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Dr. Liam Fox (Woodspring): I thank the Secretary of State for his statement and for his courtesy in making a copy available an hour before he delivered it--that was extremely helpful to the Opposition.
It is not surprising that all parties will agree with a great deal in the statement. Perhaps the most important aspect is the need to reduce the stigma that is attached to mental illness and encourage a new culture that is far more understanding of the problems for affected individuals and their families.
I welcome the move to more care in the most appropriate setting, which must lead to better clinical outcomes. I welcome the move towards compulsion in community settings, which brings the law more into line with current practice. I also welcome the establishment of the tribunals and the commission, which will create a better balance in the system.
Although there is a place for compulsion, it would be unfortunate if it dominated our debate about mental illness and our discussion was perceived to apply only to a small number of people when many other more pastoral issues need to be addressed.
The Secretary of State's rhetoric is not matched by the Government's priorities. He spoke of the desperate need for reform and said that that was a key priority. Yet the Queen's Speech could have provided for legislation on the subject--the Opposition would have supported that. If the public are at such risk, they might want to ask the Government why they make time available for banning fox hunting or considering the plant varieties legislation, but not for much-needed mental health legislation.
There are a number of specific matters on which I would like the Secretary of State to explain the Government's thinking. The first is severe personality disorder. What is the Government's estimate of the number of people who fall into that category, both inside and outside the criminal justice system? Will the right hon. Gentleman give a guarantee to the House that those patients will not find their way on to already overstretched acute psychiatric wards? He rightly referred to vulnerability. Patients who are recovering from severe depression or are tackling schizophrenia find things difficult enough without the disruption caused by potentially dangerous patients on the same ward. We must be given an absolute guarantee that such disruption will not occur.
I was confused by one of the right hon. Gentleman's remarks. He said that, in place of the flawed concept of treatability, new criteria would separate those who need treatment for different reasons. However, the whole point about personality disorder is that it cannot be treated. The right hon. Gentlaman then said that the use of compulsory powers would be linked to a care and treatment plan. What treatment? The assumption seems to be that a large number of personality disorders are based on an underlying condition that can be treated, but, as the right hon. Gentleman knows, that will apply only to a small group of people. Was he speaking about treatment or management? The terms must be clearly delineated.
I have three specific points for the right hon. Gentleman. He spoke about the single point of entry to compulsory treatment. Does that mean reducing the number of sectioning mechanisms that currently exist, and that the single entry point, as he put it, would consist of sectioning with the signatures of two doctors and a psychiatrically qualified social worker? If that is the case, flexibility will be dramatically reduced, which would be a problem in many rural areas. I hope that he will take that practical point into account when he deals with the matter in more detail.
How will the proposals specifically address the Bournewood judgment, which relates to patients who lack the capacity to give consent? I was sorry that when the right hon. Gentleman spoke about the much-needed balance for victims of mentally disordered offenders, he did not say anything about mentally disordered offenders themselves. I am sure that hon. Members on both sides of the House feel strongly about the fact that people under the care of the Prison Service who suffer from mental illness are less likely to be diagnosed and treated, and are consequently at far higher risk of suicide.
The Opposition will support the Secretary of State if, when he puts legislation before the House, he proposes to dismantle the prison health service and bring it into the national health service. That would give to mentally ill offenders the same access to care and quality of care that is enjoyed by everybody else. If we want to provide the appropriate treatment for individuals in the appropriate setting, it would make sense to introduce a far more seamless change in the way in which such patients are dealt with.
There is a great deal with which the Opposition agree, some things that we do not believe have been adequately explained, and areas that we would like to explore. The proposals are a start and we will support the Government where we think that they are sensible, but we would like to see far more detail and want the Secretary of State to consider some areas that he does not seem to have considered so far.
Mr. Milburn: I am grateful to the hon. Gentleman for his overall welcome for our proposals. There is clear agreement on the first three points that he made. First, those of us who care about the national health service and about the needs of people with mental illness must do all that we can to reduce stigma. My Department is making efforts to do that, alongside other Departments. I know that the matter has been the subject of genuine concern among hon. Members from all parties and especially those who serve on the Select Committee on Health. We need to up our efforts.
Secondly, we must ensure that patients are cared for in the most appropriate setting. My view is that we must ensure that people with serious mental illness are provided with care in the least restrictive environment that is consistent with their needs and safety, as well as the safety of the wider community and the public. Thirdly, although tomorrow's newspapers will inevitably be full of headlines about the proposals for dangerous people with severe personality disorders--or SPD--the hon. Gentleman was right to say that the White Paper extends much more widely. Indeed, we published it in two parts to try to make it clear that a legal framework exists, that it should apply to all patients, and that specific measures
It is difficult to estimate of the number of dangerous people with a severe personality disorder. We are breaking new ground in trying to estimate the numbers and in trying to provide new services for the people concerned. Our best estimate is that there are about 2,200 such people in the community and in the prison population, although largely in the prison population.
On the subject of overcrowded wards and the pressures that are placed on staff, there are, undoubtedly, real pressures on psychiatrists, nurses, social workers and others. Investment is going in to the hospitals and to the community services to help ease those pressures. Arguably, that investment should have gone in many years, or even many decades, ago. We are talking about providing a whole range of new, specialist services for dangerous people with a severe personality disorder, on top of the mainstream mental health services that we are already expanding and reforming.
The hon. Gentleman referred to the inability to treat those with a severe personality disorder. However, there are real differences of clinical opinion on that. Some clinicians say that such people are impossible to treat; others say that they can be treated. We take the view that current legislation provides a lottery, because some dangerous people with a severe personality disorder get treatment and services and others do not. The people who do not are a risk not only to the wider community--and, especially to their families, who inevitably bear the brunt when things go wrong--but to themselves. If it is good enough to provide specialist mental health services for one person in this group, it should be good enough to provide them for all.
Countries such as Holland and Germany have had some success in piloting new therapeutic interventions to manage the behaviours that arise from these mental disorders. We are undertaking further piloting, both in Whitemoor prison and in Rampton, to roll out the appropriate model of care.
The hon. Gentleman was right to raise the Bournewood judgment, which is important for those with a long-term mental incapacity, including those with learning disabilities. The White Paper provides new safeguards--particularly for that group of patients--partly as a response to the Bournewood judgment. That group of patients will be brought under the umbrella of the new Commission for Mental Health. I hope that that will help to deal with some of the concerns that have been expressed on the issue.
I agree that prison mental health services need improvement. My right hon. Friend the Home Secretary and I are working closely to ensure far closer integration between mental health services provided in the national health service and those provided in the Prison Service.
My final point is about the time that it takes to make the changes. The hon. Member for Woodspring (Dr. Fox) was a Minister in the previous Government, who were in power for 18 years. They had the opportunity to put right the deficiencies in the law and in services, but they failed to do so. This Government are getting on with the job, modernising the services and putting in the investment. It would be good to hear from the hon. Gentleman that he supports the investment being made, and that his party would match it.