done.

And may I also say this? These parents face their problems with a cheerfulness and heroism that is an example to the rest of the community. They spare no sacrifice of time and money and energy to help one another. They emphasise the spiritual values in their own lives and in the lives of these children who so desperately need their help. We plead very much to-day, and very rightly so, for our old-age pensioners. But think of those elderly parents of pensionable age who have mentally handicapped children on their hands and who have worked so hard throughout their lives and sacrificed so much to help these children entrusted to their care. We, as a community, should pay our tribute to these parents who have done so much to help one another, and to ease the burden on our own consciences. Speaking for myself, I can only say that I have felt personally drawn rather less to the professional and scientific bodies than towards these parents' organisations, because I feel that they supply a real need in our community that no other organisation, governmental, local authority or professional, can ever hope to supply. They are especially deserving of our gratitude and our generosity.

Naturally enough, with all their rapid growth, despite their steadily increasing income, the demands being made upon them are now becoming greater than ever. I have been appalled to realise the devotion of their workers in cramped overcrowded premises almost bursting at the seams. There is a crying need to-day for some public-minded benefactor to endow in our midst a Mental Health Centre where these organisations can expand to meet the heavy demands now being made on their services from all sides. I know of no more urgent need in our community to-day, nor one more richly deserving of Government aid or public benefaction.

Think of the plight to-day of young parents who suddenly find their child is growing up under the severe handicap of mental retardation. To whom are they to turn? First to their own doctor. He may or may not be able to render help or advice. Quite often, with a shrug of the shoulders he says that nothing can be done. But these parents will go to almost frantic lengths to help their children. They turn to the local authorities, to the local branch secretary of the National Society for Mentally Handicapped Children. They come into contact with other parents who, in their turn, help and advise them in every possible way.

But I should like to see established in London a Mental Health Centre to which these parents could turn, to be helped at once with the fullest information and the best available advice. This centre would house our parents' organisations and other mental health bodies in a way that would allow them full scope for expan- sion and enable them to carry out every branch of their rapidly increasing activities. Not only in the field of treatment and research, but in the field of education much more can be done. New trends in education, new methods of instruction, the use of electronic aids, such as that of the recently introduced "talking typewriter", all these should be exploited and developed as fully and speedily as possible.

The urge from the parents pleading on behalf of their own children is powerful and insistent. They constitute something far better and finer than a mere pressure group. They are themselves deeply involved. By their own sacrifices and devotion they are an example to the whole of our community. They are determined to press on with their efforts until the last mentally handicapped child in our country has been given the opportunity of attaining its own birthright of human dignity, self-respect and creative achievement. To-day tuberculosis has become an almost forgotten disease. May I urge upon the Government to strengthen the work of these voluntary organisations and many others of a similar character, to assist them in every possible way, so that by their own unique contribution to these problems they can help to eradicate the scourge of some types of mental illness present in our midst.

4.38 p.m.


My Lords, I think we are all greatly indebted to the noble Lord, Lord Grenfell, for raising this matter in your Lordships' House to-day, and for giving so many people the opportunity of saying something about a subject which I think does not divide this House at all but is one in which we are all deeply interested. I would also add my word of congratulations to the noble Baroness, Lady Hylton-Foster, on her altogether admirable and charming contribution to this debate, and to the noble Lord who has just sat down, whose speech was most moving and whose appeal for help for those working in the voluntary organisations is one that I echo fully. I think we are deeply indebted to those people who for many years now have struggled to build up these really splendid groups of voluntary organisations working in this field.

I also speak, if I may (I have done so in your Lordships' House many times), as a member of a local authority charged with the duty—and a very responsible and difficult one it is—of administering the Mental Health Act 1959. The problem is a very large one. I do not think that anybody has quoted the figures this afternoon, but some of your Lordships' may know them—they are of a very formidable size. In 1964 there were approximately 587,297people who were mentally ill. Of those, 180,056 were in hospitals and 399,241 were in the community. These are very large and very disturbing figures, and they give some idea of the challenge given by the Mental Health Act—and a very great Act it is—to those who are struggling on local authority committees to try to administer it.

We are speaking particularly this afternoon of children and young people. Here also the figures are most distressing, though not of quite the size that I quoted just now. During 1964, 6,400 adolescents were admitted to hospitals for the mentally ill. There were only 157 beds, in only 7 special units, for the psychologically ill adolescents, and probably each adolescent would require something like six months' treatment in hospital. There were also only 370 beds for mentally ill children. This represents about 3 beds per million for the adolescent population, and only 8 beds per million for the child population.

In this circular which I have here, issued in 1964, the Ministry of Health urged that there should be at least 20 to 25 beds per million for the short-term treatment of children, and 25 beds per region for long-stay cases. This is approximately, in all, 1,500 beds, compared with the existing 370. Twenty to 25 beds per million for adolescents represents approximately 1,000 beds, as compared with the existing 157. However, the increase since 1964 has been of only 36 beds. In my opinion, this is a great challenge to the Minister of Health and to the Health Department. Of course, they are enormously hampered by a shortage of staff and training facilities and, as I think Lord Grenfell mentioned, by the low salaries paid to teachers who are instructing the mentally ill and those who are nursing the mentally sick. Therefore, whatever our political opinion, whatever our views, this is something which is a real challenge to the whole community; and we must work in every possible way we can, whether it is in local government or in the voluntary organisations, to see if we cannot really make a real step forward to meet these problems and these shortages of staff and accommodation.

The question of hostels has been raised. So far as I know, there are no hostels for mentally disturbed adolescents to live in while going to work outside. Of course, such hostels would need trained staff. But if we could get such hostels going, through either local authorities or voluntary organisations, I am sure that we should be doing something to help the young, who in my opinion should not be in hospital if they can be employed, even in a humble capacity, in the community. One noble Lord (I think it was the noble Lord, Lord Brain) has referred to the letter which Mr. Tudor Davies published in the Observer. I, too, was enormously impressed by the figures he gave. They stress strongly this problem which I have mentioned at the beginning of my speech.

The noble Lord, Lord Segal, raised a point about which I have always felt tremendously strongly; namely, the inadequate amount of money that we have for research into mental illness. Thirty-five per cent. of mental illness is either schizophrenic or manic-depressive. As has been said, new methods have been discovered in recent years for treating this kind of illness. And again far too little money is available for this purpose. The noble Lord, Lord Segal, gave the figure. But 8 per cent. of the Medical Research Council's budget is far less than has been spent in the past, certainly on the magnificent work that has been done on tuberculosis research, and also that which is being done to-day. I entirely agree with Lord Segal that we do not want to see any reduction in that work, or on the work that is done on cancer research. But if we calculate that one out of every nine girls aged six to-day will enter a mental hospital at some time in her life, and that one out of every fourteen boys aged six years to-day will probably do the same, it shows the absolutely desperate situation which lies behind this question of mental illness and research into it.

As Lord Segal has said, I am sure the research has helped the medical profession to cure tuberculosis and to create the position where sanatoria are now closed or used for other purposes. I should like to see as much power, as much money and as much desire put behind research into mental illness as was put behind tuberculosis research and is behind cancer research to-day. It is essential that we get public support for this, that we increase the great funds that are being raised for research into mental health, because I am sure that herein lies the best way to arrest the increase in the incidence of mental illness to-day.

I should like to pay my tribute, as did Lord Segal and others, to the National Association for Mental Health. They have done a perfectly marvellous job, both with the public and with the patient. More people to-day look on this illness like any other illness, and in the recent campaign which culminated in the Mental Health Week I think we had something of quite outstanding importance. It was supported by 32 voluntary organisations. It was a costly business for them, since they had no help from the Ministry except moral support. I should like to urge upon the Minister that he might realise that a campaign of this kind, doing something which is vital to him as well as to the voluntary societies, is something to which he might well give some financial support on future occasions. It must have benefited him and the local authorities and the medical profession as much as it did those who inaugurated it in order to explain to the public about mental health and what the National Association for Mental Health and its 32 supporting organisations means at this time. The B.B.C. and I.T.V. took part.

