Mental Health: After-Care (Hansard, 2 March 1988)

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skellmersdale)
My Lords, Section 117 of the Mental Health Act 1983 places a duty on both health authorities and local authorities to consider and arrange provision of the after-care needs of discharged patients formerly detained under certain sections of that Act. We believe that there are many good examples of after-care planning in different parts of the country, but elsewhere we understand that this is not the case. We will not be satisfied until there is an appropriate level of after-care for each patient covered by the section.

§ Lord Mottistone
My Lords, if that is the case, would it not be appropriate for the Government to encourage the regional and district health authorities to slow down the closing of hospital beds for the mentally ill until the Government are sure that aftercare facilities are available for the patients?

§ Lord Skelmersdale
My Lords, Section 117 does not cover all ex-patients from mental illness hospitals but, as I have just explained, only the detained ones. In March 1987 the Home Office and the Department of Health and Social Security jointly published revised guidelines for hospitals, consultant psychiatrists, social workers and probation officers on the supervision and after-care of mentally disordered offenders subject to a restriction under the Mental Health Act. The revised guidance was welcomed by the Mental Health Act Commission.

§ Lord Broxbourne
My Lords, does my noble friend accept that, when community care as an alternative to prolonged hospitalisation was introduced in the parent Mental Health Act 1959, it was fully accepted that there needed to be a firm logistical infrastructure for this concept? My noble friend is too enviably youthful to recall these matters at first hand, but will he accept the importance of the points so persuasively brought to the attention of your Lordships by my noble friend Lord Mottistone and reiterate the Government's intention to give this logistical support to after-care?

§ Lord Skelmersdale
Yes, my Lords, most certainly. I would acid that over the past eight months or so I have been in a position to study the 1959 Act and the proposals and circumstances flowing from it. I reiterate that care in the community as such, which is being studied by Sir Roy Griffiths at the moment, is rather broader than this Question actually implies.

§ Baroness Seear
My Lords, does the noble Lord accept that care in the community for whatever group we are talking about requires that there should be good local hospitals which can act as day centres, provide respite care and provide short-term nursing care? Why is it that there is so marked a tendency either to shut or to reduce in size local hospitals which have formed part of their community for a long time, which are well supported locally and which are very much loved?

§ Lord Skelmersdale
My Lords, the answer is, yes, to the first part of the noble Baroness's 178 supplementary question. As regards the second part, district health authorities all over the country are building the facilities that she and I would require them to do.

§ Lord Auckland
My Lords, can the Minister say what provision is being made in areas where there is a concentration of local mental hospitals? I instance Epsom near where I live and I declare my interest as the president of the friends of one such hospital. Is my noble friend aware that enormous attempts are being made to integrate some of their patients but that there are funding difficulties? Can he say whether any special provision is being made for these areas?

§ Lord Skelmersdale
Yes, my Lords, in some parts of the country, joint finance is being arranged between local authorities, social services departments and health authorities. In other parts of the country, health authorities give an annual dowry. However, it is most important that nobody should be discharged from hospital without a proper plan for his after-care.

§ Baroness Turner of Camden
My Lords, the noble Lord referred to the community care review of Sir Roy Griffiths. Would he be kind enough to let the House know when the report is expected? It was announced in 1986 and it was expected at the end of 1987. When will it be published? In view of the general concern about the level of community care, will its finding be made public in order that there can be public scrutiny of it?

§ Lord Skelmersdale
My Lords, I have very little to add to the very extensive Question Time debate which we had on this subject the other day except to say that my right honourable friend has registered the strong concern of your Lordships that it should be published, and published soon, and is giving the matter his urgent consideration.

§ Lord Mottistone
My Lords, my noble friend said earlier that Section 117 applied to detained patients. Does he not agree that it applies to people detained under Section 3, which concerns commission for treatment? It is a general requirement and is not just for people who are locked up.

§ Lord Skelmersdale
No, my Lords, but Section 117 refers to Sections 3, 37, 47 and 48 of the Act. Those sections cover what I might call various grades of compulsorily detained patients.