HL Deb 06 December 1990 vol 524 cc269-71

3.15 p.m.

Lord Mottistone asked Her Majesty's Government:

When the substantive statement of good practice on the discharge and after care of psychiatric patients, being developed by the Royal College of Psychiatrists in concert with the other professions involved, is expected to be completed.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, the Royal College of Psychiatrists is currently revising draft guidelines which I understand will be considered by its council in January 1991.

Lord Mottistone

My Lords, I thank my noble friend for that Answer. Do I understand that there is a possibility that the statement will be published shortly or is there difficulty in reaching a conclusion?

Baroness Hooper

My Lords, I am not aware of any difficulties encountered in reaching a conclusion. There has been a remark that, in seeking a consensus of other professions, there have been some difficulties. However, I remind my noble friend that in the course of this year the department has published a code of practice on the Mental Health Act 1983 and the care programme circular which, to some extent, overlapped the requirement for guidelines prepared by the royal college.

Lord Ennals

My Lords, as the Minister knows, from these Benches we warmly welcome the guidelines. Whether or not the royal college has produced its declaration or has difficulties, will the noble Baroness accept that there is now a major crisis in the provision of community care for those discharged from psychiatric hospitals? Will she bring that crisis, which requires emphasis, action and resources at a nationally high level, to the attention of the new Minister and the new Prime Minister?

Baroness Hooper

My Lords, I remind the noble Lord, Lord Ennals, that, under arrangements proposed by the Government, by April 1991 all district health authorities will be required to initiate, in collaboration with local social services departments, explicit individually tailored care programmes for all people being discharged into the community in that way. That care programme approach, reinforced by the new specific mental illness revenue grant and increased authorisation for capital expenditure on mental illness projects, is designed to secure real improvements in community services to the mentally ill.

Baroness Faithfull

My Lords, does consultation take place between the Departments of the Environment and Health? It is quite impossible to cope with those patients in the community without the provision of some form of housing for them.

Baroness Hooper

My Lords, I can reassure my noble friend that there is such contact and co-ordination between the two government departments to which she referred.

Lord Winstanley

My Lords, while welcoming what the noble Baroness said about what will happen in April, can she tell us more about what is happening now? Does she not agree that it is inhumane to keep psychiatric patients in hospitals or institutions any longer than is strictly necessary and that it is even more inhumane to discharge them into the community before care is in place for them? Further, does she not agree that the whole concept of community care, which is very valuable and important, could be brought into disrepute if what is now happening continues to happen, even after April?

Baroness Hooper

My Lords, I agree that it is vitally important that the appropriate services should be available before patients are discharged to the community. The whole thrust of the Government's policies is in that direction.

Baroness Macleod of Borve

My Lords, can the Minister confirm that, through voluntary organisations and hospitals, a great number of ex-patients are being housed within the community and local boroughs through housing associations? That is proving to be of great benefit because the patients then live in their own homes and have their own latchkeys. A great deal has already been achieved.

Baroness Hooper

My Lords, I am grateful to my noble friend for giving me the opportunity to acknowledge the very important contribution being made by the voluntary sector. I also remind your Lordships that my honourable friend in another place announced in July a specific programme, likely to cost more than £5 million in the first two years, to help among other things to fund centrally the development of short-term hostel places and to provide people with the kind of short-term accommodation and services they need in order to progress to ordinary or supported housing.

Lord Ennals

My Lords, would the noble Baroness also accept that while paying proper tribute to voluntary organisations, local authorities are facing serious financial problems? The sum referred to is very small if it is to meet the desperate needs of local authorities and the voluntary organisations.

Baroness Hooper

My Lords, we are wandering rather far from the Question on the Order Paper. In so far as good practice is important in this area, I agree that vie should take the maximum care to ensure that housing and accommodation is available for patients when they are discharged.

Lord Gainford

My Lords, in addition to the care and concern provided for discharged psychiatric patients, and in order to help them feel more like members of the community, could they not be given a really smart set of clothes? Perhaps the women could also be given a smashing new hairdo.

Baroness Hooper

My Lords, I feel sure that those who need to take note of that suggestion will do so.

Lord Stallard

My Lords, will the noble Baroness accept that we welcome all the measures mentioned? However, the good practice should include some follow-up to help prevent the large number of ex-psychiatric patients we find ending up in cardboard boxes on the Embankment. Where was the good practice when those people left the psychiatric hospitals? Should they not have been followed up?

Baroness Hooper

My Lords, it is important to look to the future and ensure that some of the mistakes that we recognise occurred in the past do not continue. I believe the care programme approach to which I referred is an important step forward.