§ Mr. Stephen O'Brien (Eddisbury)
I am grateful to Mr. Speaker for making the time available for this debate on mental health services in the United Kingdom. It is clear to those of us who take an interest in the subject that the debate will be extremely important. The way in which a society treats those least able to play a full role is a measure of how civilised it is.
Mental illness is society's unspoken epidemic. It is rarely discussed. All too often, people regard mental illness as a weakness and stigmatise the individuals who suffer from it. The draft Mental Health Bill, which was published by the Government in 2002, has not helped to alleviate that. The debate surrounding the Bill concentrated on the potential dangers posed by psychiatric patients rather than or the more important issue of the appropriate treatment for all patients. We need to shift the debate away from those rare incidents of violence—important as they are when considered individually—that stigmatise anyone with a mental health problem. Health policies can and must be shaped to support those who suffer from a mental health condition in what can, at times, be an atomised and alienating society.
More than one in five people are afflicted by mental illness during their lifetime. It is therefore fair to say that everyone in society—whether in the context of the family, or in a caring capacity—is affected by mental illness. However, those suffering from such an illness often have the smallest voice in terms of representation and in getting society, and the Government in particular, to wake up to their needs.
This debate is therefore a good opportunity to give the mental health sector, and the people affected by it, a true and loud voice. I therefore welcome the Minister, and hope that she will be able to give answers today that will provide hope to all those following the debate. If she does, that will be in contrast to the lamentable performance—and that is not intended to be a pun on his name—of her predecessor at the virtual Dispatch Box in Westminster Hall, now the Under-Secretary of State for Constitutional Affairs, the hon. Member for Tottenham (Mr. Lammy). In his response to the debate on this subject on 7 May 2003, he did not treat the subject with the seriousness, respect, dignity or importance that it warranted.
I therefore hope that the Minister will be able to put right the deep deficit on the Government's balance sheet in the way that debates in Westminster Hall have been handled. I also hope that—because her predecessor has been moved on—she will be able to make amends for the woeful Government response on that occasion.
It is fair to say that all Governments have moved on since the dark days when we used to talk about mental health patients and the asylum. It is important and necessary to pay tribute to the enormous number of highly professional workers in the mental health sector, and to those who are committed in a voluntary capacity to our mental health services. In our constituencies, we are aware of the enormous debt that we owe to all those who, with deep commitment and long-term dedication, care for many people who are afflicted by mental illness. To those of us who are lucky enough, at this stage in our 24WH lives, not to believe that we suffer from mental illness, devising the optimum treatment for such sufferers appears baffling.
We must also be careful, however, not to be cowed by the wish for what is increasingly becoming the norm in today's politics—and described by that ghastly word "consensus". Consensus is soggy and invariably ineffective. It is a sort of middle way or third way, which is anathema to getting action. We need action rather than words or comfort blankets in this area, and we have been waiting for that action from the Government. I do not differ from other Opposition parties in saying that we are looking for action, not simply rhetoric and fine words.
Before I move on to more detailed and substantive issues, I should like to talk about a phrase that society generally should stop using. The Government have been wont to use it completely erroneously when talking about the official Opposition and saying, "The lunatics have taken over the asylum". It is disgraceful of them to use such a phrase. I do not use it; I have never used it because it shows such deep disrespect. Yet Ministers and even some Cabinet Ministers have used it. The media have occasionally used it too. Normally I am absolutely against political correctness, but this has nothing to do with political correctness. It is to do with the deep sensitivity and the concern that society should show for people who have a mental illness. I hope that from hereon that wrong, nasty and thoughtless phrase will not be used by any Minister or by anyone in a position of authority.
I say that with some passion because I well remember as a young boy my mother driving me past what was then known as the asylum near Warrington. She was a nurse and she used to say, "Now, Stephen, just remember that those are really poor, afflicted people in there. There are fantastic nurses who look after them. The one thing I hope you will never grow up to do is to call this place an asylum. It is a hospital and a place of care." I have always held that thought with me. She said the same about Fazakerley hospital near Liverpool and Lancaster Moor hospital. It is time that we moved away from some of the language that was relevant a hundred years ago. In view of the compassion and expertise that we have in today's society, mental health sufferers deserve better than some of the loose language that we continue to use. This point matters.
The mental illness spectrum is vast. We must take care to recognise that some mental illness is defined in terms of the potential risk to self, as opposed to a risk or even danger to the public at large. That is a key feature of mental illness, once it is diagnosed correctly and the right medication prescribed. I know from my personal family experience that medication is the key to maintaining a regime of control and dignity in these matters, yet medication is often the one thing that the sufferer does not want to take, which makes the illness even more difficult to treat.
In addition to the range of risk, there is the age spectrum. We have increasing longevity; shortly some 2 million in our society will be over 85. Many of them will, of course, develop Alzheimer's and dementia. Such increasing longevity certainly presents problems and challenges for our society.
25WH At the other end of the spectrum are young people. Most hon. Members present will be familiar with the organisation YoungMinds. Incidentally, it is disappointing that only three Conservatives, two Liberal Democrats and only the Minister and her Parliamentary Private Secretary are present. It is a shame that this is such an ill-attended debate, particularly on the Government side. YoungMinds describes the unrelenting rise in mental illness among the young. We have all become aware in our constituencies of the marked increase in the number of young male suicides. It is a significant issue revealing both stress and an inability to cope in what I referred to earlier as an increasingly alienating and atomised society. We need to observe that issue carefully and take the right steps.
Other points on the mental illness spectrum are what might be described as stress and forms of depression moving through, say, schizophrenia to what are also called personality disorders. I do not want to get into a debate on this today, which would be straying a bit far from the main topic on the Order Paper, but we need to take a much more clinical and dispassionate view of the difference between mental illness and certain personality disorders. I do not want to go down the rather legalistic route of examining whether, for example, paedophilia—abhorrent as it is in all ways—is a mental illness, a personality disorder or some other form of condition. What matters, and what was so patently missing in the draft Mental Health Bill that we saw a year ago, is a focus on what is treatable rather than simply on what is a danger.
If we look at mental health from the point of view of what is treatable, we can, as part of our responsibility as a civilised society, examine what can make the life and participation in society of certain individuals better, rather than examining the danger to, and protection of, those of us lucky enough not to be afflicted. Our mental approach, our mindset, to mental illness—I hope that I am not being too tautological—should be that we are on the side of the person suffering, helping to give them better prospects in life, rather than being on the other side. Without wanting to apportion blame, I think that being on that person's side has not generally been the mindset to date.
