The Homeless Mentally Ill: Care (Hansard, 19 February 1990)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, we are aware of and concerned about this problem. We are currently in discussion with health and social services authorities and voluntary bodies in central London, with a view to identifying practical steps to help people get the support they need. We hope that any approach developed for central London will prove a useful model for other parts of the country.

§ Baroness Fisher of Rednal
My Lords, I thank the noble Baroness for that Answer. Is she aware that it is not only a London problem? I can speak with great experience of Birmingham. Do the Government realise that the run-down of mental hospitals is causing a terrific financial and managerial burden on hostels that originally were meant to cater for homeless alcoholics, but the same hostels are almost becoming mini-institutions catering for the former patients of psychiatric hospitals? Do not the Government feel that their policy of closing down mental hospitals without adequate community services is a wrong one?

§ Baroness Hooper
My Lords, we are aware that this is a problem that goes wider than that applicable to central London. As I said in my original Answer, 2 the intention is to study the central London problem not simply to solve that, but in order to replicate the findings throughout the country. The closure of mental hospitals has never been a primary object of government policy. In the White Paper Caring for People, published last November, the Government emphasised that the number of mental illness beds should be reduced only as a consequence of the development of new services. We have made it clear that Ministers will not approve the closure of any mental hospital unless it can be demonstrated that adequate possible alternatives have been developed.

§ Lord Renton
My Lords, is my noble friend aware that regarding the mentally handicapped, the need for them to be settled in the community is being largely solved by help from the various voluntary societies including MENCAP? Can my noble friend say whether the voluntary societies are able to help in the case of psychiatric patients?

§ Baroness Hooper
My Lords, I am grateful to my noble friend for raising this aspect of the matter. We very much recognise the work of the voluntary organisations in this field. As regards the homeless mentally ill initiative affecting psychiatric patients, the Government have had a number of discussions with voluntary organisations and others with direct experience of helping the homeless in London. These organisations include St. Mungo Housing, Bondway Housing Association, Thames Reach and the psychiatric team for single homeless people at Guy's Hospital.

§ Lord Ennals
My Lords, if the Minister has referred to a new initiative, then it is a bit late. Will the Minister confirm that it is the intention of the Government to impose some limits on local authority expenditure because of the inequities of the poll tax? I believe that over 100 local authorities are involved. Can the Minister give the House an assurance that such cuts in public expenditure for electoral reasons will exclude the provision for community care, especially housing, in order to meet the appalling problem described by my noble friend?

§ Baroness Hooper
My Lords, concerning funding, the Government certainly do not regard community care as a cheap and easy option. Nevertheless, we take the view that much can be done within existing resources given local commitment and collaboration which we believe to be there. However, gross spending on hospital and community health services for mental illness grew by 20 per cent. in real terms between 1978–79 and 1986–87 to £1,149 million. That is the most recent figure available. Estimated gross expenditure on local authority services for mentally ill people rose in the same period by 46 per cent. in real terms to £44 million. I feel sure that the noble Lord will agree that money is not the only consideration.

§ Lord Ennals
My Lords, I ask the Minister to apply her mind to the question that I put to her. I am impressed by the list of statistics. The question is: is it true that the Government are proposing centrally to impose a clampdown on local authority expenditure concerning about 100 local authorities? Can she give an assurance that the cuts that will be required of those local authorities will not include housing provision for homeless people?

§ Baroness Hooper
My Lords, the Government are by no means intending to impose a clampdown on local authorities. They are intending that local authorities should react responsibly to their local responsibilities.

§ Lord Mottistone
My Lords, following on from the query raised by my noble friend Lord Renton concerning what is being done for those who seek help from the voluntary organisations for the mentally ill as opposed to the mentally handicapped, is my noble friend aware that the National Schizophrenia Fellowship in Bournemouth has sought approval to convert a house to act as a hostel for schizophrenic patients in that area? Is she further aware that notwithstanding many efforts, two successive houses were chosen, but in each case the planning committee of the local district council turned down the request on the ground that "it is a jolly good idea, but not in our area, please"? Does my noble friend not agree that that situation is disgraceful, and can she say whether the Government can bring some pressure to bear to get the Bournemouth District Council to act as good Christians?

§ Baroness Hooper
My Lords, there has been concern in recent years about how to make effective arrangements for the continuing care of mentally ill people being treated in the community. In this context we believe that the voluntary organisations have a very important role to play. The department has already issued National Health Service planning guidelines. Shortly detailed guidelines will be issued to ensure that by 1st April 1991 all district health authorities are required to initiate in collaboration with local social service departments explicit individually tailored care programmes for all such people.

The Lord Bishop of Manchester
My Lords, is the noble Baroness aware of the growing concern in the Churches about the strain on the clergy—mainly Church of England and Catholic clergy—who live in these areas, particularly the inner cities, and who have these folk on their doorsteps very regularly? Can she assure us that in any consultations about the right way forward the views of such clergy will be taken into account?

§ Baroness Hooper
My Lords, as I said at the outset, we are aware of the general concern. All interested parties who can make a contribution will be consulted. I should like to re-emphasise that the care programme approach, reinforced by the new specific mental illness grant to local authorities payable from 1st April 1991, should have a significant impact on the provision of adequate locally based services.

§ Baroness Seear
My Lords, does the noble Baroness agree that the care of the mentally ill coming out of institutions is a problem on its own and is quite different from the care of people who are frail, infirm or physically ill in a minor way? Such people require highly skilled attention. Voluntary help is often totally inadequate and cannot be relied upon for dealing with these especially difficult cases.

§ Baroness Hooper
My Lords, the research and evaluation funded by the Department of Health has shown that, most commonly, homeless mentally ill people—the group to which the question is directed—have had care organised outside hospital but have subsequently lost touch with services. In the future, we are working to direct our efforts to ensure that the numbers losing touch in this way will fall as a result of the care programme approach.

§ Lord Mellish
My Lords, is the noble Baroness aware that in the heart of London a hospital has been empty for more than 10 years? I do not blame the present Government for that, but it has been empty all that time. It used to provide 250 beds. It is called St. Olave's. Would it not be a good idea to use it to help the people to whom the Question refers?

§ Baroness Hooper
My Lords, I am grateful to the noble Lord for drawing that point to my attention. I shall look into the matter.

§ Baroness Ewart-Biggs
My Lords, is the Minister aware that one of the resident psychiatrists at Holloway Prison has told me that he and his colleagues have recognised more and more that they are treating in prison now the same women they used to treat in psychiatric institutions? Does she not agree that that is strange care in the community for the mentally ill?

§ Baroness Hooper
My Lords, it is difficult to obtain reliable figures on the position across the country in regard to how people are being dealt with. As I said previously, in many cases homeless mentally ill people have had care organised outside hospital but have lost touch subsequently with the services. This 5 is a consequence of the new approach; it has developed as a result of the new approach. It is something at which we are looking and which we hope to be able to avoid in the future.

§ Lord Nugent of Guildford
My Lords, I wonder whether we ought not to move on to the next Question. We have had 11 minutes on this one.

§ The Lord Privy Seal (Lord Belstead)
My Lords, we have taken 11 minutes. It is perhaps the moment for the next Question.