Mental Health: Security of Patients (Hansard, 22 June 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the level of security should be consistent with the danger patients may present to themselves or other people. This is generally a matter for the clinical judgment of the responsible doctor in co-operation with the clinical team. A patient who is subject to a restriction order or direction under Section 41 or 49 of the Act may only be discharged, given leave of absence or transferred to another hospital with the consent of the Home Secretary.

§ Lord Mottistone
My Lords, does my noble friend agree that there are fewer secure and lockable wards in mental hospitals these days? The Reed Report recommends that there should be over 1,000 such wards: there are only just over 600. Does my noble friend agree also that the late Lord Butler's committee suggested that there should be 2,000 places available in regional secure units and the Glancy Report recom-mended that there should be 1,000? Altogether, there are not nearly enough secure facilities available. Does my noble friend agree that that results in the release of people when they should not be so released?

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right to quote the Glancy Report and the Butler Report. The discrepancies between the two figures arise because the Butler Report took into account the numbers of people needing to be moved from the courts and prisons. That accounts for the difference between the figures of 1,000 and 2,000 beds. Successive governments have accepted the recommendations in the Glancy Report. It is fair to say that although we accepted those recommendations as long ago as 1974, five years later not one of those beds had opened despite the funding being available for them. Now the figure stands at 635 beds and we have a dynamic building programme which will ensure that 1,200 places are provided by 1996.

§ Lord Merlyn-Rees
My Lords, what procedures are followed on the release of people who were detained under the Mental Health Act? Are they on their own once they reach the gate of the hospital? If they come originally from another city, are they given a warrant or guided to the social services department which can offer them help? Problems arise because some people are completely lost after years of detention. I support fully 264 the fact that people should be released or given leave of absence. But the procedures do not meet the needs of individuals who were detained.

§ Baroness Cumberlege
My Lords, there has been a great deal of anxiety about: patients discharged from mental institutions. Because of that, my right honourable friend the Secretary of State wishes to introduce supervision registers so that those who are discharged from hospital will have allocated to them a responsible professional person who will maintain contact with them in the community. In May this year we issued discharge guidance to ensure that the people who are discharged from hospital are well enough, have somewhere to go to and are well looked after. Therefore, there has been a problem, but I believe that the action that is now being taken—although there will be need for some legislation—will correct some of the difficulties being experienced.

§ Lord Renton
My Lords, has my noble friend any figures to enable us to tell what proportion of those really difficult patients are mentally handicapped and, therefore, incurable, and to what extent they suffer from mental illness, which is very often curable?

§ Baroness Cumberlege
My Lords, I believe that we have overcome many of the long-term problems associated with the mentally handicapped. That has been due partly to the success of mentally handicapped registers. Therefore, that is something that we shall introduce for mentally ill people. It is impossible to give exact figures of those who are mentally handicapped and those who are mentally ill. Very often mentally ill people do recover but then they relapse. Therefore, it is a very difficult area in which to keep accurate figures. However, I believe that those who are mentally handicapped are now looked after better than they have ever been before.

§ Baroness Jay of Paddington
My Lords, will the Minister accept that much of what has been said this afternoon reflects the debate that took: place in your Lordships' House on the subject of community care for people suffering from mental illness? Those issues arose in particular in relation to the Jonathan Zito case. Noble Lords on all sides of the House expressed the view in that debate that the actions taken by her right honourable friend, which the Minister has described, were not sufficient. Is the Minister aware that my honourable friend Mr. Ian McCartney, who works on the subject of mental health in the other place, wrote recently to Mr. John Bowis asking for specific assurances with regard to the eight urgent recommendations made by the Mental Health Act Commissioners and the recommendations by the Select Committee on Health of another place calling for much more stringent action than the Minister has suggested?

§ Baroness Cumberlege
My Lords, perhaps I may take first the report of the Select Committee to which my right honourable friend the Secretary of State gave evidence in December. We shall be issuing our response to that report this afternoon. We have also issued guidance on hospital discharge; introduced, from 1st 265 April, supervision registers; and increased the mental illness specific grant to £36 million this year with a commitment to continue it for a further three years. We have given grants of £500,000 to support 37 best-practice projects; have strengthened the monitoring of the care programme approach; have taken specific initiatives in London; and, nationwide, have given £2.4 million to voluntary organisations working in the field. I assure the House that a great deal is going on. I have mentioned only eight of the initiatives. There are another four, but I shall not bore your Lordships with the details this afternoon.

§ Lord Avebury
My Lords, what advice would the Minister give a prison doctor who has written to me stating that he was unable to find a place in a secure hospital for a prisoner under his charge who, he believed, needed to be accommodated in such a unit? What should happen in such a case where there is an argument between two different areas as regards who is responsible for such a person? How would that prison doctor having to accept continued responsibility for a patient who, he thought, might be a danger to himself or other prisoners, be able to get around such a dilemma?

§ Baroness Cumberlege
My Lords, the responsibility is quite clear. However, if it is being fudged I should certainly like to take up the case personally to ensure that the responsibility is placed on the right person. We have set procedures that should be followed with people who have been discharged from prison.

§ Lord Avebury
My Lords, I am sorry. I did not make myself clear. The person concerned was a long-term prisoner. He was in prison and the prison doctor considered that he needed treatment or examination in a secure psychiatric unit which was not available within the prison.

§ Baroness Cumberlege
My Lords, again, the position is quite clear. It would be the unit nearest to that prison which would take responsibility for such a person. If there is confusion in the matter, I shall be happy to deal with it on a personal basis.

§ Lord Stallard
My Lords, the Minister's replies have been most helpful so far. However, can she be more specific and give the timing as regards the implementation of the proposals and the legislation?

§ Baroness Cumberlege
My Lords, like other departments, my department will be pressing its case very strongly for legislation. We feel it to be most important to tighten up some of the current procedures. However, as noble Lords will be aware, it is in the hands of the business managers. As regards the other aspects of the recommendations, we have set aside the funds that are necessary and are working towards implement-ing our programme as soon as possible.