What is the scale of the problem? The number of people off work sick with mental illness has increased by a quarter in a long period of relatively static figures for missing work through sickness. Since 1997—this is not a political point; it just happens to be the date that I have—the number of those claiming disability living allowance because of mental illness has increased by three quarters. The toll of personal distress, and distress for families and carers, is something that we do not cost, but can all appreciate, and we should not be shy of discussing the economic cost to the nation, because it is real.
Another very real factor is not often discussed. When we speak from the very privileged surroundings of a debating forum in which we all expect to have our full mental faculties and when we discuss people who suffer from temporary or long-term mental illness, we should see it as part of our sense of self—our sense of pride and confidence in our country and ourselves as part of a civilised and compassionate society—to address the matter with the priority and care that it deserves.
26WH More needs to be done on the interactive side, and on how those with mental illness can participate most in day-to-day society. I look to the Minister to give at least an indication about and, I hope, answers on the pathways to work strategy. We must look very carefully at whether people on benefits are capable of being at work. A three-pronged strategy is needed. First, we need to increase doctors' sensitivity and understanding. I am not making any criticism of current practice, but we must increase their diagnostic and other abilities in mental illness, so that they match those in the field of physical illness. Secondly, there must be more flexibility over part-time working. It is quite obvious that many people who have gone through stress and who may be the most capable of being treated so that they can get back to work more easily and earlier may not initially be able to face a full week's work. An environment of flexible part-time working would help.
Finally, we need to do much more—whether we call this joined-up government or joined-up benefits—to link rules. If someone is capable of going back to work part-time, they are therefore no longer incapable. However, if they are no longer incapable, there is a real risk that they will lose their disability living allowance. We need to look carefully at how the rules link. There are often perverse incentives for the professionals, and there is the possibility of adding to the stress and confusion of those trying to overcome problems.
Another point to bear in mind, although I shall not stray too far down this path today, is the need to consider learning disabilities. Although such disabilities are not in themselves mental illness, it is interesting to note that Mencap has said that learning disability leads to an intense, long-term unrelenting frustration, even agony in the sufferer, that can lead to forms of mental illness. Without reservation, I praise Mencap for all that it does; I am sure that I am joined in that by everyone here today. It is an outstanding organisation, which is very well led and has a most remarkable, committed field force with the deepest expertise. I hope that that is not regarded as something that is too easily said. Mencap deserves praise, and it will certainly get it from us today.
We must look carefully at linking learning disability provision with mental illness. The Hebden Green school for learning and physical disabilities in my constituency deals with the families and provides residential opportunities—an issue to which we may have to return. I recommend that the Minister visit that place one day as it is an example of the best practice that makes links in the community.
Before I touch on a couple of other issues, I would like to mention another underlying principle. We have heard from the Government on the matter before, and I would appreciate hearing from the Minister today a genuine update on where the valuing people strategy has got to following the White Paper. My point relates particularly to child and adolescent mental health services. In relation to the valuing people strategy, one of the critical issues that the Minister will have been briefed on may well concern whether we will get the mental health legislation. When will we see the Bill that has been so long under consideration?
As we know, the Government published a draft Mental Health Bill in the autumn of last year, and it was met with near universal condemnation. I do not think 27WH anyone would seek to correct me on that. The proposals in the Bill that provoked the most concern included measures to introduce compulsory treatment in the community, and proposals for the indefinite detention of people with severe personality disorders. It was a coercive measure and, ultimately, a shockingly dehumanising piece of proposed legislation from the Government.
The Mental Health Alliance, representing a group of more than 50 mental health organisations, said that the proposals would backfire because more compulsory detentions and forced treatment in the community would drive people away from seeking services. Marjorie Wallace, the chief executive of the mental health charity SANE, claimed that the Bill would not address the fundamental problems of mental health provision. The Law Society and the Royal College of Psychiatrists issued a joint statement unequivocally rejecting the Government's proposals for reform of the Mental Health Act 1983. They said that
in our opinion, the proposals are fundamentally flawed.Having promised mental health legislation for the 2002–03 parliamentary Session, the Government have failed to publish a final Bill or to give any indication of when legislation will be forthcoming. However, the Department of Health has promised to publish the consultation responses before publishing the new Bill. I hope that we can learn today, as a result of the debate, what the Government's intentions are. That would be helpful for all and not just those in the House. An awful lot of people—notwithstanding the fact that the Chamber is not overflowing today—will be following today's deliberations, and will be looking to see what answers are given.
The Conservative party has made it clear—I rely on the latest position from the shadow Minister who is here today—that if the Government were to introduce the Mental Health Bill as previously drafted, it would oppose it. That is well understood and accepted. We have had a year's consultation with, I hope, all the specialties, and shown a great deal of sensitivity to the various spectrums that I have outlined. We also recognise that the removal of liberty is the last, not the primary resort, so we have to put it on the record that there is a desperate need for a mental health Bill, but it must be the right Bill. It must contain the right provisions.
I call for such a Bill today, and I know that my party has consistently called for it. I ask the Minister to say whether it will be a priority for us in the forthcoming legislative year. All those who take a genuine interest in the subject need to feel that the time and care that they spent in consultation and in trying to influence Government policy was worth while because it will result in a genuine step forward. There should be a legislative move rather than simply the massive, protracted talking shop that is getting us nowhere.
On medical services for mental health, the interface with social services is critical. It is critical not only in emergencies, but in day-to-day life, particularly in relation to housing in residential areas, and the more common aspects of the ways in which people with 28WH mental illnesses find that they have to live their lives. I refer to people with a relapsing or remitting form of mental illness that is not consistent over time.
There is now a new challenge. When the three district authorities in my parliamentary constituency were under Labour and Liberal administrations—I am glad to say that the situation has changed somewhat dramatically over recent years and we have Conservative administrations—there was a rush to privatise the social housing stock. I am sorry. I said that we must be careful about the use of language so I must be politically correct and use the Government's message. The word is "transfer", not "privatize".
There is now an increasing problem because people with mental illness are no longer able to go to a connection of various agencies and authorities, and there is also the matter of considering what is the appropriate placing, within housing stock, of people with relapsing or remitting types of mental illness. We need to consider that issue carefully. I hope that the Government will have something to say about that.
