Community Care: Mentally Ill (Hansard, 15 July 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, my right honourable friend the Secretary of State for Health is considering the case for new legal powers in this area and will be announcing her conclusions shortly.

§ Lord Harris of Greenwich
My Lords, I thank the noble Baroness for that Answer. Is she aware that apart from the three killings which have already taken place and a case of multiple rape, there has been a significant number of cases of violence to which members of the public have been subjected by mentally disordered offenders? Is it not clear that care in the community in those cases is simply not taking 342 place? Will the noble Baroness say what specific action the Government will take to protect the interests of the public?

§ Baroness Cumberlege
My Lords, I believe that, in general, community care is working well, but I accept that it is failing a small minority of people. I have already outlined to the noble Lord the action which the Government are taking. My right honourable friend the Secretary of State is considering whether increased legal powers are necessary. She will announce her conclusions in the autumn.

Lord Campbell of Croy
My Lords, does my noble friend agree that each mentally ill individual should be sep, rately assessed, and that only a small minority of schizophrenics are violent, but that they must be identified and special arrangements made for them?

§ Baroness Cumberlege
My Lords, I agree absolutely with my noble friend. That is why we introduced individual care plans for every person who is discharged from hospital into the community. The challenge is to ensure that there is adequate supervision as regards their whereabouts and their medication.

§ Baroness Masham of IIton
My Lords, is the Minister aware that recently a unit for mentally ill people has been opened in Brixton prison? What communication and co-operation does her department have with the Home Office when mentally ill people are discharged from prison into the community?

§ Baroness Cumberlege
My Lords, a great deal is being done in conjunction with the Home Office. A number of reports have been produced by Dr. John Reed who chaired a committee composed of both Department of Health and Home Office officials. That committee has produced 10 reports and a further report is to be published shortly on services for people with psychopathic disorders. Clearly, the department will wish to look at that carefully to see how we can best implement the recommendations.

§ The Earl of Longford
My Lords, will the noble Baroness, who is so much admired by all involved in these topics, reconsider the idea that community care is working well? She must be the only person in the world who thinks that it is. Will she bear in mind the possibility that community care is a tremendous ambiguity? On the one hand, it involves the conception of all kinds of active provision by local authorities and voluntary bodies and, on the other, it leaves it to the man in the street who, of course, does nothing.

§ Baroness Cumberlege
My Lords, I do not believe that my views are unique. In fact, a survey carried out this week showed that more than three people out of four favour the policy of caring for people with mental illness in the community. I am sure that my views that community care is working well are supported by the vast majority of people in this country. I accept that a 343 small minority of people who need special attention fall through the net.

§ Lord Merlyn-Rees
My Lords, I am sure that many meetings are taking place and many surveys are being carried out. But what happens in practice, for example, if a person as referred to in the Question moves to a certain area in Leeds and then goes to the social services? What happens in practice rather than in theory?

§ Baroness Cumberlege
My Lords, the care programme that we have introduced has to be agreed by the patient. It is a multi-disciplinary exercise so that all individuals who are professionally involved with that patient are involved as are the relatives and carers of that individual. If a person who has been discharged from hospital, hostel or some other accommodation then moves to another area, it is up to the key worker designated to look after that patient to ensure that adequate supervision is maintained. It is that area that we are addressing.

§ Baroness Faithfull
My Lords, does my noble friend agree that some of the problems, although not all, are due to the fact that mental patients discharged from hospital do not take their medication? That being the case, does the Minister agree that a community treatment order should be made so that a district nurse, health visitor or someone with medical knowledge is named who can help such a person and supervise him on a daily basis? Would not a community treatment order meet that need?

§ Baroness Cumberlege
My Lords, that has been the subject of wide discussion now for several years. Indeed, the Royal College of Psychiatrists produced a report recently suggesting something of that nature. But we must be very careful that under the European Convention on Human Rights we do not violate people's freedoms. It is clear to us that people cannot be made to take medication in the community and cannot be returned to hospital just because they refuse that medication. Many difficult issues are involved in this matter. That is why a departmental team has been set up to consider whether the present legislation is being adequately used, and whether further legislation is needed. That group will report to my right honourable friend in the autumn.

§ Lord Murray of Epping Forest
My Lords, does the Minister agree that the reason why the special unit has been opened in Brixton prison, and the reason why there has been a great increase in the numbers of such people incarcerated in our prisons, is the far too rapid rate of closure of psychiatric beds in hospitals? Those beds are being closed at the rate of more than 4,000 per year. Further, does the noble Baroness agree that the solution is to slow down considerably the rate of those closures?

§ Baroness Cumberlege
My Lords, it is a very tiny minority of people who suffer from mental illness. When we look at those who have offended, who have murdered or committed some other crime, they are not those who have been released from long-stay beds. They are people who suffer from acute psychotic 344 disorders. A distinction must be drawn between those people and others who have been incarcerated in mental institutions for many decades. Some have been incarcerated merely because they were socially unacceptable. In some cases, young girls who became pregnant were unacceptable to the community and have spent decades in mental institutions as a result. That is unacceptable. We must address those problems. We must also address the problems of those who are causing harm to society.

§ Lord Rea
My Lords, is the Minister aware that the cases mentioned in the Question of the noble Lord, Lord Harris, represent only the tip of the iceberg and that there are many thousands of other seriously mentally ill patients in the community not receiving adequate care? Can she grasp the nettle that it is not so much long-stay patients discharged into the community either from prison or from mental hospitals that cause the problems but the new generation of severely mentally ill people who have been discharged after a short time, often to be repeatedly readmitted in what is called the "revolving door" syndrome?
Does not the Minister realise that good community care, whether or not we introduce some form of community care order, is not cheap and that it may in fact cost more money than that spent on hospital care—at least initially—to develop the service?

§ Baroness Cumberlege
My Lords, we believe that there are about 750,000 people living very successfully in the community who have had a mental illness. Indeed, only 0.7 per cent. of the population will suffer from schizophrenia at some time in their lives. Those people need care, supervision and help. However. it is a tiny minority causing great distress and trouble within the community. We must keep the matter in proportion.

§ Lord Harris of Greenwich
My Lords, is the Minister aware that most of us know that we are talking about a small minority of potentially violent people? Is she also aware that in the cases that I have cited—and in many other cases to which social agencies, including the police, have drawn to the attention of Ministers—there is a deep sense of public concern that such people are not receiving the degree of care in the community that they require?

§ Baroness Cumberlege
My Lords, that is why we are reviewing our present policies to look at the cases of a very small minority of people who clearly are a great distress to society.