§ Mr. Alfred MorrisTo ask the Secretary of State for Health (1) what representations she has received concerning registration of people with a mental illness under section 29 of the National Assistance Act 1948; and if she will make a statement;
(2) what guidance she has given as to the circumstances in which a local authority may exercise discretion as to whether to register any people with a mental illness under section 29 of the National Assistance Act 1948; and if she will make a statement;
(3) what guidance she has given to local authorities concerning registration of people with a mental illness under section 29 of the National Assistance Act 1948; and if she will make a statement.
§ Mr. YeoOne letter has been received from the right hon. Member on 19 February 1992.
Guidance is contained in local authority circular LAC 13/74, which also sets out my right hon. Friend the Secretary of State's approvals and directions under section 29 of the National Assistance Act 1948, and local authority circular LAC 17/74.
Under my right hon. Friend the Secretary of State's directions contained in LAC 13/74, those who are mentally disordered (the expression used by the Act, which includes those who are mentally ill), should be registered under section 29 and local authorities need to provide for their registration.
LAC 17/74 recognised that the registration of mentally disordered persons had not been widely practised, nor had it been encouraged by the Department, and reminded local authorities that the Department's views on registration of mentally disordered persons remained unchanged. Copies of the circulars are available in the Library.
In practice, neither the Department nor local authorities have considered it appropriate to register all people with a mental illness, as the majority do not meet the criteria laid down in the circular of substantial and permanent handicap. Decisions about the provision and management of personal social services for mentally ill people, including the assessment of care needs, are the responsibilities of local authority social services departments.
Mentally ill people are entitled to aftercare help under the care programme approach introduced from April 1991.
This required all district health authorities, in collaboration with local social services departments, to initiate explicit individually tailored care programmes for all in-patients about to be discharged from mental illness 148W hospitals and all new patients accepted by the specialist psychiatric services. The essence of the approach is that the needs of each patient, both for continuing health and social care and for accommodation, are systematically assessed and appropriate arrangements made. These include the identification of a key worker to keep in close touch with the patient and to monitor that the agreed package of health and social care is delivered.
Mentally ill people will also be eligible for assessment of their needs by local authorities under the NHS and Community Care Act 1990. Local authorities also have a duty to provide after care services to persons detained under the Mental Health Act 1983 (section 117).