The perfectly laudable aim of the national service framework for mental health, which sets seven national standards for mental health services, is to drive up quality and reduce variations in services to patients and service users. It is intended to include round-the-clock crisis teams for emergencies, more mental health beds and improved training for general practitioners. As I understand it, there is a genuine attempt to ring-fence mental health money and the various mental health trusts are intended to reflect that.
It is, however, October 2003 and—although I condemn in all other respects the Government's completely ineffective and distorting ghastly target regime—we have had more than three years under their target regime for an assessment of what they believe they have achieved in comparison with the targets that they have set themselves. I refer to the impressive speech made in this Chamber by my hon. Friend the Member for Daventry (Mr. Boswell):
I turn now to the NHS plan targets. I hope that the Minister will comment on the Department's claims in meeting them. I note that the mental health mapping atlas, which was published in June last year, pointed out that there were particular problems in providing a 24-hour service for mental health crisis resolution teams. Fewer than half the teams then established-52, from memory—were meeting that requirement. We all know that mental illness does not operate on a nine-to-five basis—even if the office does. A problem may become acute in the small hours of the night. It is simply no good fulfilling targets nominally, but not meeting them in substance."—[Official Report, Westminster Hall, 7 May 2003; Vol. 404, c. 221WH.]The complete lack of any assurance or answer to that point is partly why I was so openly critical of the former Minister and why his performance on that occasion was so disappointing and lamentable. I hope that there will be an answer today.
I hope that there will be a genuine recognition that staff vacancies continue to be a problem. My wife is a nurse and we met when she was doing her psychiatric training at Highgate. It was part of the critical training for all nurses to understand how to nurse psychiatric patients and that led my wife to decide to continue nursing in the oncology and terminal cancer care area, working particularly with old people. Having an understanding of how to nurse psychiatric patients 29WH becomes a must in terms of the full-scale professionalism that must be devoted to people of that age in those conditions.
There are a huge number of staff vacancies in the nursing, psychiatric and medical areas. I hope that the Minister will tell us what progress has been made since the problem was highlighted in the earlier debate, and before that, by the shadow health team. I hope that we will hear that there has been genuine progress, because there is no point in having fine words and strategies without having enough of the professionals who choose to do a particularly tough type of professional care and work. I am worried that only one third of primary care trusts have completed evidence-based guidelines.
I thank the British Association for Counselling and Psychotherapy for briefing me today, although there is not enough time to go into all its arguments. There is a real concern that, partly because of targets, there is too little flexibility to recognise the huge value that counselling and psychotherapy can add to the provision of mental health services. The Government should be tested by the measures that they set themselves, even if we do not agree that those measures are likely to be effective. The targets have been in place for more than three years. By any test, a target can be assessed as met, not met or, at least after three years or more, whether it is on target, missed or fudged.
We must consider whether the targets focus only on severe mental illness rather than on primary care for mental health. We should also examine the assessment of the effectiveness and desirability of early intervention. In so many walks of life, early intervention is key. I cannot find—I will be grateful to the Minister if she can prove me wrong—where early intervention was measured in the target regime. I come from the world of business, so I know that what one measures is what one gets. If early intervention is not measured, we will not get a real focus on it.
I have two further points and then I will have taken up my full share of time. First, there has recently been a huge campaign about community pharmacies. Thousands upon thousands of my constituents have signed petitions, and, as a result of the enormous pressure brought to bear on the Government and various quangos to recognise the real danger of community pharmacies being lost, there has been movement in the right direction.
I have received the briefing from the Pharmaceutical Services Negotiating Committee, and I am happy to copy it to other Members who are interested, although I would be surprised if it has not been made available to them. It sets out very clearly why, in addition to all the advice that they are able to provide, community pharmacies are so important in recognising early symptoms of mental health problems, identifying signs of relapse, helping with concordance, encouraging good mental health practice and helping to change attitudes towards mental health patients and the perceptions of their problems.
We should not forget the enormous difference made by the footfall of communities through those shops. People can be seen regularly without losing face, and other members of the community can help them. I hope that the Government will not relent and will recognise that, in addition to all the other arguments, those with 30WH mental health problems benefit enormously from the advice, knowledge and discretion available in community pharmacies.
Finally, a story from my constituency may help. Several of my constituents have used the wonderful Gainsborough road respite unit in Crewe for many years. Crewe is not in my constituency; it is in that of the wonderful hon. Member for Crewe and Nantwich (Mrs. Dunwoody). Sadly, the unit was recently closed despite a prolonged and determined campaign conducted by a number of us. It is so easy to forget how important the respite or drop-in opportunity is for mental health patients. It provides medication and a support group of people whom the patients know and trust. It is as much a part of their treatment and their ability to cope as anything else. If we know anything about mental illness in addition to the professional medication and treatment programmes, we know that people need coping mechanisms and trust so as to surround themselves with confidence, the lack of which is often the deepest undermining aspect of their mental make-up.
The Gainsborough road unit was a marvellous place for people quietly to recharge their batteries. I have received a letter from a constituent, Sheila McKeowen, who is a state registered nurse. She is deeply involved with the unit:
Last year the Respite Unit for the mentally ill in Gainsborough road Crewe was closed despite all our efforts to keep it open. You intervened on our behalf but unfortunately to no avail. Prior to its closure in May 02 four of us had a meeting with management and were promised in its place a Rapid Response Team and a unit to be run by trained staff and social services. None of this came to fruition.Since then numerous clients have been admitted to hospital, who would have benefited from a short stay at Gainsborough road. Not only was it residential for 8 people. It was manned by trained staff 24 hours a day. This meant people in distress and alone could phone arty time day or night for advice and reassurance. The problem is psychiatric staff and social services finish work at 5 pm and are unavailable weekends and bank holidays. The only alternative is to phone Leighton and speak to a stranger.I have been fortunate in having good community support from a psychiatric nurse and an outreach worker for whose services I pay the County Council. In your final letter to me last year you asked me to keep in touch if there were problems. Winsford has a small MIND group.Mind is another laudable charity, but she points out:
Other than that there are no facilities for the mentally ill.She asks us to do all that we can to reverse that desperately distressing situation, which has exacerbated the already tough time endured by those who benefited from the services provided by Gainsborough road.
The Minister should ask mental health trusts and other NHS organisations whose work relates to the provision of mental health services about their strategies to recognise the importance of front-end respite care, because opportunities to use respite units seem to be diminishing.