I should like to make one comment about the B.B.C. film which appeared on "Panorama". Looking at it and studying it, I found it to be unnecessarily depressing. In one of its shots of a mental hospital it showed a long, gloomy corridor, overcrowded wards and an atmosphere of Edwardian or even mid-Victorian institutional treatment. I am sure many of your Lordships know, as I do, mental hospitals of to-day which are not in the least like that. Even though some of their exteriors are of the Edwardian or Victorian age, inside they have been reconstructed; they are cheerful, they are gay, they have modem colouring and modern furniture. I was in one, The Dingleton Hospital, in my own county of Roxburghshire, only on Monday. I have also been many times to the Crichton Royal, in Dumfries.

There is nothing depressing about these places. There is nothing which gives you the feeling of people not being cared for. There are no locked doors. There are wonderfully beautiful gardens. People walk in and out. People who are not patients are welcome to come and visit in a hospital of that kind, just as people are welcomed and cared for if they are patients. I do not think that the "Panorama" programme which the B.B.C. put over in regard to a mental hospital (I have forgotten which hospital it was; it may not have been named, but, in any case, it was an old-fashioned hospital) was anything but a great mistake. It gave people the wrong impression. We want to give to people the impression that mental hospitals are up to date and modern, and are as anxious to be welcoming in their appearance as any other kind of hospital. The noble Lord, Lord Segal, made the same point, and it is absolutely true.

I should like to speak for a few moments about a voluntary organisation with which I am closely associated, the National Society for Autistic Children. This is a small organisation only five years old. It was formed as a result of the many developments which have taken place in the treatment of mental health and which are so very encouraging. Due to research, experiment and experience, it has been possible to break down the various types of mental illness which at one time were described generally as subnormality or as "ineducable". Research and work carried out both inside and outside hospitals have led to this break-down, so that there are now many new definitions available and this is most encouraging. It means that one can look at all these different types of mental illness and know that they can be cured.

The small society with which I am associated has been formed because so many doctors and people working with this type of child have discovered ways of teaching them and bringing them into a normal life. This Society has been in existence for only five years, and it is estimated that there are about 5,000 autistic children. This is a withdrawn, mental condition. In the past when children could not speak and when they showed signs of great mental disorder they were often designated as uneducable. This is now proved to be quite untrue because, with skilled teachers and with parental care and love, these children can be and are educated. Only the other day I had the privilege of opening a small new school in the Borough of Ealing devoted to the teaching and training of autistic children. I was enormously impressed with what is being done. Although it is a tiny unit it is a pioneering unit which will show to anybody who cares to see it what can be done for this type of child.

One very important matter in connection with the Mental Health Act 1959 is the great importance of the diagnosis of children who suffer from mental disorder. I am speaking of Scotland because in my local authority in Scotland I was chairman of the education committee and I have had something, although not as much as many noble Lords, to do with this question of educating or not educating mentally disturbed children. In Scotland the assessment of children is done by an educational psychologist in cooperation with the medical officer of health and also the director of education. I understand that in England the question of educational diagnosis by an educational psychologist is not compulsory. The diagnosis is done in the main by a medical officer, who may of course be a highly skilled mental specialist; on the other hand, he may not. There is a case for seeing whether it would not be better for the assessment of children of this kind to be done through an educational psychologist in the first instance with the assistance of a medical officer, rather than to leave it entirely to a medical officer. I am not suggesting for one moment that he may not be highly competent to do this, but he may not be since the educational standard and I.Q. of children is something which educational psychologists are trained to assess, and medical doctors are not necessarily trained in this way.

In Scotland the duty of the education authority is to provide special classes for any child who is educable, and the duty of the health authority to provide help to the severely handicapped who are perhaps non-educable. I think the same applies here in England. There is nothing like enough accommodation for either of these categories. A definition which defines specifically many categories of handicap should, I hope, in the long run, do away with a general label like "subnormality" which is sometimes put upon children and which depresses everybody, particularly the parents. The autistic child has in the past been labelled in that way, but through long study and by adopting different methods of teaching he can be brought a long way along the road to normal development. The classification of "uneducable" is hard to overcome, and the National Society for Autistic Children have spent many years doing some hard fighting, on the part of their professional workers and parents, to win the right of an educational trial for these children. I would suggest to the Minister that in this year of 1966 no mental condition should be called incurable. Therefore, it is vital to get the educational department to assess the child.

Just as there is a shortage of nurses and teachers, there is a shortage of educational psychologists, but I hope we shall encourage people to train for this vital profession. I do not know whether our system in Scotland works better through the education committee than it does in England through medical officers of health only, but I feel very strongly that the value of educational assessment as well as of medical assessment is of the greatest importance. On page 2 of the Mental Health Act, in Section 4, one finds the definition and classification of mental disorder. Then on page 103 of the Act there is, in the Second Schedule, a definition dealing with medical examination and classification of children who are unsuitable for education. The Second Schedule stresses very strongly the question of using the education authority. There seems to be a slight anomaly on this matter, and I wonder whether the Minister will look at this to see whether or not in England the importance of the education authority should not be stressed still further so as to give the education authority, rather than the medical officer of health, responsibility for the educational future of the child.

Then there is the emphasis on community care in the 1959 Act which makes it more important to try to assimilate the child in its own environment and the home environment into the community. The most helpful way of dealing with the children in this way is by the care of the home and family and by special classes which in the circumstances are essential. This is where I entirely agree with noble Lords who have stressed the great disadvantage which can arise from children being sent into hospital and left there for too long. I believe—and I have seen some of this myself—that a disturbed child needs more, not less, love and care and companionship than a normal child. Indeed, the probability is that there will be other normal children in the family who are able to help in the rehabilitation process. This, possibly more than any other factor in the child's life, as the noble Lord, Lord Grenfell, has stressed—and he is perfectly right—is so important.

This remarkable Act of 1959 was the biggest challenge to local authorities in many years. It put responsibility in the community, as the right reverend Prelate the Bishop of Coventry said, and I am sure that is right. It is a very great responsibility. I think it is essential that we should have more professional help, and this must be a priority in the health services.

But I sometimes wonder whether we make full use of the professional help that is available. The modern mental hospital is open to all who are interested. In my county I have tried to link the child who comes into care under the Children's Service, with action from one of the psychiatrists or psychologists available through the local mental hospital—the Dingleton Hospital. In the Borders area the skilled professional doctors and social workers of Dingleton are willing to help with advice on community care, or to visit these cases in their own homes. This is something which I hope will develop all over the country; otherwise, the home care of mental patients will not be as good as it could be. Inevitably the families need help with the problems which they have to face. It is not only the patient who wants help; it is also the family. So the co-operation between the health and welfare services and the hospital in any given area could be of very great value.

If I may sum up, we need more trained professional help, more teachers of mentally-handicapped children and more special schools and classes; not to keep them segregated but to enable them to grow up, to join in with the normal schools when they have reached that stage and it is possible. We need more money for research. I should like to support the suggestion of the noble Lord, Lord Segal, that we might try to have some centre in London where research and co-operation between all the agencies could come together. We need, above all, the determination of all of us to break down the barriers that the words "mental illness" still erect between the patient and the community. We must carry into this battle for the children the faith and knowledge that every child can be helped, if not to perfect normal life at least to a place in the community. I hope this debate will have helped in that cause.

5.3 p.m.


My Lords, it is with very considerable diffidence that I rise to speak on this very vital matter which has been raised by the noble Lord, Lord Grenfell, especially at this stage of the debate when practically all the great and important points have been so ably made. I can claim no special knowledge of the subject; nor have I had any special experience of the ways in which the problem of subnormality is being directly met. It is for me but one aspect, albeit a particularly poignant and challenging one, of the general concern which anyone in my position must have for the well-being in the fullest possible sense—spiritual, mental, moral and physical—of all children.

Behind anything that a Bishop says on this subject, or on such an issue as this, is the knowledge that he is representing the compassion which innumerable parish priests bring, and have brought, to individual cases in their parishes with which they inevitably come in contact. Also, as I see it at any rate, in a sense he represents the devotion and skill of all the hundreds of workers in this field whom he must regard as his lay colleagues in the pastoral care of handicapped children and handicapped people of all ages, be they professional and fully trained, or amateur, voluntary, partially-trained or not trained at all.

