§ 8.3 p.m.
LORD SANDFORD rose to ask Her Majesty's Government on what terms and particularly on what financial terms they intend to co-operate with voluntary bodies over hostels for the rehabilitation of drug addicts. The noble Lord said: My Lords, the object of my Question is to elicit further details from Her Majesty's Government about their policy on the rehabilitation of drug addicts. May I start by reminding the House of the view of the Brain Committee, which reported on the subject in July, 1965. On page 9, paragraph 25, of their Report they say:
The withdrawal of a drug is only the first step in the treatment of an addict. Those who are discharged after satisfactory withdrawal of the drug of addiction may soon relapse on returning to their old haunts.
They go on:
The situation would, in our view, be greatly improved if there were proper facilities for long-term rehabilitation, both psychological and physical, in the treatment centres and elsewhere.
They point out that in dealing with this subject they are outside their terms of reference, and they leave it at that.
Nearly twelve months later, we had a useful debate in your Lordships' House on a Question asked by the noble Viscount, Lord Amory, by which time public anxiety about this problem—not so much about the size of the problem as about the rate at which it was growing—had considerably increased. The noble Lord, Lord Stonham, who replied, in dealing with this aspect of the problem said that after the withdrawal stage, which was usually successful:
…the addict needs to be in hospital. The second stage aims at removing psychological dependence on the drug, and this usually requires the patient to be under psychiatric supervision in hospital or in a local authority hostel. These hospitals are being provided,
and there is no reason to confine them to those addicted to narcotic drugs. The centres will deal with anyone in such need."—[OFFICIAL REPORT, 30/6/66, col. 833.]
He ended with the further statement:
These are not simple matters. Her Majesty's Government are conscious of the need to reach early and sound conclusions, and hope to do so shortly.
In fact, my Lords, another seven months elapsed, and then there was a debate in another place. This time the Minister of Health, giving the further development of the Government's policy in this matter, said:
I should like to say a little more about the problem of the rehabilitation of addicts. The Brain Committee said, and this is generally recognised, that withdrawal is only the first stage of treatment. The problem is to prevent subsequent relapse, and that can he prevented to some extent by improving facilities of long-term rehabilitation."—[OFFICIAL REPORT, Commons, 30/1/67, col. 140.]
We must have these facilities for long-term rehabilitation in order to complete and round off the cure of drug addicts. I do not know what facilities for this rehabilitation have been provided by the hospitals or local health authorities. Perhaps the noble Lord who is going to reply can tell us something. Treatment centres are in process of being set up. We know that. And we know that the Minister said at the end of January, in the same speech from which I have just quoted (col. 140):
I am anxious to build on existing services and try new methods. One possibility is the accommodation of addicts in hostels, where they can receive psychiatric supervision and support while in regular employment. In arrangements of that kind I feel sure that there is scope for voluntary bodies, and I certainly welcome their co-operation.
§ What have the voluntary bodies done? I have some details, not I hope an exhaustive list, but a few examples. We have, I suppose, among the longest-established hostels the one at Spelthorne St. Mary's run for the past 88 years by the Wanted Sisters to deal with alcoholics and drug addicts. Perhaps most of their patients are those who pay privately for treatment, but they take in as many others as charitable subscriptions and donations will allow. They have developed over these long years good cooperation with local doctors and hospitals and with the local health authority. It would be interesting to know what is the further pattern of co-operation the Minis 518 ter has in mind for an establishment of this sort.
§ Then there is the centre at Chelsea, run, I believe, by doctors in private practice, and linked with a hostel run by the Salvation Army at which occupational therapy is given to the patients who are being treated for their medical condition. It would be interesting to know what pattern of co-operation is envisaged in a case like this. The third example is the centre near Bristol, run by a group of which the local rector is chairman, yet to be established, but trying to cope with the demand in that area and linked in some way with the local council for social service. What is the pattern the Minister would have in mind in a case like that?