Finally, I am not calling for the micro-management of that area—we must trust and boost the professionals. It is, of course, up to the Government to find the necessary resources to ensure that the right things to treat all those afflicted by mental illness can be done. There is a responsibility to examine where there are dangers to members of the public, but we should not make that the 31WH focus of our attention and activity. For the sake of patients, carers and professionals, we should compassionately and professionally examine the full range of treatment available to anybody who is afflicted by mental illness at any time in their life. In a civilised society, people should be able to live participative, dignified, respected and full lives. That is a minimum requirement for us to be proud to live in our country.
§ Mrs. Patsy Calton (Cheadle)
I congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing this important debate. I was pleased to hear him refer to child and adolescent mental health services because I want to highlight an issue that affects children and their families in my constituency and, indeed, the whole of the metropolitan borough of Stockport.
I know that the Minister is not responsible for child and adolescent mental health services and, given the title of the debate, it will obviously be difficult to get answers today. I have corresponded with other Ministers about the issue in Stockport, where there is currently no specialist child and adolescent mental health service. There are no consultants in what used to be Stockport health authority, which has been subsumed into Greater Manchester health authority.
The correspondence to which I referred involved trying to find out how, despite the lack of child and adolescent mental health specialists, interim services can be provided in Stockport while child and adolescent mental health services are sorted out. Although there are 13 or 14 specialists in the Greater Manchester area, they unfortunately cannot take on work from Stockport. My latest correspondence from a Minister indicates that general paediatric consultants, excellent as they are, have the benefit of a telephone helpline. That might be appropriate for the outback of Australia but not for Greater Manchester, where the distances are not as great.
Unfortunately, child and adolescent mental health services has become an umbrella term not just for mental health conditions but for a range of others that may have associations with mental health but that are not directly mental health-related. For example, I have become particularly interested in autistic spectrum disorders, given the number of my constituents who are affected.
The Government have produced the document "Every Child Matters" for consultation. It includes much that is good and commendable, but I am very concerned that it suggests that all areas are expected to put in place a comprehensive child and adolescent mental health service by 2006. That is more than two years away at the minimum, but children and their families in my area need specialist advice now. They need to know where to go. Unfortunately, they are in the position, not just with medical health advice but with related agency advice, of having to go from one appointment to another—if they can get appointments, which is not always the case. Sometimes they have to wait two or even 18 months, when virtually everyone is aware that early intervention is needed for child and adolescent mental health problems.
32WH I am not in any way decrying the excellent services that Stockport metropolitan borough council and the local health service provide. I recognise the benefits of the portage service, the social care that is available, the work that is done in education and by community services, the Connexions service and the disability database. The problem is that Connexions and other services are not connected. At present, there is no lead person or professional who points parents and carers and their children to the right place. I am very worried that there may be a two-year period in which little or no improvement is made.
There are bits of excellent service available all over the place, but parents and carers must find it for themselves. It is not clearly laid out for them, and it is almost as though they stumble by accident on to some of the services that they receive. That simply is not right. They should not have to go to their Member of Parliament to find out about such services. If a child is identified as needing multi-agency work, that work should be available from the beginning.
My plea today is that the named person—the lead professional—and full, comprehensive child and adolescent mental health services must be in place well before 2006. Children and their families are suffering and having to cope now. They must get the help and support that they need before another two years have passed. It is in the interest not just of the families and the children but of the whole society that early intervention, which makes such a huge difference, and the wrap-around service that people need should be available to my constituents and others.
§ Mr. Robert Key (Salisbury)
Mental health services in Salisbury and south Wiltshire are very dear to the heart of my constituents. Therefore, I am pleased to be able to take part in this debate, thanks to the foresight of my hon. Friend the Member for Eddisbury (Mr. O'Brien). We are all very grateful to him for securing this debate for our first day back.
I wish to address the broad issue of the provision of mental services, mentioned by my hon. Friend, and the matter of locking up people who have not committed a crime just in case they commit one. That is the most contentious part of the Government's proposals for the reform of mental health services.
I give an example from my experience. A convicted man, who was in prison for some years for manslaughter, was released into Salisbury precisely because he had no connection with the town. There was an enormous police and health service operation to provide surveillance of him from the moment he was let out of the bus. We were briefed in advance that he would be watched and were told that the moment that he broke his bail conditions he would be put straight back inside, so everything would be all right. We thought, "Is this right?" Of course, he broke his bail conditions. He hopped out of the bus, walked up the road, went straight into an off-licence and was immediately rearrested and put back inside. Everyone breathed a sigh of relief. The alternative was to say that, because this man had a diagnosed mental condition and because there was a significant chance that he might reoffend, he should not be let out in the first place. As I understand it, that is what the Government are proposing.
33WH In a mature democracy, it must always be unacceptable to deprive a citizen of his liberty just in case he reoffends. That is the position that we have to take. The reform of the Mental Health Act 1983 must be consensual because there will always be professional differences of opinion between different branches of psychiatry. If they cannot agree, it is right that such moral and ethical issues should be decided in the House of Commons. We will have to take those decisions on behalf of our constituents, the professionals and those to whom future laws will apply. Indefinite detention is the problem, not the solution, when it comes to mental health services, and I hope that my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) will have something more to say about that matter.
In my constituency, in common with most others, the provision of mental health services over many years has been complex. There is a complicated pattern of delivery in general medical services and, in particular, in mental health services. There was a splendid Nightingale hospital, the Salisbury general infirmary, in the heart of town, and it was an excellent place.
In 1945, the former American field hospital at Odstock, a hutted hospital that had been built in preparation for the liberation of Europe, was handed over to the new national health service. It provided the backbone of local acute services for my constituents for many years; I had my tonsils out there in about 1952 in an American hut. It did not do me any harm; indeed, it did me a lot of good. We were grateful for those facilities and for the generosity of the American people in providing them just after the war when we needed them more than they did. A hospital is still there on the same site, although I am glad to say that hardly any huts—either American-style or Nissen—remain; there is a fine Salisbury district hospital.
A contentious strategic decision was taken not to relocate the old asylum to the new hospital site. The acute provision was to be at Odstock in the new district hospital and the mental health services were given a lower priority. There is nothing new in that; it is the experience up and down the country. Mental health services always get the Cinderella treatment. However, I am delighted that a substantial building programme, which has been planned for more than a decade, is at last coming to fruition and new buildings are opening, although the strain on the mental health team has been enormous. I pay tribute to the magnificent consultant and the team who run the local site. They have been pushed around from pillar to post. They moved to a new office block to administer the service at Century house in Endless street, which is aptly named, and were then told that the premises were too expensive and that the building would be sold to pay their wages for another year. I jest not. That is what happened.