I shall never forget the impression made on me by a great statement which confronted visitors to the Church Pavilion at the Brussels International Exhibition in 1958, the year before the Act about which we are talking came into force. In four languages, it read: Every human being, educated or ignorant, rich or poor, of every nation and of every race is a creature of God and King of Creation. Every human being has an immortal soul, and is called to enjoy an eternal happiness. This is the true foundation of the dignity of man and the sole basis of an unalterable happiness. It is in that kind of faith that one approaches this subject of the care and education of the subnormal person, however defective, however limited, he or she may be, and one knows just how far those terms can be stretched.

It is as Chairman of the Church of England Children's Council, a department of our Board of Education, that I am particularly concerned—and I am so very glad to be following the speech of the noble Baroness, Lady Elliot of Harwood, who speaks with so much authority on this whole subject of education—though I also have some concern as Warden of a Guild which has to do with the Church's ministry of healing. From the point of view of the Children's Council, the care and education of severely subnormal children is necessarily seen as one very special aspect of the education of all children for life in its fullest and deepest sense. It is this that we ask for children, however limited they may be. Our responsibility is only for children up to the age of 14, and therefore adolescents do not come within our responsibility to a great extent. I was so relieved to hear that at last, in the speech of the noble Baroness, something said about adolescents and their need.

Four years ago we appointed a research officer, the Reverend Anthony Denny. He had already been interested in handicapped children and adolescents, and this interest led him to do some research, which was most valuable from our point of view, into what is being done for the ESN and SSN children, and into experiments which are going on within both the Hospital Service and the Education Service. The report, which he edited two years ago, with the titled Number Unknown—and how often that fact of the unknown number has been referred to in your Lordships' House this afternoon—has aroused fairly wide interest, and his most recent book Children in Need is a very helpful and competent statement of the whole problem. What little understanding I have of the issue is very largely due to what he has taught me.

How recent it is that opinion has changed on this whole subject, from the attitude which thought that the severely subnormal child should just be put away in an asylum, to the attitude that such children can be helped to live some measure of normal life and even take some part in the life of the community! I suppose the ideal which the 1959 Act put before the country, that there should be a reorientation of the mental health services towards community care and away from hospital care, except where the special facilities of the hospital are needed, has done as much as anything else to bring about this change. But it has come to be recognised in only comparatively few circles in the country.

A look at what has happened since 1959, therefore, must call for a look at what local authorities are doing (as the noble Lord, Lord Grenfell, has so carefully pointed out) as they set themselves to translate this ideal into practice. I am afraid that I have not looked at what authorities other than those in my own West Riding have been doing—because, of course, as your Lordships will understand, a Yorkshireman does not normally think it necessary to look at what other counties are doing. He is quite happy to think that things are going on as well as they should in Yorkshire.

Be that as it may, my own authority was, in fact, spending£99,500 on this service in the financial year 1957–58; in 1965–66 it spent£516,000; and it has budgeted this year for£579,000. That is a very considerable advance; and, when you look into what this expenditure represents, you realise that it is a very considerable advance in many directions since the Act was passed. For instance. there are many more training centres now than there were—not enough, but more; and in these centres the whole conception of training is being widened so as to get away from the idea of just teaching patients suffering from the various kinds of subnormality to occupy their time in some sort of way—often, as we all know, with a deadening, repetitive sort of occupation—and in the direction of helping them make the most of whatever capacity can be discovered in them, so that they may live, and live with other people, instead of just existing.

Special care units have been mentioned. They are being experimented with, I am glad to see, for those who are too handicapped to fit into the routine of the junior and adult sections of the training centres, and these are proving an immense boon, especially to parents. I am also thankful to see that one sheltered workshop is to be built, which will provide places for 36 subnormal older people. There is only the one, but it means that perhaps there will be more to come. I only wish there were more special hostels for the younger people when they first go to work in the ordinary, workaday world. How important it is that they should be very carefully looked after in those early stages! It is clear that more is being done to secure that the staff in the various establishments are being more adequately trained. At present, about one-third of the staff hold the teaching diploma—one-third only. From what I can discover, a good deal of thought is being given to what should be the real content of the course leading to a diploma—and here, it seems to me, is where the great problem lies: in the recruitment and training of teaching staff.

When we consider the amount of research which has been undertaken at Brooklands (which the noble Lord, Lord Grenfell, will know so intimately), where Dr. Tizard and his staff have been applying normal methods of residential care and using up-to-date educational methods which would be used for normal children of a comparable mental age; when we realise the response of the children to this educationally; and, of course, when we take into account the trends in the thinking of many psychologists and educationists to-day, not only in this country but in many other countries, it seems to me that, whatever the physical conditions that may be provided, we must make absolutely sure that when we speak of "care" we do mean education.

Whether it is hospital care or community care, the aim must be to help the child to develop as a person to the fullest extent of which it is capable. Social training, speech training, occupational training—all contribute towards helping the child to live. Naturally, religious education is my special concern, but religious education is not adding a subject which has to be taught as an addition to a general curriculum: it is aiming to develop a person spiritually, mentally, physically and morally so as to live up to whatever capacity he or she has. This is in order that a person may respond—and this is how every person concerned with one of these children is trying to help—not only to what might be called the natural environment, but to the whole of life, the very substance of which, from the Christian point of view, is personal, because its origin and source is God.

Now the evidence to-day increasingly points to the conclusion that, although a child may be classified as incapable of reaching even the educationally subnormal standard, that no longer means that he is ineducable (this has been said several times this afternoon, and I want to underline it), given the best educational methods available. It is here, my Lords, that we come to the debate, which is quite clearly warming up at the present time, as to whether all such children should be transferred to the Department of Education and Science and taken out of the hands of the Ministry of Health. No doubt there would be advantages in this course. The teaching staffs in hospitals and training centres would not be cut off, as they are at the present time, from their colleagues and fellow educationists; their salaries would certainly be higher if they came under the Burnham scale (and they certainly ought to be higher: that has been said only too plainly this afternoon); training centres and similar establishments would be inspected, like any other school, to their great benefit; and the training of teachers for this highly specialised and exacting work would be upgraded, as it certainly should be.

But there would also be disadvantages, for there must always be a great deal of the kind of care which is fundamentally skilled nursing care. This care has been accepted as a major responsibility within the health services, and it might so easily become the Cinderella of the education services if the transfer were made. The Motion before the House does not explicitly call for this transfer, and I am fairly sure that this is not the moment to ask for it. Nevertheless, a review of the situation as it is now, seven years after the passing of the Act, makes me certain that, whatever happens, there needs to be a real understanding, not only within the services themselves but also by the public, that the problem of the care of these children is fundamentally an educational problem. For this reason, there ought to be as effective a co-operation as possible between the two services, and arrangements should be made to ensure that community care, as well as hospital care, is more and more understood in these terms. The most crucial point at which this has to be tackled is, of course, the training and the recruitment of staff. While all that the National Association for Mental Health has done, in developing the diploma, particularly needs to be appreciated, it is still not enough. What is called for is teacher-training of a specialised kind. And I cannot believe that this cannot be worked out.

While I cannot claim that this is yet the general opinion of the Church—for Church people, like most other members of the community, still have a long way to go in catching up with the real insights of those most personally involved in this subject—I can, I think, say that it is the view of those who have thought their way through the practical application of the Christian faith in relation to the severely subnormal child. I hope this debate to-day will help in the whole process of the reorientation of the ideas of the general public about this subject, as my brother, the Bishop of Coventry, has so splendidly stressed.

There is one last point. Again it has been made, and better made, by the noble Lord, Lord Segal. "Prevention is better than cure" is a truism which applies very much in this case. So often, so much more could be done if care and education could begin at the earliest stage of a child's life. If there were more understanding by the public of just how much can be achieved by way of education, not just by way of custodial care, how many more parents would have the courage to seek help when their child was in its infancy instead of waiting until the problem defeats them!

5.21 p.m.


My Lords, just over seven years ago the Second Reading debate of the Mental Health Act, as it now is, took place in this House. I have been reading some of the proceedings and I find that I and a number of noble Lords who have taken part in this debate took part in that, too. I should like to add my thanks to my noble friend Lord Grenfell for having enabled us to discuss this very vital question to-day. I have the honour of serving on the house committee of one of the mental hospitals within the Carshalton Group, of whose hospital management committee my noble friend is chairman. I know from first hand that wonderful work he and his associates have done, particularly for that group of hospitals.

