Mental Illness Services (Hansard, 7 December 1971)

§ Sir K. Joseph

My right hon. and learned Friend the Secretary of State for Wales and I are today issuing to hospital and local authorities and to general practitioners a Memorandum on Hospital Services for the Mentally Ill which sets out the main elements of a local district service and foreshadows the eventual replacement of the large isolated mental hospitals. The memorandum envisages a comprehensive hospital and community service based on psychiatric departments in general hospitals.

It has for some time been generally accepted that patients who are mentally ill can be treated in hospital on much the same footing as those who are physically ill; and in many areas long-term custodial care has given place to a pattern of treatment in which the time spent as an inpatient is but one episode in a course of treatment most if which is carried out while the patient lives and works in the community. This pattern of treatment is made possible by services based on 280W psychiatric departments in general hospitals with day patient and out-patient services playing just as important a part as the in-patient services. Close links with general practitioner services and local authority health and personal social services are essential; all need to work together to provide a properly integrated service. The whole concept is that of a professional team approach in which all the members work together as flexibly as possible. Complementary planning of hospital and local authority services is vital. The voluntary services can make a significant contribution.

The expectation is that general hospital psychiatric departments, given a proper combination of in-patient, day patient and out-patient services and fully developed links with corresponding community services will eventualy be able to provide all the hospital services needed for the treatment of mental illness, including the small proportion of patients who will require relatively longer-stay. It is important to avoid transferring such patients to the mental hospitals and so building up a separate service. The memorandum stresses that before a patient's discharge appropriate arrangements should be made as necessary for his continued treatment as a day or outpatient; and for his living and work conditions to be reviewed to ensure that the situation to which he is discharged is acceptable. As each general hospital psychiatric department is set up the professional teams responsible for the service in the district will transfer their base from the mental hospital to the general hospital where all new patients will be treated, the teams retaining responsibility at the mental hospital for existing patients so long as they remain there. The setting up of services in all areas on the lines described in the memorandum is intended to lead in time to the replacement of the large isolated mental hospitals. In the meantime it will be important to take advantage of the steady decline in numbers of patients in these hospitals to raise the standards in them. This is one of the objectives I had in mind for the extra money which I announced on 22nd November.

We are encouraging regional hospital boards to develop services in this way as rapidly as their building programmes 281W permit and to consult local authorities and local medical committees about co-ordinating hospital plans with plans of the corresponding local authority services, for which extra resources are also being made available.

Clearly the transition to a fully modern service will take many years to accomplish. Although this new type of service needs fewer hospital beds, it needs just as many nursing staff and so far as possible staff will transfer to the new departments as and when these replace the services in and present mental hospitals. The memorandum emphasises the need in each case to explain fully to staff at the outset the objectives, phasing and timing of the programme of transition.

The memorandum does not deal with services for elderly patients suffering from mental deterioration due to ageing or physical illness. Additional services are needed for them and separate guidance will be issued on this.