The position of the people providing mental health services has been uncertain. The team has been overstretched and undermanned and the reforms that were introduced in recent years have caused the loss of quite a lot of income from, for example, the county of Hampshire because the service went over the county boundary and provided services for part of Hampshire. That has now stopped so staff have been withdrawn.
34WH There has been no guidance yet on, for example, how the service can be run to conform to the new European directive on working hours. The staff have no clue as to how that will be met. That matters enormously and even more to the acute provision of mental health services than to general acute provision. The staff do not know how they can possibly afford the new mental health services in the face of such bureaucratic decisions.
The team battles on and there is no doubt that it will settle down on the new site because its dedication is clear to everyone. However, a particular problem remains—the lack of an overall strategy for the provision of mental health services, including health services for young people. The county council has an excellent children's service, which it reorganised. It provides a wonderful service for my constituents and their children, but how does its attitude to mental health provision interface with the primary care trusts and the district hospital? There are elements of the mental health service for young people and the rest of the community at the district hospital when they should perhaps be based with GPs or in a special unit run perhaps by a children's trust. Some people suggest that the way forward is for the various partners to come together in care provision. There is also the overriding problem of respite care and how that interfaces with the different agencies whose mission seems to be very unclear indeed.
I needed to put those matters on the record because this is a great opportunity for the Minister to deal with our points. She is a sensitive Minister and I know that she will do her best. However, I hope that the Government are aware that joined-up government must take account of the provision of children's services not only by her Department, but by county councils and ensure that there is a proper read-across from the acute services provided by district hospitals and GP services supervised by the primary care trusts.
In Salisbury and south Wilshire, we are holding our breath. I shall continue to speak from the heart for those constituents who need our help and I shall continue to champion the cause of the remarkable professionals who run our mental health services. In the dying years of this Parliament, we shall expect the Government to address some of the issues with more vigour than they have shown since 1947.
§ Mr. Paul Marsden (Shrewsbury and Atcham)
I add my congratulations to the hon. Member for Eddisbury (Mr. O'Brien) on securing this important debate. He did well to introduce the wide-ranging issues and I associate Liberal Back-Benchers with his kind tributes to many of the mental health organisations, charities and health care professionals. I also echo his concern that not a single Labour Back-Bencher seems to want to contribute to the debate, which is regrettable as the issue is so important.
I congratulate the hon. Member for Salisbury (Mr. Key) on raising constituency issues and the eloquence with which he spoke. I hope that the Minister will deal with those issues. The matters raised by my hon. Friend the Member for Cheadle (Mrs. Calton) may not fall directly within the Minister's remit, but I sincerely hope that she will pass them on to her hon. Friend because the problem is clearly serious.
35WH I shall direct my comments to the draft Bill, which we have seen some 16 months after the Government promised that they would introduce it. It is long overdue and will replace the Mental Health Act 1983. It is highly regrettable that the Bill seems to have been introduced in a vacuum, as it does not relate to other parts of the health services, such as primary care or housing or social services. It is a mixture of a much-needed updating of mental health legislation and repressive legislation that will lock up people who have personality disorders. I agree with the hon. Member for Eddisbury, as we will add to the stigma that is regrettably attached to those with mental health problems if we allow the Bill to proceed unamended.
The Bill seems to focus primarily on compulsory treatment in the community, and its definition of mental disorder is far too widely drawn and regressive compared with the original 1983 Act. The Bill mentions care plans but does not guarantee that they will be implemented. It also removes the treatability test in the original Act, which is that an order for compulsory treatment can be made only when treatment is likely to alleviate or prevent a deterioration of the medical condition. I cannot understand why that is removed.
The Bill may lead to excessive and inappropriate use of compulsory treatment in community settings, and real damage may be done to the relationship between the health care professionals and their patients, who will have the fear of compulsion hanging over them. There may also be pressure on the professionals to recommend compulsory treatment in the community as a form of defensive medicine. We already have the ongoing problem of disproportionate use of compulsory treatment for patients from ethnic minorities—that will continue and might be made worse by the Bill.
Other vulnerable groups, particularly the homeless, will also be targeted by the Bill. In 1998, the Government published their report on rough sleepers, which found that between a third and a half of the homeless suffer from mental health problems. We should be trying to help those people more rather than locking them up, which will be the practical effect of the Bill. That will also be a distraction to and diversion of existing mental health resources, taking them away from where they are needed—front-line patient care—into more bureaucracy and red tape. We will find more procedures to cover compulsory treatment, which may ultimately be a waste of public money.
The worrying point is that the Government, after being opposed by more than 50 mental health groups led by the Mental Health Alliance, want to go even further. In June this year, The Guardian reported that following a meeting between the Home Office and the Royal College of Psychiatrists, the Government want to give courts the power to detain in hospital people who are deemed to be dangerously mentally ill, even if they are not charged with an offence that is punishable by prison. For example, if someone was stopped for speeding and deemed to meet the criteria, they would be locked up.
That is not my suggestion, but that of Tony Zigmond, the Royal College of Psychiatrists' lead member on mental health reform. He has also said:
36WHThis new plan is a disgrace and shameful. The government should be hanging its head in shame in how it is treating the mentally ill. If this action was taken against any other group in society it would be called prejudice.This is not a personal attack on the Minister, because she is new to the issue and I know that she is a fair-minded individual who has a good track record of listening to people. I hope that she will listen now, as there is a danger that this will come across simply as a quick-fix solution to try to grab an easy headline for the writers of certain right-wing newspapers to satisfy their prejudices.
The professionals are overwhelmingly against the current form of the Bill. What was reported inThe Lancet belies the Government's approach. It said that at a conservative estimate, six people with dangerous and severe personality disorders would have to be locked up to prevent one of them from possibly acting violently. Five out of six people, who are not violent and are no danger to society or themselves, could be locked up to try to find that one other who might be. That is no way to act in a decent, democratic society.
I shall put that figure in context and get it into proportion. Each year there are approximately 700 tragic homicides. Every life is precious and we want to act where we can to reduce that number. Out of that average of 700, however, only about 39 a year can be attributed to people who have been referred to mental health services in the year preceding the offence. Those 39 may have had mental health problems that led to the violence, but we do not know that for certain. Let us weigh that up against the fact that, as reported in the last health profile in June, in my county Shropshire alone there are on average 31 suicides. Almost as many people commit suicide in one small county in Britain as arguably have mental health problems and commit homicide in the whole country. Yet, to try to satisfy those headline writers, all the attention seems to be focused on the draconian action that the Government should take against those individuals.