There are, it seems to me, two separate problems here: one is of the children up to the age of, say, 11; the other is that of those who have gone beyond that age and become adolescents. Only yesterday my wife and I attended one of the many jubilee half-century celebrations of the Royal College of Nursing which are taking place. This one was held at Horton Hospital in Epsom, one of the largest mental hospitals in that area. We spent several hours attending a forum, having a long tour of the hospital and ending up with a cheese-and-wine party which enabled us to have a most interesting discussion and also refreshment after a long tour.

I listened with great interest to the speech of my noble friend Lady Elliot of Harwood and, in particular, to her reference to the recent "Panorama" programme on mental health. I saw that programme and I saw, too, a programme on the other channel later in the week which I believe was called "A World of their Own", and which showed mental hospitals in both Canada and this country. I was very impressed by the contrast between these programmes. As my noble friend said, the "Panorama" programme tended to stress the depressing aspect of these hospitals. No doubt some hospitals of a depressing aspect still remain in this country; but from the limited experience I have had of visiting such places I believe that they are now in the minority and are becoming more so. The general attitude of the Independent Television Authority programme and the hospitals they chose to feature made a very much contrasting picture. It showed the great reforms which have taken place, particularly in making these places much more cheerful and colourful.

At Horton Hospital, which has a population of all ages (a great many geriatric patients and a number of adolescent and slightly older patients) one of the most vital features was the accent on bright colour: colourful carpets and curtains and well laid-out gardens. I believe this has a very important psychological effect on a large number of its patients. While I should be the last to decry the use of drugs, which obviously are of great help, particularly in the case of severely disturbed patients, I think this accent on brightness is of great importance.

I would add my congratulations to those already given to the noble Baroness, Lady Hylton-Foster, on her very brief, very lucid and very sincere maiden speech. Living in Surrey, as I do, I know of the very valuable and practical work which she has done in the hospital world, not only for the Red Cross but in other fields; and I know it is the wish of all of us to hear her more often; and particularly on these vital social problems which this House can discuss so valuably.

One of the most important results of the 1959 Act was the removal of the stigma attached to the lunatic asylums, as they were called in days of yore, and the ending of the locked doors and padded cells. As has already been said during this debate, it was not so many years ago that children who were mentally disturbed were neglected, kept away from other children, kept away from the world in general. It is very different to-day. I know of at least two or three schools in my own area where many of the pupils go to these mentally-handicapped children to read and play with them; and this is much appreciated.

I should like to ask the noble Lord, Lord Champion, one question; and I apologise for not giving him notice of it. I wonder whether he could tell the House what progress is being made in encouraging local authorities to appeal to schools in their areas in their turn to appeal to their children to help out by reading and playing with some of the children in these hospitals, particularly on an informal basis. I know a great deal of this goes on already; but I think the more this happens, the more work is taken off the hands of the already overburdened teachers of these children, who do such splendid work.

Some of your Lordships may have visited the Qantas Gallery in Piccadilly recently and seen the exhibition of paintings by mentally handicapped children. I have seldom been more moved by anything than I was by some of this work. Admittedly, much of it was hand-picked, but some of the children concerned were, I am told, very mentally disturbed. Yet much of the painting—I say this quite seriously—would have been well placed in some of our National Gallery exhibitions. Some of it was quite brilliant. One of the fascinating aspects of mental health is the way in which these patients have a tremendous aptitude for painting.

Again reverting to Horton Hospital, I saw there only yesterday the work of some patients of all ages who had been trained by a Czech-born charge nurse who had taught himself to paint. He served in the Czechoslovakian Air Force and settled in this country, and now devotes much of his free time to teaching many of the patients in this large hospital to paint. I am told that therapeutically the results have been absolutely staggering. Certainly results, particularly in respect of some of the more severely schizophrenic patients, have been very good indeed.

My Lords, one cannot speak too highly of the staffs of these hospitals, particularly those who look after very violently disturbed children. I have seen some of them and I know many of your Lordships have done likewise. My information is that if you try to transfer one of these nurses to another ward after they have looked after very mentally disturbed children, a great deal of trouble is caused, because the nurses become very devoted to their charges even though these children have literally to be nursed day and night.

This has been a very valuable debate. Since 1959 we have seen a great deal of progress. Going into these hospitals one finds that locked doors are very much an exception to the rule. There is more association between the sexes and this works very well. I am told that it causes very little trouble. There has been a great deal of progress in the case of children. For example, if hydrocephalus is diagnosed at a very early age now, although not curable, it is possible for it to be treated pretty effectively. Alas! those of a more advanced age cannot be so treated. One can only hope that medical research in the years to come will make that possible too. As has been said, much more money is needed for this purpose. During the course of the forum at Horton which I attended yesterday the point was made that£900 million was spent each year on gambling. A lot of that money, I know, goes back to the Exchequer, but it is a sobering thought when one compares that amount with the money available for mental health research.

In conclusion, my Lords, I should like to ask the Government seriously to bear in mind that the progress which has been made since the 1959 Act, and before that, is due very largely to the devoted work put in by those in voluntary service, and of nurses and staffs of these hospitals. It is to be hoped that the Government will find a way of allocating more money to mental health research as soon as possible.

5.36 p.m.


My Lords, to be bottom of the list is probably a very good training in self-discipline. As the debate, which was particularly interesting this afternoon, went on one found that point after point one wished to raise was already being raised. I therefore ask your Lordships to forgive me if I cover points which have been raised already in the debate, except in respect of mental health research, about which I feel one must pummel away rather like a machine-gun, whichever Government may be in power.

The debate has drawn attention partly to the workings of the Mental Health Act. I believe that to be one of the greatest pieces of legislation ever to pass through Parliament. As we have heard to-day, it produced a completely new feeling in mental hospitals. The wards were unlocked. It produced generally a new outlook on the future of mental health and also—this is rather extraordinary—almost at the same time a great change came about in treatments. For instance, the old insulin treatment has departed completely and, according to what one hears from psychiatrists to-day, the analytical couch and the analyst are also on the way out.

To come for a moment to the question of children and adolescents, I think it is one of the big problems that if a breakdown occurs at an early age it is bound to be serious. If it is treated in the right way, which probably needs a great deal of patience and understanding, when a person is young, there is a very good chance that the child will be cured for life, but, alas!, if this does not happen, the child will probably become neurotic or need continually to go back to hospital for further treatment.

I do not myself know of child-caring hospitals in the National Health Service. I do, however, know of two places outside the National Health Service; I know them very well. One is a very remarkable place run by a man named Mr. Lywood. It is called Fincheden Manor in Kent. Some of your Lordships may have read a book called Mr. Lywood's Answer. He was a public schoolmaster, in fact a housemaster, and he was offered the headmastership of Repton. This was before the war. He turned down the offer on the assumption that the public school system of this country could not be judged on its successes, but on its failures.

He started the school, if one can call it a school, for maladjusted boys. It was so successful throughout the war that after the war he was approached by the London County Council and asked whether he would take the really bad maladjusted children from London. This he has been doing for some twelve years. They all seem to get on extremely well. I went down to see Mr. Lywood, and when travelling back in a car with a leading psychiatrist I asked his opinion of the Lywood theory. He said: "It is traditional. Quite how it works I do not know, but it is rather like your House—it works". I think that this covered the situation very well. Mr. Lywood is a man who has a strong appeal and has produced a system which with children of this type works very well.

To enlarge a little on the whole subject of mental health—my next point is one about which we have heard a little this afternoon—one of the great problems in our mental hospitals is the shortage of staff. I think this probably comes about through a certain amount of prejudice, and also because of the extra training that is necessary before a person is qualified as a fully trained psychiatric nurse. How this is to be overcome is a great problem. One of the ways which seem to be helping is the use of voluntary workers. An interesting experiment has been taking place at the Fulbourn Hospital near Cambridge. There they have had a considerable number of volunteers working within the hospital at certain times.