§ Fourthly, there is a centre consisting of two houses in Watford, operated by a group of doctors and nurses—the Crossroads Trust. What is to be the pattern of co-operation here? Fifthly, there is the Hill Farm enterprise outside Birmingham, another centre not yet fully set up, but running in conjunction with All Saints' Hospital, so far relying entirely on subscriptions from the churches. What is the pattern of co-operation here? Lastly, there is Narcotics Anonymous, led by a group based on Dulwich, chaired by a clergyman, and using a house at Ripton in the country, entirely dependent on private subscription. These are not the only cases in the field; this is just an example of what the voluntary bodies are so far doing.
§ I mention these because all the other medical and psychiatric treatment of addicts in hospitals and clinics which was spelt out in some detail in the debate in another place at the end of January will be wasted if matching provision is not made at the same time for the rehabilitation of addicts in homes or hostels. As the Minister of Health has said, this is an ideal field for the voluntary bodies. As I have shown, they are already in action, or about to go into action in this field. It is good to know that the Minister welcomes their co-operation, but these bodies in turn would welcome his co-operation, and they want to hear now, and if not now, later, in what terms he is going to express it.
§ 8.11 p.m.
§ LORD BESWICK
My Lords, I congratulate the noble Lord, Lord Sandford, on raising an important matter 519 in such an interesting way. I am only sorry that the lateness of the hour has precluded other speakers who would have liked to join in this little debate from taking part. I am sorry, too, that I am not in a position to give him much additional information to that which he has placed before us. By "rehabilitation", in this context, as he has said, we mean the second stage in the treatment of addiction.
The first stage, which is of short duration, involves the withdrawal of the drug of addiction, and that usually takes place in hospital. When it is completed, the patient is free from physical dependence on the drug, but only rarely is he free from psychological dependence. Most patients, therefore, as the noble Lord rightly says, need to enter a second and longer stage of treatment, which may be called rehabilitation. In this they receive psychiatric supervision, social support and are actively employed. The object is to enable them to overcome their psychological dependence on drugs, and to lead a normal life. At the present time, most of the mental illness hospitals which offer the first stage of treatment also offer the second stage. The treatment may be on an in-patient basis or on an out-patient basis. For in-patients, occupational or industrial therapy is usually provided in the hospital, or arrangements may be made for patients to go out to work in the community during the day and to return to the hospital at night.
For those patients who have left hospital, after-care services, including hostels of local health authorities, are available as to other patients who have completed treatment in psychiatric hospitals. There are, as the noble Lord said, various voluntary bodies who are running hostels, and some accept persons who have received treatment for addiction. The noble Lord made special mention of the Spelthorne St. Mary's hospital, and I should like to say how highly their devoted work is regarded. Hospitals in the Health Service, of course, usually offer continued supervision and support by means of regular out-patient clinics.
Given that there are all these services, it is perhaps not obvious why the noble Lord has stressed the need to improve arrangements for rehabilitation. But, of 520 course, he is quite right to do so. The explanation is that drug addicts make insufficient use of available services or—to put it another way—the services are not generally acceptable to addicts. In order to consider what is possible or desirable in the rehabilitation of drug addicts it is necessary to reflect on some sad, but relevant, facts.
The first is that, in general, addicts are not willing to undertake treatment which involves withdrawal of the drug of addiction. There are no reliable figures of the total incidence of addiction, and I cannot say what proportion of addicts undertake withdrawal treatment; but it is generally believed to be very small. Secondly, a substantial proportion of the addicts who enter hospital with the expressed intention of accepting treatment leave almost immediately and before undertaking treatment. It is thought that they enter hospital because of some personal crisis, and not because they have a genuine intention to accept treatment. Thirdly, there are patients who enter and remain for withdrawal treatment, which is, as the noble Lord said, usually completed successfully. They require the second stage of rehabilitation, but all too often they leave hospital against the advice of their doctor and then, having returned to their old environment, relapse into addiction. Finally, there are those who successfully complete the second stage of rehabilitation.