Likewise, as has been said, the number of prison suicides has risen under this Government from 41 in 1997 to 94 at last year's count. This year, the number will be more than 100. A person is 13 times more likely to commit suicide in prison than in the wider community. Does that not tell us that something is fundamentally wrong, which the Government should address rather than focusing their attention as they have?
The Liberal Democrats would like to ensure that the treatability test is put back into the legislation. We want to ensure that there is a reciprocal principle so that where compulsion is required—sometimes it is—entitlement to appropriate care and access to that care is also guaranteed. There should be the necessary resources for all the additional administration that will no doubt be created and there should be a guarantee and a right for all patients to nominate a person to act on their behalf, including access to trained advocates. In short, we want treatment and care of the mentally ill to be based on optimising patient advocacy and providing the highest quality care for those who need it. The vision should be about people, not about perceived problems. We want more support for families, carers and mental health professionals, who are overworked and under enormous pressure. The Royal College of Psychiatrists has said that another 600 professionals will be needed to cope with the new legislation.
37WH My questions on the Bill for the Minister are as follows. When will the final Bill be published? Have the Government listened to the thousands of voices steadfastly opposed to the current drafting? Will they focus the new mental health Bill on the individual patient rather than on the Home Office's perceived problems? Otherwise, the Liberal Democrats, like the Conservatives, will oppose that legislation.
One final thought: we talk about our concerns at a high level and we are concerned about possible effects, but the Government are not tackling the fundamental problems. A gentleman came into my office three or four weeks ago. He was homeless. He readily accepted that he had mental health problems. He had been released from hospital in Yorkshire and was wandering around the country. He had arrived in Shrewsbury and was trying to find a place for the night. There was a complete lack of understanding; there is no joined-up thinking between services. My office spent two hours on the phone trying to secure a roof over the gentleman's head. There was a lack of understanding—the housing office wanted him to walk a mile and a half to fill in forms so that they could put a roof over his head for that night. They then expected him to walk another half mile or so in order, possibly, to secure some travel money. As he was mentally ill, he refused to travel by train. He would take only buses or coaches, so we had to ensure that we could get him back from my office to the Yorkshire hospital the following day. We did that, but we did not do it by filling out forms. We did not do it by saying, as the services seemed to do, "We expect you to walk all the way across town even though you have broken ribs because you slept rough on the streets. I'm afraid we do not take any great interest in your personal well-being." It was easier for me to pay for a bed and breakfast to take him in for the night than to force the services to work together and to appreciate what it is like to be mentally ill. Such problems can be overcome; nevertheless, a helping hand is required. That is what it is all about.
The Government will say, rightly, that there are more resources and I congratulate them on that and on making it a priority. However, they must ensure that the resources get to the front-line services. They must ensure that they start to deliver for the most vulnerable people in society. At present, they are failing those people.
§ 12.1 pm
§ Tim Loughton (East Worthing and Shoreham)
What the debate has lacked in numbers, it has certainly made up for in quality. I reiterate the congratulations to my hon. Friend the Member for Eddisbury (Mr. O'Brien) on returning to this important subject. He was right to say that the former Minister responded woefully to the debate on 7 May, which made it all the more necessary that we keep the subject at the top of the agenda. My hon. Friend struck exactly the right note with his wide-ranging comments—perhaps not surprisingly, as I noticed during his speech that his comments were written on the back of a music score. The way in which society values and looks after people with mental illness is a touchstone of the strengths of that society.
I agree with the hon. Member for Cheadle (Mrs. Calton) about the big problems around the country with child and adolescent mental health services. There are 38WH big divergences in the level of services provided and early intervention for young people is crucial, because it is a false economy not to get to the root of the problem while an increasing number of young people develop mental illness in those early years.
My hon. Friend the Member for Salisbury (Mr. Key) is absolutely right about coercion. There is a libertarian issue in the proposed legislation. We all agree with his comments about a Cinderella service, although we did not know that he had made such a large personal sacrifice of his internal organs to cement Anglo-American relations in the post-war environment. The details he gave suggest a tonsils-for-tanks approach.
The debate is timely because the Queen's Speech is in a few weeks, and Opposition Members hope that it will include a mental health Bill that reflects all the horror at, and the objections to, the Government's original attempt in draft form 16 months ago. It is also timely to have the debate a few days after world mental health day last Friday, in which I am sure many hon. Members participated.
Part of the Conservatives' intention is to keep mental health high up the agenda, and to raise the profile of a subject that has been far too much hidden away and feared as a taboo. We have held two mental health summits in Westminster and we should be holding a third at the end of the month ahead of the debate on the Queen's Speech. We have been working with the Mental Health Alliance and all its partners to maintain the pressure for the right mental health legislation.
The debate is also timely because, as hon. Members will remember, the extraordinary headline "Bonkers Bruno locked up" appeared in The Sun just three weeks ago. Many of us who saw that headline recoiled in horror at the language used by our most popular tabloid newspaper. Frank Bruno would not have attracted that sort of headline if he had been diagnosed with cancer or had suffered a stroke. Why, therefore, should he be castigated in such disgraceful terms simply because he fell foul of a mental health problem? We must reach the day when people with mental health problems are treated no differently from those who have suffered a stroke or have a condition such as diabetes. Mental illness is just another health problem; it does not make people any less human or less deserving of the help and treatment that is required than if they had a physical ailment.
As my hon. Friend the Member for Eddisbury rightly said, the way we treat people with mental health problems is a test for society. That headline pandered to the "lock 'em up" mentality of certain tabloids, and I fear that the Secretary of State for the Home Department shares that mentality. That is not the answer. We must give the mental health services greater access to funding within the NHS, and further dispel the stigmas that affect one in four people in the UK.
However, that headline did a lot of good, because the readers of The Sun forced the paper to reverse its approach. The following day, it contained an article by Marjorie Wallace, the chief executive of SANE, and the paper has been forced to set up a fund to help people with mental health problems. I welcome that big turnaround in its approach. It could prove to be a 39WH significant turning point in the way in which people regard mental illness. I wish The Sun well in its conversion, if it now promotes a manifesto for greater understanding of mental health by ordinary people in the UK. In targeting Frank Bruno, The Sun picked the wrong target, and I am glad to see that he is fighting back. I am sure that all hon. Members here today wish him well.