The interesting thing is that a person from an outside environment produces a totally different feeling in mental patients. They produce new ideas; they can talk about different things. Often when I have run into one of these volunteers who has worked in a hospital he has said: "This is quite extraordinary. Surely such-and-such a person cannot be ill. He appears to be absolutely normal. "This relates to the quite natural reaction of a patient to a person he does not know. The indent makes a supreme effort, and can probably hide his difficulties and problems while conversing with this person. But then, after the person has gone, he will revert to his problems once more. But this is a progressive system, and it helps enormously in the general welfare and rehabilitation of the patients.

There is one point I should like to ask about, and it is whether or not in these hospitals it would be possible for the voluntary workers to be paid out of public funds. As I think the noble Lord, Lord Champion, knows, I am really asking this because it is of some importance and the hospitals have found that they cannot leave it to the staff to get this organised. There are a lot of difficulties which come up in connection with the work of these volunteers, and it is necessary for a fully trained person to deal with them.

I wish to turn for a moment to the problem of occupational training and facilities for it. As I think we all know, this has now become one of the big factors to help patients recover. The actual occupational training is long and arduous, and there is no doubt that those people who provide it do great work. But often the accommodation they have to work in is appallingly bad. The other day I was going round a psychiatric clinic attached to one of the big teaching hospitals in London. One can tell this story, because both the patients concerned are now practically cured. There was a girl sitting there doing some knitting, and just behind a barricade was a gentleman hitting a piece of iron with a large hammer. Every time he hit this, naturally the girl jumped about a foot in the air. I said to one of the occupational therapists, "Surely something could be done about this." She said, "It is a problem, because we are so short of room. But the girl has been told that she has to face noise, and we cannot stop the gentleman who is hitting the iron because he has got to get rid of his repressions on the iron. "These are the kind of problems that have to be dealt with.

I now want to turn to the amount of money that is available for mental health research. This has already been mentioned by the right reverend Prelate, and we have had some figures given by the noble Baroness, Lady Elliot of Harwood, of the numbers of mental cases in this country. I think this has a great bearing on the situation. At present, so far as the Mental Health Organisation know, there are some 587,000 mentally disordered people in the country. The figures broken down, are: mentally ill in hospitals, about 130,000; mentally subnormal,57,000: in the community, mentally ill, 310,000; mentally subnormal, 89,000. This, of course, is a gigantic figure. But I feel that if the Government could be persuaded to provide some additional funds (I know it is not easy, because every day we sit in this House and hear demands made on the Government for more money for this and for that) this would greatly assist the whole of psychiatry, which I believe is on the verge of a breakthrough.

I do not know whether your Lordships know this, but for a long time there has been a feeling that the whole glandular system of the body has been very much tied in with any form of mental illness, even schizophrenia. An interesting thing was done not long ago at the Menninger Clinic in America. A mental health worker there, a chemist, got a line on the question of blood. They found out that a great many people who suffer from schizophrenia had a certain type of blood complaint. Some of this blood was injected into normally healthy people, who then suffered an attack of schizophrenia for a few hours. This shows that we are getting closer and closer to many of the answers to this enormous problem. As I have said, I feel that if the Government followed up my suggestion to allocate additional funds, I believe that in the long run it would pay them, because it would start to empty a lot of the beds in the National Health hospitals; and, after all, the percentage of beds taken up by mental patients is enormous at the present time.

I apologise to your Lordships if I have taken slightly longer than I meant to, but this is a subject that I have studied carefully over a good many years. It is a vast problem, but light on mental illness is filtering through, and the more the community can do to lessen the suffering of people who are mentally ill, the more will the hell on earth which patients suffer be lessened.

5.49 p.m.


My Lords, I apologise for joining your Lordships halfway through this debate, which concerns a subject that interests me deeply. The reason why I was late this afternoon was because I was taking my son to St. Andrew's, at Northampton. Unfortunately, he suffered a serious cycle accident which has resulted in his being unconscious for twelve months. From my own painful experience, I should like to draw your Lordships' attention to one serious shortage in our medical facilities. We have establishments which deal with young persons' physical disabilities, and we have hospitals—some exceptionally good—which deal with mental problems. But we appear to have almost no facilities for children and young persons who require physical and mental treatment simultaneously for their disabilities, which are due mainly to road accidents. I understand that there is a steady increase in the numbers of this type of patient. May I, as a concerned parent, urge Her Majesty's Government to look into this particular shortage of our facilities for children and young persons, and may I hope that in the not too distant future the necessary facilities will be available to patients requiring this dual treatment.

5.51 p.m.


My Lords, the last speaker has drawn attention to the wide scope of the problem we are discussing this afternoon, and I am sure that he has the sympathy of every Member of your Lordships' House. I should like to follow what he has said by drawing attention to another aspect of this matter, one that I think has not been touched upon this afternoon. Something has been said—and it was said particularly well, if I may say so, by the right reverend Prelate the Bishop of Wakefield—about the tremendous progress that has been made in connection with mental problems over the last few years. It is really this aspect which has brought me to my feet, because a number of my friends who are interested in these matters, and who are also musicians, have been much concerned over these last years with the problem of music as a method of therapy for mentally ill patients. So far as I can judge, there has been a quite remarkable breakthrough, or something in the nature of a breakthrough, which I think needs to be known much more widely and to be appreciated much more than it is.

Many years ago, a very close friend of mine, who had a distinguished career in music, gave it all up in order to run a home for mentally sick children on the basis of seeing what could be done to help them by musical means. So far as I can judge from meeting people who have had children in this place, the experiment has been a great success. This was a pioneer effort, at any rate in this country, but of quite recent years it has been recognised that it is a valuable method of therapy in connection with this mental problem. At more than one of the great mental establishments—certainly the one at Epsom, about which everybody knows—music is now part of the regular mental therapy; musical therapy is now recognised as a type of help which has considerable value. It has been found that many of these people, however abnormal they may be in ordinary mental ways, are exceptionally musically sensitive, and can provide executive musicianship of a very high order which may well enable them to take part in the general musical life of the country. I do not want to say any more about that subject, except that I hope the Ministry of Health will be able to pay attention to it.

I am really echoing something the right reverend Prelate said on the question of the pay of those who are taking part in the trying, difficult, and important work of educating and helping these mental cases. The right reverend Prelate pointed out that if they came under the education scheme they would get Burnham scales, which are better than those which now exist for them. As I understand it, some of the highly qualified musicians who are helping in this work are classed as occupational therapists, and most of the work is done on a part-time basis. I should be ashamed to tell your Lordships what miserable fees are paid to them. I hope that the noble Lord who is to reply, and the Minister of Health, will look into this matter, because to hear about it made me feel quite ashamed. It is only right that the workman should have the proper pay for his job, and I am sure that if those who are concerned with the arrangements in the National Health Service will look into this point they will feel that the present basis is not a fair or equitable way of handling this aspect of this important matter.

5.56 p.m.


My Lords, the debate to-day was opened by the noble Lord, Lord Grenfell, with a speech charged with compassion for those with mental illness, and with understanding for their parents. It is good that someone such as he ensures, by periodic prodding of Governments, no matter what their complexion, that we are always moving forward. Because of his exceptional knowledge, he prods us to move forward in the right direction. The whole House has rightly thanked him for putting this Motion down for consideration to-day.

The debate has been given distinction by the maiden speech of the noble Baroness, Lady Hylton-Foster. Until she came here, I knew of her only as the wife, and then the widow, of a dis- tinguished Parliamentarian whom I tremendously admired. To-day she has proved herself a Parliamentarian in her own right, in a speech full of knowledge of the problems we have been discussing. When I say that the House will be happy to hear her again, I can assure her that this is no empty formula—we really do mean it.

The speech that I have to make tonight is designed as something of a report to Parliament of the progress in this whole field, and will, I fear, be fairly lengthy. So if noble Lords decide to go out saying, "I will read it to-morrow" I shall not regard it as a discourtesy, so long as I am left with a quorum for this House, which happens to be three. The noble Lord, Lord Newton, in a speech full of knowledge, was kind enough not to use past speeches of my noble friends to berate me. I am grateful to him for that as I am for his continuing interest in this whole problem, to the solution of which he has made a useful contribution. I can assure the noble Lord that I will read his speech carefully to-morrow, as will the Department, and if I find that I have not replied in my speech to some of his points I will ensure that he has a reply by letter. This also applies to the other speeches made here to-day.

