Mental Health Services (Hansard, 21 January 1999)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)
My Lords, yes. This paper has already been brought to the attention of the External Reference Group advising the Department of Health on the development of the National Service Framework for Mental Health, and of the expert group undertaking a scoping study as the first phase of the review of the Mental Health Act 1983.

§ Lord Laming
My Lords, I am grateful to the Minister for that helpful reply. Does the noble Baroness agree that this research indicates that, contrary to popular belief, of the number of murders committed in this country during any one year those committed by people with mental illness has declined steadily? Will she ask the review team to consider requiring each mental health authority to put in place a multidisciplinary outreach team dedicated to maintaining close contact with those mentally ill people who have a tendency to drift in order that we can ensure that they take their medication and do not drift out of sight?

§ Baroness Hayman
My Lords, my noble friend is right to draw attention to the article, which takes a balanced and considered view of the issues relating to homicides committed by mentally ill people. In urging that balanced view, we should not stigmatise the mentally ill because of rare occurrences. Neither should we divert ourselves from the need to improve services to reduce those incidences.
Assertive outreach is important to deal with those who suffer from mental illness who, as the noble Lord rightly pinpoints, are particularly difficult to reach by conventional systems. The National Service Framework for Mental Health, which we hope to publish in the spring, will give advice on alternative ways of providing such a service.

§ Lord Clement-Jones
My Lords, in the light of the Minister's reply, will the noble Baroness agree that the paper should also be referred to the review by Professor Richardson of the Mental Health Act? If or 697 when Professor Richardson's review group makes a proposal for a community care order, will she confirm that there will be full consultation on the principle, and practical application, of any such community care order?

§ Baroness Hayman
My Lords, yes, I believe that Professor Richardson's group has received a copy of the document. She was asked to consider how community treatment orders might be implemented when the review group scoping study was set up last July. I understand that she has consulted fairly widely already but that before she puts proposals on the subject to Ministers she will consult again.

Earl Howe
My Lords, does the Minister agree with me that dangerous mental disorders, in particular schizophrenia, are often triggered by drug abuse; and that there is a close connection between these two types of disorder? Is it not therefore as important to educate young people on the many dangers of drug abuse as it is to ensure that schizophrenia is effectively treated?

§ Baroness Hayman
My Lords, the noble Earl is correct to point out that some sufferers from mental illness who are most difficult to reach, and some whom the article identifies as the most likely to be in that small minority who commit offences, are those who have drug or alcohol abuse problems. He is right to point out that we need to consider those issues as well as the issue, for example, of schizophrenia, if we are to be effective.

§ Lord McNair
My Lords, will the Minister please insist that research is carried out into the violence-producing side effects of modern psychiatric drugs, in particular that of Akathesia, which makes it difficult for many who work in the mental health services to handle the people in their charge?

§ Baroness Hayman
My Lords, it is important to recognise that we must look at many new treatments in the round. We have to consider the side effects as well as the primary effects. For example, we need to give clear advice on treatment protocols. The national institute for clinical excellence will have a key role in developing and disseminating guidance on drugs in the future.

§ Earl Russell
My Lords, I am sure this is not the first time the Minister has heard a good proposal for putting an additional obligation on a local authority. Will the noble Baroness agree that the tendency to put additional obligations on local authorities without ensuring adequate funding to meet them has increased, is increasing, and should be diminished?

§ Baroness Hayman
My Lords, I do not think that the hypothesis to which the noble Earl refers applies in this circumstance. We did indeed put extra obligations on local authorities, not least the obligation to work with health authorities on services for the mentally ill because their needs go across the organisational boundaries of 698 the health service and local authorities. But I am glad to say that with that exhortation we provided extra funding for both social services departments in local authorities, and health authorities, so that they could take action on that.

§ Baroness Gardner of Parkes
My Lords, the Minister states how successful outreach teams are. I have experience of them and agree with that. Is the noble Baroness aware that, no matter how good the outreach team is, there are people who will deliberately make it impossible for that team to contact them? In that circumstance, the outreach team cannot fulfil the task it sets out to do. Will the Mental Health Act review cover such an eventuality?

§ Baroness Hayman
My Lords, the Mental Health Act review must look at several problem areas. Some people who can safely live within the community can do so only if they are complying with treatment. We must have back-up to ensure that the treatment is complied with or that there are alternatives if it is not. We must provide safety for patients and public alike. Whether through 24 hour nurse-beds, secure provision, additional treatment for those with severe personality disorder or outreach teams in the community, we wish to have a range of provisions to meet all the needs within the spectrum of mental health.