Some of my previous policy work from 2002/2001/2000 is detailed below:
-On 25 June 2002 the Government published a draft Mental Health Bill and there was an opposition day debate in Parliament. My contributions to the debate are posted below.
-Click here for Early Day Motions:
EDM 1432 THE ZITO TRUST AND A WORLD CLASS MENTAL HEALTH SERVICE 12 June '02
EDM 1345 BENEFITS FOR PATIENTS RECEIVING LONG TERM IN-PATIENT CARE 20 May '02
-Response to the Government's statement on the Mental Health white paper - December 2001
-Article for Mental Health Today - December 2001
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Opposition Day Debate on draft Mental Health Bill
Intervention:
Lynne Jones (Birmingham, Selly Oak): Will my right hon. Friend acknowledge that Government policy will have failed if the use of compulsion does not decrease in future?
Mr. Milburn: That is what we want. We must try and are trying to undertake two parallel processes. The first is to deal with the loopholes in the law that, admittedly, only ever affect a small minority of people and a small minority of patients, although with huge and sometimes tragic consequences. However, our effort overall must be to develop services that are capable, in an appropriate way, of dealing with people's problems without compulsion. That is why we are trying to build up services in hospitals as well as crisis intervention teams in the community, assertive out-reach teams and some of the new services that are being made available for young people with the first onset of psychosis.
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Normally such young people, who are among the most vulnerable in the community, are simply not dealt with at all. They often have to wait years to be seen. However, we now know that the model that is being rolled out in 18 local communities across the country works. It can provide quick, interventional services and makes a real difference to those people. It prevents them from ever requiring hospitalisation.
As I tried to make clear earlier, the trick is to get the range of services right. Although the national service framework and the NHS plan are, by necessity, 10-year programmes—we must build up capacity and change the culture of the service—progress is under way. Last year was the first year in perhaps decades in which the overall number of mental health beds in the national health service rose rather than fell. There are more than 500 extra secure beds and 320 extra 24-hour staff beds. Such services were never available in the past, but more of them are to come.
Clearly, everything cannot be done at once, because of staffing and capacity constraints. None the less, a range of services that gets early intervention into place and ensures that appropriate services for those who need them are available in primary and hospital care is in place across the country as a whole.
Speech:
Lynne Jones (Birmingham, Selly Oak): Today's debate has been interesting and enlightening. I agree with many of the comments made by previous speakers, and congratulate the Conservative party on making mental health the subject of this Opposition day debate.
There is much consensus between Government and Opposition on this issue. It was, after all, a Conservative Secretary of State for Health who coined the term "spectrum of services", acknowledging that there had been a failure to put adequate services in place in the community. It is sad that the hon. Member for Woodspring (Dr. Fox) did not acknowledge the failures of the Conservative Government. I agree with much of the Opposition's motion, but I am sad about its failure to acknowledge the positive progress that the Government have made. They have made the vision of the spectrum of services a reality by increasing the number of assertive outreach teams, improving talking treatments and psychology services and investing in the physical infrastructure in our acute wards.
There will be considerable investment in new mental health services in Birmingham. An acute hospital that is not very old is to go. It was provided in the late 1980s, and when I went there, I was appalled at the lack of therapeutic atmosphere in the building. It was a very constrained building that had obviously been subject to a great deal of cost cutting. At last we will get new services; many will be for in-patients, provided locally rather than at the main hospital base. The Government are making that investment. The Conservatives are right to say that we have a long way to go, but it is churlish not to acknowledge that great progress is being made.
I have not yet had an opportunity to look at the draft Bill, but I welcome its publication. I agree with the hon. Member for Gosport (Mr. Viggers) that it should be subject to Special Standing Committee procedure. It is now nearly 20 years since the last major piece of mental health legislation. The draft Bill represents the opportunity of a lifetime, and we must ensure that we get it right. We must ensure that we balance the emphasis on public protection—which I think is over-emphasised—with people's right to receive appropriate care. That right is not in place at present. Every time we use compulsion it is an indication less of failing in the individual than of failing in the services provided for people in need.
The Government are initiating a 10-year programme to build up capacity. Goodness knows, more money is needed, and we must be vigilant in ensuring that money allocated for mental health services is not diverted to deal with other pressures. However, no matter how much money we put into services, it is also essential that we have enough staff with the necessary skills.
We do not have enough staff at the moment. The Sainsbury Centre for Mental Health has pointed out that in the existing establishment, one in eight positions is
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vacant. If the ambitions of the Government, expressed in the national service framework and other plans, are to be realised, we shall need an additional 8,000 staff—a 12 per cent. increase.
Psychiatry is a Cinderella service in more ways than one. It is not attractive to newly qualified graduates, and we need to ensure that it becomes more attractive. One reason why people shy away from mental health services is the culture of blame in our society, which creates problems in many services, including social work. Because of the stresses and strains on a service, things go wrong—and it is too easy to blame individual clinicians or social workers for their mistakes. That is not to deny that bad mistakes are sometimes made, or that there is some culpability. In many cases, however, people are working against the odds and we should acknowledge that.
We must deal with the blame culture, and we should move away from too much emphasis on public protection. The only time there is any great publicity or press interest is when a tragic event, especially homicide, occurs. In that context, it is commendable that the Opposition have initiated a debate on mental health when that type of public interest is not current. It is also commendable that they have adopted mental health as one of their priorities; it is already a priority for the Government, so there is much consensus, on the basis of which we can move forward.