I listened with a lump in my throat to the touching speech of the noble Lord, Lord Macpherson of Drumochter. It was brief, but his personal experience moved us all, and I can assure him that his short speech will receive a special study, arising, as it does, from his personal experience. That applies also to one other noble Lord in the House to-day.

Perhaps it would be helpful to the House if I now gave a short outline of the main services provided for mentally ill or subnormal children and adolescents and their parents. I shall refer to some of them in detail later. Medical treatment and hospital and specialist services for people of any age who are suffering from any form of mental disorder are provided by general practitioners and hospitals as part of the National Health Service. Local health authorities also have a statutory duty to provide a wide range of services; since the earlier special legislation was repealed by the Mental Health Act 1959, these also have been provided entirely under the National Health Service Act. Health services for the mentally ill and subnormal are thus now fully integrated as part of the comprehensive National Health Service.

The services for which local health authorities are responsible include attention to the mental as well as the physical health of mothers and young children; early screening for handicapping conditions, such as phenylketonuria; advice to parents on the special problems of bringing up a subnormal child; training for children whose mental disability is so severe that they are unsuitable for education at school; training and occupation in adolescence and adult life for those who are not capable of open or sheltered employment; residential accommodation if they are unable to live with their own families, and skilled advice on the special social problems which are associated with these forms of illness and handicap. Many of these services are still at an early stage of development, and though much progress has been made in recent years, we are far from having a fully developed comprehensive mental health service in all areas. Local education authorities are responsible for the education of all children other than those whose mental disability makes them unsuitable for education at school. This includes responsibility for providing special education, where necessary, for children who are maladjusted or educationally subnormal.

Before describing these services in more detail, I should like to deal with some of the points raised by the noble Lord, Lord Grenfell and I am extremely grateful to him for having advised me of some of the points he was going to make in this debate. He mentioned the need for diagnostic and counselling centres to which general practitioners could refer children showing symptoms of backwardness, and in particular the need to identify as early as possible deafness in children where this may be responsible for the symptoms. This is, I know, a subject which the noble Lord has very much at heart, and he is right about it.

It is right that we should ensure too, that in the early examination of children we look for other things as well. I think of my own experience of a niece of mine who was very backward in school. We could not understand why. Eventually it was found that her eyesight was so bad that she could not see the blackboard. When this was remedied she went on to pass the usual examinations, went to a university and ended up with a Bachelor of Arts degree. Had her defective eyesight not been discovered she probably would have been regarded for years and years as a mentally retarded child, to some extent, so that I most heartily support the noble Lord on this point about identifying defects, both physical and mental, as early as possible in life, so that some remedial treatment may be given.

The necessity for this has been stressed repeatedly by circulars issued by the Ministry of Health in recent years. In particular, a circular issued last December referred to the value of out-patient clinics held in general hospitals by specialists in subnormality, the importance of investigating sensory defects and other neurological abnormalities, and of assessing the emotional and social problems which are frequently associated with subnormality.

From the time when subnormality is first diagnosed in a child, and continuing through the often lengthy process of assessment of its nature and degree, the child's parents ought to have an adequate service of advice—what is now becoming known as "a counselling service". I was grateful to the noble Lord, Lord Newton, for having especially stressed the need for this. The statutory and administrative framework within which this service should be provided is already in existence. The health and welfare departments of local authorties, and, where appropriate, their education departments, and the hospitals and general practitioners can and should contribute. But I would be the first to admit that this service is not yet fully developed in most parts of the country, and that we still have a long way to go before the parents of every subnormal child receive all the help and support which they should have. This also was stressed in the memorandum issued last December, and I hope that we shall see a great improvement in the aspect of our services for all types of handicapped children and their families. This is an aspect of the service in which the national and local societies for mentally handicapped children naturally take a great interest and in which they can play a most valuable part, both by forming a group through whom the views of parents can be made known to the responsible public authorities and through the support which parents gain from contact with each other. This, too, has been rightly stressed to-day.

To return to the early diagnosis of deafness, this matter is, as I have indicated, one in which the Ministries of Health and Education are deeply interested; and, of course, they issued a Memorandum on it which I am sure will be known to the noble Lord, Lord Grenfell. This recommended that every infant should have a hearing test at between nine and twelve months, though it was recognised that it would not be practicable to do this immediately for all children. It added that all infants with a family history of deafness, those with congenital abnormalities or other handicaps, and all retarded children should be considered to be at special risk because of the danger that impaired hearing might otherwise remain unsuspected and untreated for several years, or even lead to a mistaken diagnosis of mental subnormality.

We do not know how many children are screened early for deafness but the number is probably very large. Practically all local health authorities screen all children on their "at risk" register and, in addition, as many other children as they can. If a child fails the screening test, it is followed up and, if necessary, referred through the general practitioner to the appropriate hospital specialist to find the cause of the failure. The Ministry of Health are encouraging authorities to maintain "at risk" registers and to provide facilities for appropriate screening tests, including tests for phenylketonuria and congenital dislocation of the hip, and vision and hearing tests. More and more local health authority medical officers are taking an interest in development diagnosis which should help to pinpoint the children who are not developing normally at an early age.

The noble Lord referred also to the need for special care units, possibly under joint hospital and local authority administration. Special care units run by local authorities can make a considerable contribution to the care of children with severe physical and mental handicap, and many local authorities have established such units. But it is important that the resources of the health services as a whole should be properly deployed in caring for these children, many of whom may benefit from the specialist services which are provided by the hospitals. The provision of day hospitals for multiply-handicapped children or adults who need specialist treatment or constant nursing care but who can be managed in their homes at night, was commended to hospital authorities in the circular issued last December to which I have already referred; we hope they will eventually become a feature of the services for the subnormal in all areas.

The noble Lord, Lord Grenfell, also referred to the use of hospital grounds for facilities of this type. The difficulty here is that many hospitals for the subnormal which may have land available are far removed from centres of population and would not therefore he well suited to this purpose. But where a site is conveniently placed and not needed for other purposes, the Minister of Health is always willing to consider proposals, for its use, either for a day hospital or for a unit run by the local health authority.

The noble Lord and the right reverend Prelate the Bishop of Coventry referred to variation in the quality of the arrangements made by local authorities for the training of severely subnormal children and suggested that the Government should consider laying down minimum provisions. I would say that the variation to which I have just referred applies over the whole field. The variation as between one local authority service and another, I think, is something that we have to try to get over as early as possible and to ensure that the worst is brought up to the level of the best. This is really what it amounts to. Where the provision of the service is below an adequate level, it must be the job 'of the Minister of Health to continue to prod, to stimulate and to ensure that we work up to an acceptable standard of service to be provided everywhere.

I must admit I am always a bit worried about this fact. We give to local authorities jobs; inevitably if we are going to have local authorities they must have responsibilities within their own areas. And yet one finds in so many of these services for which they are responsible this wide variety, which really is a disgrace to this civilisation of ours. I hope that my words will come to the notice of some of the backward authorities, whom of course I will not here name to-day.

Reverting to the training point I was speaking about, I can assure the noble Lord, Lord Grenfell, that even though no formal guidance has been issued—and indeed it might be inappropriate or even harmful to attempt to prescribe standards in a service which is developing so fast, with new methods and techniques professional officers of the Ministry visit local authority training centres and hospital schools to give guidance on these subjects. They also encourage the local health authority and hospital officers to use the resources which can be made available by local education departments.

The noble Lord, Lord Grenfell, also suggested that in order to keep young children out of hospital, consideration should be given to making payments to parents who are willing to keep their children at home. I can assure the noble Lord that we fully appreciate the problems faced by parents who have at home a child who is severely mentally handicapped, and indeed parents who have at home a child suffering from a severe physical handicap—mental or physical or both. A great burden is placed on the parents. Some Members of this House may have seen the film called Stress which was made recently by the Mental Health Film Council in collaboration with many voluntary societies concerned with the mentally or physically handicapped and which shows in a vivid and very illuminating way the strains which this imposes on the parents and on the whole family, in many cases fundamentally affecting their whole social life when they devote themselves to the care of a severely handicapped child. I can assure the House that this is not the film to which the noble Baroness, Lady Elliot of Harwood, referred, and if we ever get a chance in this House to see this film I am sure we all ought to see it. The love and individual care which is given by the parents of an afflicted child is of the greatest possible value in ensuring that such a child is able to develop to the maximum of his potential, whatever that potential may be—provided of course that use is also made of any available services for expert treatment or training.