My Lords, I fear that this is a sombre picture, and it is no satisfaction to any of us to say that it is even darker in other countries. One study in the United States which followed up patients who had been discharged from hospital after treatment for addiction showed that more than 90 per cent. were re-addicted within six months.
This is the background of our discussion which the noble Lord has started. The problem is well-known to the psychiatrists who treat addicts, and it was, as the noble Lord said, recognised by the interdepartmental Committee on Drug Addiction under the chairmanship of the late Lord Brain. But it is one thing to recognise a problem, and another to find a solution. The fact is that there is no ready-made system of rehabilitation which guarantees success. We should all 521 like to see an effective form of rehabilitation, which is really to say that we should all like to see a reliable cure for addiction. But that is not to say that it can necessarily be provided by Government action. However, the Government accept the need to improve rehabilitation measures.
They have set up the Advisory Committee on Drug Dependence. Its duly is to keep under review the misuse of narcotic and other drugs which are likely to produce dependence, and to advise on remedial measures that might be taken, or on any other related matters which the Ministers may refer to it. Legislation is being prepared to limit the authority of doctors to prescribe or supply restricted drugs to addicts, initially heroin and cocaine, and to require all doctors to notify to a central authority patients who are addicted to dangerous drugs. Hospital authorities have been informed of the treatment facilities that are required for addicts unable or unwilling to accept withdrawal treatment, and they have been asked to provide it urgently. The Government intend to introduce the necessary legislation—by way of an Amendment to the Dangerous Drugs Act—during the Session. In a memorandum that the Minister of Health sent last week to hospital authorities about the organisation of hospital facilities for the treatment of heroin addiction, he said that the question of after-care and its co-ordination with the hospital service was receiving further attention, and that guidance on the organisation of the rehabilitation of addicts would be forwarded separately.
Having outlined the existing arrangements for the rehabilitation of drug addicts and some of the problems, I should like now to outline some of the considerations that appear to the Government to be of the greatest importance in the development of future arrangements. The main difficulty in continuing treatment in hospital after withdrawal lies in retaining the interest and co-operation of the patient, and some modification of the usual occupational and recreational activities and arrangements for after-care may be necessary, especially in order to meet the needs of those addicts who are young, active and intelligent.
522 A conference of psychiatrists with experience in the treatment of addiction has considered this problem of rehabilitation. It seems to be necessary to provide psychiatric supervision, social support and employment, all in a form acceptable to the addict. It is possible that the services will be acceptable if they are provided in a hostel. These requirements suggest that there are important parts to be played by both the statutory services, including the hospital and local health authority services, and the voluntary bodies. It seems likely that the best results will come from co-operation between these services by joint ventures, and that the range of experiments in the rehabilitation of addicts should include the use of hostels, which may be run either by voluntary or by statutory bodies. I am afraid I am not in a position, and it would not be right for me here, to discuss the particular examples to which the noble Lord referred in his speech.
These are some interim observations pending the completion of the Government's consideration of the problem. I am sure the noble Lord will understand that I cannot today precisely define the role of voluntary bodies in rehabilitation generally, or in relation to hostels, or in the financial terms for which he asked. I assure him, however, that the Government recognise the need to improve arrangements for the rehabilitation of drug addicts, and will press forward their consideration of this matter with a view to reaching early conclusions and to issuing guidance about the desired form of co-operation between the statutory and the voluntary services. Our intention is to improve existing services and to experiment with new measures in order to reduce the rate and the risk of relapse which is such a tragic feature of treatment at the present time. In devising these measures, although I realise that I have employed terms which the noble Lord himself said had been used on previous occasions by other Ministers, I assure him that what he has said this evening will be taken fully into account.
§ House adjourned at twenty-three minutes past eight o'clock.