It is important to discuss mental health services because, as the hon. Member for Shrewsbury and Atcham (Mr. Marsden) said, we are not merely updating the 1983 Act. Mental health legislation is still based on the legislation of 1958 and 1959, and it is therefore about 45 years since it was fundamentally reviewed. That is why we must get the new legislation right.
The evidence, however, does not give great cause for optimism. YoungMinds, which was mentioned earlier, launched its new website on mental health day. I congratulate that organisation on the great job that it does in providing information to people affected by mental health problems. One million children have some sort of mental health disorder, yet only 27 per cent. of them will receive assistance from specialist health services. Some 45 per cent. of looked-after children between the ages of 15 and 17 have some sort of mental disorder, and that problem needs to be given greater priority.
I also refer to the campaign by the The Independent on Sunday. A recent article by Sophie Goodchild, which was based on research done by the newspaper and by the Conservative health team, focused on the treatment of people from ethnic minorities with mental health problems. The article revealed some starkly worrying figures. For example, Afro-Caribbean men are seven times more likely than white men to be sent to a medium-secure unit, 51 per cent. of patients in the London psychiatric hospitals surveyed were black, compared with their 17 per cent. representation in the population as a whole, and 28 in every 100,000 black men end up in a secure unit compared with four in every 100,000 white males. Women born in India and west Africa have a 40 per cent. higher suicide rate than those born in England, and Caribbean men are 10 times more likely to be diagnosed as schizophrenic.
I therefore ask the Minister how the Government are addressing the problem with real action. Is it true that the Government suppressed a report by Professor Sashi Sashidharan? She is a member of the Government's mental health task force and produced the report "Inside Out", which concluded that mental health services were institutionally racist, that the issue of ethnicity in mental health services has been marginalised or even ignored and that the problems were getting worse. Perhaps the Minister would like to comment on that.
I have mentioned the campaign by Maca concerning people suffering from mental health problems in the workplace and my hon. Friend the Member for Eddisbury has covered that ground. I would also like to mention the survey by the Royal C allege of Psychiatrists concerning funding, which found that on average among mental health trusts there had been a real-terms reduction in budgets of 0.8 per cent. Out of 45 trusts 40WH surveyed, three had experienced a reduction of more than 5 per cent. in their budgets, another three had experienced a reduction of between 2 and 4.9 per cent., and 10 a reduction of just under 1 per cent. Those are alarming figures.
We hear about all this new money but it is not ending up at the sharp end treating people with mental health problems where it is required. We carried out an extensive survey of all mental health trusts throughout the country and found—surprise, surprise—that the new money is being used far too much to pay off inherited debts. We found that 73 per cent. of trusts have not yet employed primary care workers, only 22 per cent. have multi-disciplinary assertive outreach teams, only 17 per cent. have early intervention teams, only about half the trusts with crisis resolution teams have 24-hour cover, 85 per cent. of the trusts that we spoke to said that the provision for child and adolescent mental health services is inadequate and that 70 per cent. do not offer women-only day-care facilities. Those provisions are all required by the Government's mental health strategy. Boxes have been ticked, but at the sharp end the services are not there, the coverage is far too patchy and people are not benefiting from the things that we all agree they need.
I come finally to the draft Mental Health Bill. It is a vital opportunity to update 45-year-old legislation. The draft Bill was published 16 months ago, but more than 2,000 consultation responses have still not been published by the Government. Will the Minister tell us when those consultations will be published, and will she confirm that they will be published in full rather than in some abbreviated form? Will she give us a progress report on whether we are going to see the Bill in the Queen's Speech? Will it be the same as the draft Bill, or will it be a properly amended Bill that takes account of the consultations? Will the Bill be examined by a pre-legislative scrutiny committee? A precedent has perhaps been set by the draft Mental Incapacity Bill, and many of us would welcome such consideration given the legal expertise one would be able to call upon from both Houses to inject some sense into the Bill. Perhaps the Minister will show us that the Government really are listening in relation to this important legislation.
We have serious problems with many aspects of the draft Bill and, most of all, with the elements that involve coercion. There is also the duty to provide general assessment that is not a requirement. The treatability test has already been mentioned, and we want to see process and safeguard measures involving advocates, nominated people and the role of carers. There is the issue of continuity of care such as the right to free treatment for mental health, which was in the 1983 Act and is not mentioned in the draft Bill. Some people require special protection: what are the rights for 16 and 17-year-olds who fall down the gap between child and adult services? How will the legislation relate to the Children Act 1989?
There is also the matter of some of the more severe treatments, such as ECT, psychosurgery and high drug dosages. Prescribing standards are not mentioned in the Bill for those and other intrusive treatments, but will it take account of them? Many questions arise from that draft legislation, and we need to get it absolutely right. It is vital legislation that we have the opportunity to produce only once in a generation. I urge the 41WH Government to introduce a proper Bill. Let us take the coercion out of it. We need a Bill that is all about treating people and helping people with mental health problems—a health Bill—rather than a Bill that is all about locking them up, which would be a law and order Bill. I hope that Minister and her colleagues are listening. If they are not and the Government go ahead with the draft Bill as it was, we will be part of the enormous alliance that wants to kill the Bill and get back on track with real mental health legislation that is about helping people with mental health problems, not just about locking them up and stigmatising them.
§ The Minister of State, Department of Health (Ms Rosie Winterton)
It is a pleasure to serve under your chairmanship, Mr. Deputy Speaker. The debate has been very interesting, and I congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing it. It has highlighted the importance of developing modern mental health services for the one in six people at any one time who suffer from a mental health problem.
I shall try to address as many of the points raised in the debate as possible, as well as some aspects of the draft Mental Health Bill. I hope that hon. Members will understand that I cannot go into too much detail about the Bill at this stage, but I shall certainly try to return to it.
I begin by highlighting the fact that the priority that the Government have given to mental health, putting it up there with cancer and coronary heart disease, has been welcomed by all sections, many of whom felt that mental health had been considered a Cinderella service. There has been under-investment in it for many years. Many hon. Members have talked about targets, planning and priorities. The feedback that I get from those who are working on the front line and in the voluntary sector is that we should continue to give mental health the priority that it has at present, because what has happened has made a real difference.
