Mental Health Care: Support (Hansard, 13 December 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, people with mental illness are best cared for through locally-based health and social services rather than in large remote institutions. A wide range of hospital, residential and community services will be in place to enable people with mental illness to receive care and treatment to meet their individual needs.

§ Lord Thurlow
My Lords, I thank the Minister for that reply. Does she agree that much as we welcome the increase in facilities in the community, there will for the foreseeable future remain a need for complementary accommodation in hospitals for acute services? If the review, which I understand has taken place, with regional health authorities reveals a gap in the prospect of available services with skilled staff, will the Government be prepared to consider a review of the timetable? I understand that more than 50 old hospitals are due to be closed down in the next five years. That seems to imply a requirement for replacement facilities far in excess of what facilities in community care can provide

§ Baroness Cumberlege
My Lords, I agree with the noble Lord's first statement concerning acute facilities. With regard to his second point, we have given a firm undertaking that we will not approve the closure of any hospital unless we are satisfied that adequate alternative services are provided.

§ Baroness Faithfull
My Lords, do patients have a choice as to whether they can remain in hospital or are they discharged even against their will? If discharged, are there day centres that they can go to? I refer in 1270 particular to schizophrenics, who are extraordinarily difficult for social workers to deal with in the community without a base in the community and who tend to disrupt their families completely because the families are unable to cope.

§ Baroness Cumberlege
My Lords, we issued guidance in August of last year that patients should only be discharged when and if they are ready to leave hospital. Clearly, they have a choice in that matter, and their carers' views are also taken into consideration. Secondly, there should be no risk to the public or themselves, or if there is, it should be very minimal and effectively managed. Thirdly, when they are discharged, they should get the support and supervision which they need.

§ Baroness Masham of Ilton
My Lords, following the stabbing of a doctor in his surgery yesterday, can the Minister say how much of the violence now hitting general practitioners in their surgeries is due to those who have mental health problems? Is this being monitored and how much protection can doctors be given?

§ Baroness Cumberlege
My Lords, it would be impossible to say whether violence in the community is due to mental illness. Certainly, when we look at homicides, the figures are fairly consistent and have been for many years. With regard to the protection of GPs, it is a matter for them. However, if the noble Baroness has suggestions, we should like to take those on board.

§ Lord Marsh
My Lords, I follow and agree with the general thrust of the Minister's argument and the Government's policy on this subject; but does she accept that there are numerous people around on the streets who clearly are not capable of looking after themselves? Is it not possible that we have underestimated the number of people who require residential care?

§ Baroness Cumberlege
My Lords, we have carried out some studies of people who are homeless and on the streets of inner city areas. Although I am sure many of them are mentally ill, there is little evidence that any of them have been discharged from long-stay institutions. However, I take the point that many of them probably need help for acute mental illness.

§ Lord Strabolgi
My Lords, what is to happen to those people who are so mentally handicapped that they cannot cope at all; for instance, people who have a mental age of one or even six months and have not developed for the whole of their lives? Is accommodation to be provided for them or are they to be thrown onto their families?

§ Baroness Cumberlege
My Lords, as I said in the undertaking which I gave in my original Answer, we certainly would not wish to discharge anybody from a hospital without adequate provision in the community. For those people who are very severely disabled or handicapped, we believe that there are better ways of looking after them than in the long-stay Victorian institutions. Indeed, many good homes have been set up 1271 in the community. We give very clear guidance to the health service: we have care plans which it has to follow. They ensure that there is sufficient support for these people in the community not only during the day, but at weekends and in the evenings.

§ Lord Hayhoe
My Lords, will my noble friend the Minister confirm that the vast majority of patients discharged from long-term psychiatric hospitals—particularly those ghastly Victorian monstrosities that still exist in this country—in fact do well? Does she agree that it is out of balance to concentrate unduly on some of the exceptional cases which require exceptional treatment? Does she further agree that, by and large, it is a good policy which should continue to be pursued?

§ Baroness Cumberlege
My Lords, my noble friend is correct in what he says. I was responsible for five of the largest mental institutions that catered for the needs of London and when I first went around those huge Victorian institutions they were an eye-opener. Despite the efforts of the staff, I thought that the quality of care was very poor indeed. We were denying some people all the things that the rest of us take for granted, such as living in a normal house, in a normal street; going to the pub; going to the shops; and going to church. All the things that the rest of us take for granted were being denied these people.

§ Lord Rea
My Lords, I am pleased that the noble Baroness has once again reiterated that no psychiatric hospital should close until adequate community services are available. But does she fully understand that these services need time to develop as well as requiring adequate finances? Is she aware that at present they are simply not adequate in many areas, especially in inner cities? Can the Minister reassure us that there will be no further mental hospital closures until there is solid, detailed evidence that community services in the catchment areas of those hospitals are up and running?

§ Baroness Cumberlege
My Lords, there are a number of ways of providing care for mentally ill people. Only one of those is through residential or hospital care. The number of beds available has increased from 87,500 two years ago to 90,833 in this current year, so we are seeing an increase in the number of places as well as the provision of community mental health teams who work in different ways other than through hospital provision.

§ Lord Allen of Abbeydale
My Lords, can the Minister say what the position is regarding secure accommodation, which is a subject with a long history? Are there now enough secure units? Will these be kept and added to, if necessary, or may it still be necessary from time to time to have recourse to private psychiatric hospitals for this purpose?

§ Baroness Cumberlege
My Lords, there are different degrees of security. The special hospitals provide the maximum secure accommodation. They have been in existence for some time. In 1979 there was no medium secure provision in the country. Now we have approximately 1,200 medium secure places in 33 units. 1272 That is enormous progress since 1979. That was achieved through a special financial allocation. A further 300 will be provided through the normal NHS capital programme. So we have increased the number enormously.

§ Lord Monkswell
My Lords—

Noble Lords
Next Question!

The Lord Privy Seal (Viscount Cranborne)
My Lords, I apologise to the noble Lord. I hope he will understand that this is only the first Question and we have already taken nine minutes. I wonder whether the noble Lord will be very graceful and perhaps allow us to get on to the next Question?