As the noble Lord appreciates, there are no powers under the National Health Service Acts for the payment of financial subsidies. The National Health Service provides services of many kinds, through local authorities, hospitals and family doctors, but not financial subsidies. Cash benefits are paid to adults through the National Insurance and Assistance schemes, and in most cases the severely mentally handicapped become eligible for National Assistance from the age of 16 onwards—that is, he or she can apply in their own right or application can be made on their behalf. But cash payments are not made to parents in respect of their children unless the parent is receiving benefit, and benefits are not payable if the father is at work. Family allowances are payable in respect of subnormal children, of course, in the same way as for other children, but not at a special rate, and the noble Lord is clearly envisaging that the parents of subnormal children should receive financial assistance greater than that which parents normally receive through the Family Allowance Scheme.

Local health authorities are able to provide various forms of assistance to the parents of severely handicapped children at home. When such a child is very young, his care is not very different from that of any very young child, but his development will be slower and may be very much slower; indeed, in some cases he may need for many years or even permanently the sort of physical attention which is normally only needed by very young children. Local health authorities can offer relief to parents by the provision of home helps, laundry services and special aids where the child has a physical handicap, for example, if the child is also spastic. Local health authorities and local voluntary societies can also help such parents greatly by arrangements for sitters-in to take the burden off the family from time to time. There is great scope for the development of voluntary service, on an organised basis.

I particularly welcome the speech of the noble Baroness, Lady Hylton-Foster, which had particular application to this aspect of it, as did the speech of my noble friend Lord Segal. But whether it would be right to make cash payments to parents in the circumstances outlined by the noble Lord, Lord Grenfell, is a much more difficult question. It raises fundamental issues of the responsibility of parents for the costs of bringing up their own children. In some ways, the upbringing of severely handicapped children involves the parents in special costs. There are other expenses which the parents of normal children face but which will not occur with these children. And who can say what are the normal expenses of bringing up a child? All children have their own individual needs and interests, and the expenses which go with them fall to the parents to meet, except in so far as they are relieved by the provision of public services. In our view, it is to the development of these services that we should look for helping the parents of these children, rather than contemplating financial assistance. I hope the noble Lord will not find that disappointing. Clearly, he has given a great deal of thought to it; and so, of course, has the Minister of Health, and this is the conclusion to which he has come. I am sorry I have to give the noble Lord what would appear to him, I am sure, to be a disappointing reply.

I will now comment in more detail on some of the services for subnormal children and adolescents. First, services for children. These have been growing in quantity and changing in character in recent years. Attitudes to the needs of mentally handicapped children and how to meet them have altered radically. They should and will undoubtedly continue to do so. First there are the children who are classified as educationally subnormal, whose education is the responsibility of the local education authorities. The great majority of them are quite properly placed in ordinary schools, with special attention, or in special classes. Only the more seriously handicapped are admitted to special schools for the educationally subnormal. The number in special schools rose from just over 36,000 in January, 1962, to 42,500 in January, 1965, in England and Wales.

The training of children who are too severely handicapped to be suitable for education at school is the responsibility of the local health authorities or of the hospitals, according to the nature and character of their handicap. There are, of course, fewer children with this severe degree of handicap than the children I have already mentioned who are educationally subnormal. The greater the divergence from the normal standard of intelligence—either above average or, in the case of the children we are discussing, below the average—the smaller the numbers become. There are at present about 29,000 mentally handicapped children under the age of 16 who are receiving care from local health authorities of in hospital in England and Wales. Those include children of all ages from birth to age 16, whereas the figures I have quoted for educationally subnormal children refer only to those of school age who are regarded as in need of education in a special school. I should emphasise that the care of the severely handicapped children is the responsibility of local health authorities from the time when the subnormality is first apparent, which in some cases is from birth. This must be borne in mind when comparing the total number of children receiving care with those attending training centres.

The great majority of these children are living at home and are under the care of the local health authorities who are responsible for all the services they need, including training. These authorities are, of course, responsible for services for all young children from birth, and it is often through their normal child welfare services that the special needs of subnormal children first come to their attention. Here I should like to emphasise what may seem like a very obvious point, which is that subnormal children are children. They need the same sort of stimulus and sensory training as children obtain from play, exploration and affectionate care, and they and their parents also need special help because of their subnormality. Subnormal children develop more slowly than normal children, but, as with all children, it is important for their emotional, physical and social development that they should have close and satisfactory human relationships, including contacts with other children. This was the point to which the noble Lord, Lord Auckland, referred, and I think the suggestion he has made on this particular point deserves careful study by the Minister, and it will be brought to his attention. The right reverend Prelate, the Bishop of Coventry, was, I think, right also to emphasise this aspect of the child's growing up.

One aspect of the care of the mentally handicapped in which ideas are developing in the light of pioneer work in particular localities is the need for services for children of pre-school age. In some places nurseries are being run for handicapped children in this age group, and in other areas authorities accept some young, subnormal children into some of their day nurseries and nursery schools, together with normal children. Where this can be done, I think it ought to be done. Early and expert assessment is, of course, fundamental to the provision of proper services for these children. Assessment may involve the bringing together of many forms of expertise, particularly where physical as well as mental handicap is present or suspected. In some cases temporary admission to a hospital may be needed for a full assessment to be carried out, but in other cases this can be done while the child lives at home.

As I have already said, the importance of adequate facilities for assessment and co-operation between local authorities and hospitals for this purpose was one of the main points stressed in the Memorandum issued last year. But some of these children have disabilities of a nature or degree which require specialist treatment or constant nursing care in hospital. There are at present nearly 10,000 children in subnormality hospitals. Their teaching and training is normally carried out in units within the hospital which are called "schools" and which are generally supervised by staff holding the diploma of the Training Council for Teachers of the Mentally Handicapped.

The Memorandum from the Ministry of Health of which I spoke earlier stressed the need for suitable training for all the children, and reminded hospital authorities that the more intelligent children may require special educational provision from the local education authorities, with whom the hospital should be in close contact. The Memorandum also reminded the hospitals that children aged 5 or over with an I.Q. of more than 50 or 55 should be reviewed with a view to having them recognised by the local education authorities as suitable for education at the schools provided by them.

The noble Lord, Lord Grenfell, and the noble Lord, Lord Chorley, and others, referred to the salaries of those who are engaged in this particular work. The point is one of some substance, it is true. The fact of the present position is that the salaries of staff in local authority training centres are a matter for the National Joint Council for Local Authority Administrative, Professional and Technical Staff, and are not the responsibility of the Government. However, I understand—and I hope this brings a little hope to the noble Lord—that the salaries and grading structure for these staffs are at present under review by the Council.

This brings me to the training of children of school age who are regarded as too severely handicapped for education in schools for the educationally subnormal but who do not need to be in hospital. The number of children in the local health authorities' training centres in England and Wales rose from just over 8,500 in 1956 to over 18,500 in 1965. By 1976, local health authorities plan to have places for just under 28,000 children. This we must recognise as a very considerable advance.

The provision of more and better training centres for children has been the first priority in the local health authorities' mental health building programmes during the 1950s and early 1960s, though in the last few years the provision of training centres for adults has taken an increasing part of the increasing amount of capital investment available. Capital expenditure on training centres for children has risen from under£300,000 in 1956–57 to over £1,200,000 in 1965–66—a fourfold increase. This money has been spent not only in providing places for more than double the number of children but also in replacing old and unsatisfactory premises by new purpose-built premises. I would agree with those who have said that we have to get away from buildings which were, in so many cases, built in the last century and to use specially designed buildings with all the facilities, so as to bring the necessary cheerfulness—and this is important.

A welcome trend in recent years has been the provision of separate training centres for children and adults to replace joint accommodation. There is a long way yet to go before we shall be satisfied with the provision in every local authority area, but the progress made over the last eight or nine years is really very remarkable. I should add that the total planned capital expenditure on junior training centres for the ten years 1966–76 is over £9,500,000. I have mentioned the fact that this progress has been going on over the last eight or nine years, so that the present Government cannot claim the sole credit for it. The noble Lord, Lord Newton, had some part to play in this advance, and as this is not in any sense a Party debate I am glad to be able to pay tribute to those who preceded the present Minister and Parliamentary Secretary.