Before there is too much condemnation of targets and priorities, I urge hon. Members to bear in mind the people who are involved. I join the hon. Member for Eddisbury and others who praised the work that is done in this very important sector, not only by many thousands of NHS staff but by those who work in the voluntary sector and by the many thousands of carers who give our society so much support in very difficult circumstances.
One in six people at any one time suffer from a mental health problem and, as the hon. Member for Eddisbury said, suicide is the most common cause of death among young men. We have tried to address that in the strategy that we published recently in an effort to consider the issue and to see what more can be done. Each year, more than 600,000 people with serious mental ill-health problems receive care from specialist mental health services, and many more look after themselves or rely solely upon their GP.
Let me give some background to the national service framework. It was designed with the input of stakeholders and service users. It identified the need for early intervention and crisis resolution, so that people were not put into a hospital situation but, as far as possible, were treated in the community. To fast 42WH forward delivery of the NSF, £300 million has been made available. It is new investment, over and above the 2001–02 baseline.
There are criticisms about how the funds have been feeding through to front-line services, and the hon. Member for East Worthing and Shoreham (Tim Loughton) talked about that. Hon. Members must bear it in mind that the first year was a planning year that allowed people to get a proper idea of where the money would go and which services needed to be provided at local level. We have absolutely firm evidence that, last year, some £262 million extra was spent. That has resulted in more than 100 crisis resolution teams and more than 200 assertive outreach teams being in place, and in targets for early intervention teams. At the same time, we want to consider whether there are new ways of working in those teams, to break down some of the traditional barriers that have prevented the working together that we need across the professions. The money is getting out there.
We recognise that there are recruitment problems in some areas, but 25 per cent. more psychiatrists and 7 per cent. more nurses are in place. We are considering other issues, including graduate workers, so that we can ensure that the teams operate appropriately.
§ Tim Loughtonrose—
§ Ms Winterton
Let me say this, because it may deal with what the hon. Gentleman wants to say. When we feel that the plans are not adequate, we are working with strategic health authorities to ensure that the money is directed towards the targets and priorities that we have set. Although it is important that local people set up ways of working that suit their areas, we are concerned to ensure that, through the SHAs, there is the right service delivery. We will work with the SHAs on an ongoing basis to ensure that that is the case.
§ Tim Loughton
Will the Minister confirm that, on matters such as crisis outreach teams, the figures that she gave related to a snapshot date, which I believe was 31 March? There are many cases of someone's date of leaving the service being stretched to 1 April and the date for the new person coming into the service being brought forward to 31 March, so that both could be counted in the figures for 31 March, although in reality there was only one person. That is the sort of bogus nonsense on which many of the Minister's figures are based.
§ Ms Winterton
I reject the assumptions behind the hon. Gentleman's remark. The figure for the money being spent is based on the autumn survey. I need to correct myself in one respect, because in fact the number of consultant psychiatrists has increased by more than 20 per cent. since 1997, the number of nurses has increased by more than 25 per cent. and the number of psychologists has increased by more than 50 per cent. However, we are not complacent. It is important that we continue to ensure that the 24-hour service to which the hon. Member for Eddisbury referred is available. I assure him that, when there are areas of concern, we want to ensure that an efficient, effective and high-quality service continues to be available to people.
43WH I shall deal briefly with the draft Mental Health Bill before addressing some of the points that were raised. I cannot today give some of the detail on the Bill for which hon. Members asked, but I can say that I worked throughout the summer with the stakeholder groups to ensure that we have the right Bill and I will continue to do so. I know that there are concerns, but in this area we must have a balance. I think that we all agree that there is an overall need to update the 1983 legislation. We need extra safeguards for the people who are detained. We need to ensure that the legislation is updated to make it compliant with the European convention on human rights. At the same time, with regard to stigma and discrimination, we must recognise that we need a system that reassures people that there are safeguards for the wider public. In my discussions with organisations from the Mental Health Alliance, we are reaching a consensus over some of the principles and we are discussing some of the practicalities of how the legislation will work.
I can give a firm reassurance that it is certainly not our intention to increase the number of people subject to compulsion. The definition of mental disorder coupled with the strict conditions that must be met before compulsory powers can be used will ensure that only people for whom compulsory treatment is necessary receive it. The Bill will not oblige doctors to treat patients nor make people use facilities. The conditions for compulsion include the requirement that appropriate medical treatment must be available for the individual patient concerned. That should reassure hon. Members who have raised that point. I hope that, in discussions with the groups involved, hon. Members will receive feedback that suggests that we are making progress in addressing concerns that have been raised through our examination of how the Bill can be put into practice.
I take on board the comments that have been made on children's and adolescent mental health services. We recently announced an extra £240 million for that. I realise that there is slow progress at the moment but we are looking to improve those services as quickly as we can because of the very real problems presented there.
44WH On stigma, the hon. Member for Eddisbury mentioned pathways to work. He is absolutely right. I am working with the Department for Work and Pensions to see how we can ensure that we give support to people who have been on incapacity benefit for a long time but wish to return to work. We must make sure that we do not write them off as being incapable of doing any more work for the rest of their lives. In many senses, that means, as he said, changing the perceptions of health care workers. Returning to work should be seen as part of getting better and returning to normal life, rather than it being said that being on incapacity benefit is how life is going to be led in the future. It is important to take a cross-Government approach, which is why the social exclusion unit brings together different Departments to examine discrimination against people with mental health problems.
In addition, it is important to get the message over to employers that they need to provide support to people who are in work and suffering from stress problems. Recently I, along with some high-profile people in the private sector such as Lord Stevenson, launched more guidance to employers to ensure that such support can be available. Employers should no longer be frightened of how to cope with someone who says that they are suffering from stress. We need people to come forward and be upfront about their problems, but we also need to ensure that employers have proper strategies in place to deal with them.
The hon. Member for Eddisbury also mentioned losing benefits. There is quite a lot of flexibility in the benefit system at the moment. We are running pilots through pathways to work to look at how we can improve that.
I absolutely agree that there is much more that we can do on the role of community pharmacists, especially in medicines management and respite care, which are very important and must be delivered at local level.
Today's debate has been constructive and has raised many issues, but I hope that I have provided reassurance that we are making progress in the national service framework. Issues still need to be addressed and we are well aware of them, but we are moving to ensure that there is a high-quality service for people with mental health problems and that a mental health Bill will provide greater safeguards to this important group of people while at the same time providing the public with proper security.