The training centres for children aim to encourage the emotional, intellectual, physical and social development of the children. Although their real ages range from 5 to 16, their mental level is comparable with that of normal children of 2 to 6 or 7 years of age, and their training must take this fully into account. In recent years the approach to this work has been from a viewpoint which can be described as educational in the broadest sense rather than occupational. What everybody must try to do, as the right reverend Prelate the Bishop of Wakefield said, is to enable them to develop as a person, to develop to the full the capacities which they have, and somehow to try to fit them into society as a person and not as a patient or as someone to be considered apart from the rest.

The educational methods used in nursery and primary schools are being adapted to the needs of the severely subnormal. Links between schools for the educationally subnormal and the junior training centres have also become very much stronger over the past few years. In some areas local authorities are experimenting with very close physical association between the training centre and an E.S.N. school on the same site, and in at least one case the training centre and the school are under the control of one headmaster. These experiments are being watched with great interest by the health and education Departments and by all concerned with the training of the severely subnormal.

Perhaps I might say here how much I welcome the suggestion which was made by Lord Grenfell about decorations for nurses and those who are engaged in this work. It is not for me to criticise all the decorations which have been given over the years, but some have been awarded to people who give to the community not one-tenth or one-hundredth of the service which nurses and others in our hospitals give to the community as a whole.



Perhaps I have gone a little outside my brief, but I think that in this matter it is permissible. What I can say is that I sincerely hope that the Prime Minister, who, I gather, is looking into this whole business of the Honours List, will give special attention to the point Lord Grenfell has made.

This brings me now to the health and education services for subnormal adolescents. Here the basic problem is to help the individual over a very difficult period of transition, where he has to cope not only with the strains of growing up but also, very often, with a change of environment. The noble Lord, Lord Amulree, made some reference to this. We encourage local health authorities to make careful arrangements for the move from a junior training centre into an adult training centre. We also encourage them to continue with the provision of education where this is appropriate for those who have moved into adult training centres.

In the last few years there has been an improvement in provision for the training of subnormal adults no less marked than in that for the training of children. The handicapped adults for whom these training centres are provided are those who are temporarily or permanently incapable of remunerative employment either in open or in sheltered employment. Most of them will as children have attended one of the local health authorities' training centres for children, but others will have attended ordinary or special schools but have not developed to the stage where they are capable of supporting themselves in remunerative employment. The object of training centres for adults, as for children, is to provide forms of training and occupation which will facilitate the best possible setting and stimulus for the mentally handicapped to develop to their full potential.

In recent years a much more positive approach has been adopted, with increasing knowledge of the extent to which even the severely subnormal can progress towards useful and meaningful work in adult life, if they are given the right form of training from an early age. I am sure that the noble Lord, Lord Amulree, will be delighted to hear that. Some of the trainees, after a period of training, may be able to move on from an adult training centre to sheltered or open employment, and here they are helped by the Youth Employment Service and the disablement resettlement officers of the Ministry of Labour. Perhaps I should mention here that help could also be derived from the development of youth work for adolescents, whether they are in or out of hospital, along the lines of normal youth activities but adapted to their special needs. This is a field in which voluntary effort would usefully contribute.

The noble Lord, Lord Amulree, also mentioned rehabilitation through industrial therapy of the young mentally ill. This form of rehabilitation may, of course, take various forms, but most psychiatric hospitals have an industrial therapy unit where patients, including those suffering from schizophrenia, are encouraged to undertake, and persist in, some form of occupation which is meaningful and useful, and is directed towards increasing their capacity for independent living. Those patients who are well enough can go out to work daily while continuing to receive treatment in hospital; others may be advised to attend one of the Ministry of Labour's industrial rehabilitation units before seeking ordinary employment.

In addition to providing social support for the mentally handicapped, and arrangements for training and employment, it is also the responsibility of the local health authorities to ensure that they have a suitable home in which to live. In the great majority of cases their own family home is the best place, but circumstances sometimes arise in which a handicapped child needs to be provided with a substitute home. In other cases where a child remains at home and continues to live at home in early adult life, the time usually comes when parents and relatives are no longer able to provide a home.

In some cases local health authorities provide residential accommodation in hostels of their own, but, particularly for adults, it may be possible to find suitable lodgings and in some cases groups of the less severely handicapped live together in a house provided by the local health authority without resident staff, looking after themselves with the advice and support of visiting social workers. It is only since 1959 that local health authorities have been asked to provide residential accommodation, and at the end of 1964 it was being provided for only 860 subnormal children and 1,800 subnormal adults.

The local authorities' 10-year plans covering the years 1966–76 expect expenditure of over £4,000,000 on hostels for subnormal children, providing over 2,500 places, and over £14,500,000 on hostels for subnormal adults, providing over 8,500 places by 1976. The need for accommodation for adults is likely to be far greater than for children, and even the six fold increase envisaged in the present 10-year plan is almost certainly far below what will eventually be needed. The Ministry of Health will be discussing this with those local authorities who are not at present planning to provide hostels for adults, to see how their plans may be improved.

The noble Lord, Lord Amulree, made some points about old people's homes and geriatric provisions in various areas. I will not, because of the length of my speech, attempt to give him the information which happens to be at my disposal at the moment. But I will certainly communicate with him and tell him the reply which I have.

The noble Lord, Lord Grenfell, suggested a National Lottery. As one who likes an occasional flutter I should not be against this on any ground that it would upset my Nonconformist conscience or anything of that sort. But I am bound to tell him that a National Lottery for hospitals, which might be attractive as a way to raise money, would not increase the resources available to the country as a whole, or assist the Government to make a rational and equitable distribution of the resources available for public expenditure. The noble Lord, who listened to yesterday's debate on building programmes, must realise that what really matters in these days is the allocation of resources, and not so much the provision of the money, so far as matters of this kind are concerned. This the Government must always keep in mind.

I am sure we would all agree with the points made about research. The noble Baroness, Lady Elliot of Harwood, and the noble Lords, Lord Auckland, Lord St. Just and Lord Segal, all stressed the need for this. There has been a considerable increase in the money and resources devoted to this, but I think we would all agree that there is not enough yet. I will ensure that these points are brought to the notice of my right honourable friend, who, I am sure, is sympathetic.

We shall have to look very carefully at what the noble Baroness, Lady Elliot of Harwood, said about autistic children. If I told her all that is in my brief I should be adding another quarter of an hour to my speech, and I am afraid that some noble Lords are beginning to look anxiously at the clock, thinking of the football matches which will start at half-past seven. So I will not worry the House with this.

I will conclude by saying that I have attempted to give the House a survey of the main features of the present services for mentally ill or subnormal children and adolescents. I have said little about the services for adults, but I hope that I have said enough to make it clear that, while we are encouraged by the progress which has been made in recent years, we are in no way complacent and recognise that we must continue to strive to improve all aspects of the services both in quantity and in quality. I can assure your Lordships that we regard this as one of the highest priorities among the many calls for development within the National Health Service.

6.48 p.m.


My Lords, I am deeply grateful to noble Lords, noble Ladies and right reverend Prelates for speaking in this debate, and also to those who have given a sympathetic ear to our deliberations. I should particularly like to say how grateful I am to the noble Baroness, Lady Hylton-Foster, for choosing this subject for her maiden speech—and a very able one it was. We thank her greatly. I would say to the noble Lord, Lord Macpherson of Drumochter, how much I feel for him in his dilemma, and perhaps we could have a talk together about it at some time. I should also like to thank the noble Lord, Lord Champion, for his deeply sympathetic speech.

I feel that we have moved a step further and that this debate has been a useful one. I am encouraged in that way. I hope that the noble Lord. Lord Champion, will put forward our case urgently to the Minister, with all that we have said to-day. Especially, although I realise that it is not a matter solely for this Government, perhaps he would apply a little pressure in the right place about teachers' salaries, because I feel that this matter is very urgent indeed. What we have put forward today will not cost millions, but it will bring untold relief to many families whom I know from personal experience to be hard-pressed. I am grateful to all your Lordships and I feel that this has been a useful debate. I beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.