At the last meeting of the all-party mental health group, we discussed mental health appeal tribunals. We heard about patients who had to wait more than 20 weeks for their case to be reviewed by a tribunal. The Royal College of Psychiatrists has pointed out that the process is extremely staff-intensive. A mental health appeal tribunal chair told the all-party group about the constraints on the tribunal service, including the shortage of psychiatrists to serve on the panels and the fact that the psychiatrists who have to provide reports for the tribunal are over-stretched.
The White Paper proposed automatic referral to a mental health tribunal after 28 days of compulsory treatment; my right hon. Friend the Secretary of State suggested that the Bill would include such a provision. There is concern, however, that even more psychiatric time will be taken up in dealing with the process, so there is a danger that there will be even more delays in the system. The Government need to consider that point.
Although there is consensus among us, omitted from many contributions to the debate was the need to make the experiences of users of the service central to its provision. We should have respect for them and involve them in decisions about their care. A survey carried out by the National Schizophrenia Fellowship showed that a quarter of mental health service users did not even have the opportunity to discuss their medication, while 62 per cent. said that there was no discussion of any possible alternative.
I am pleased to acknowledge the report produced recently by NICE, which made it clear that the choice of anti-psychotic drugs should be made jointly by the patient and the clinician. The report also noted that the use of atypicals should be a primary consideration, and there should be an end to postcode prescribing of such drugs. Compliance with medication is an important issue, and the use of the more modern drugs must be more
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widespread. Those drugs are not new; they came out 10 years ago, and it is one of the great failures of our service that they were not taken up.
Advance directives should have higher status; they should be given statutory recognition. If treatment is to be compulsory, the people who make such decisions should take into account the wishes of patients, who should have had the opportunity to express those wishes when they had the capacity to do so. Consideration of such wishes should be a statutory obligation, and patients should be encouraged to carry crisis cards.
The social security system is important to the well-being of mental health service users. I urge Ministers in the Department of Health to ensure that they have input to the development of services by the Department for Work and Pensions. Compulsion causes great stress to people who are already suffering from mental ill health. I draw the attention of the House to early-day motion 1345, which notes the poor availability of benefits to long-term patients, who receive only about £15 a week. The chief executive of the mental health trust in my area has pointed out that she has to use valuable trust resources to subsidise patients who cannot afford such basic needs as haircuts and shoes.
Carers are important. Too often, confidentiality is given as an excuse for excluding them. Obviously, if a service user expressly wishes to exclude relatives, that wish should be respected—although questioned. However, family members are too often excluded by default, because clinicians and service providers do not discuss the needs of the whole family with the service user. We must give greater priority to the involvement of carers. People who suffer from mental ill health, as well as those who suffer from personality disorders—the distinction is sometimes blurred—have often experienced trauma in their lives, and family members can help to provide support and enlightenment.
We need joined-up services. We need good services that take into account the fact that many mentally ill people also suffer from alcohol or drug abuse. Too often, services are either not provided at all or are provided separately, without appropriate links.
More and more health and social services are being provided through partnership arrangements. However, that means that when people want to complain about a service, there is no single point of reference. The local government ombudsman deals with complaints about social services, while the health service ombudsman deals with complaints about the health service. Will the Government consider appointing an ombudsman specifically for mental health service users and their carers?
Much has been said about stigma. We will not be able to give priority to mental health services until we deal with the stigma. The hon. Member for Woodspring began by saying that in mental health we accepted services that would not be acceptable in any other aspect of health services, and he is right. Too often, people are afraid to speak out about their experiences; they hide their feelings under the carpet.
One day, the shame attached to visiting a psychiatrist will be no greater than the feelings that people have when they visit any other medical practitioner. People will seek help when they need it. They will be able to talk about their experiences. Indeed, they will be proud of their
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ability to do overcome all the problems associated with mental ill health in our society. Their family members will not suffer the stigma of having someone with a mental illness in their families. The Government are putting in place the policies to achieve that, and we all have a role to play in ensuring that the day when people can talk about their experiences comes sooner rather than later.
In May and June 2002 I tabled the following Early Day Motions on Mental Health issues:
EDM 1432 THE ZITO TRUST AND A WORLD CLASS MENTAL HEALTH SERVICE 12 June '02
That this House notes the parliamentary launch on 13th June of The Zito Trust report entitled, Looking Forward To A World Class Mental Health Service; welcomes the fact that this report follows the recent National Institute for Clinical Excellence guidance which recommends the first-line use of the modern atypical antipsychotics for people with schizophrenia; recognises that the report highlights the current postcode prescribing that NICE was in part established to address; and calls on the Government to ensure that sufficient funds get through to healthcare professions to ensure that this landmark guidance is implemented in a timely manner.
EDM 1345 BENEFITS FOR PATIENTS RECEIVING LONG TERM IN-PATIENT CARE 20 May '02
That this House notes that long-stay patients receiving free in-patient care, including large numbers of people suffering from mental ill health, receive only £15.10 per week state benefit; also notes the comments of the Chief Executive of South Birmingham Mental Health NHS Trust that the trust is regularly having to supplement this allowance from care budgets to ensure that people's basic needs for clothing, toiletries, haircuts and other personal items are met, causing a drain on NHS resources; further notes that this grossly inadequate personal income is depriving patients of the means to develop greater independence and compromises severely their social inclusion and integration into the ordinary life of the community; welcomes the campaigning work on this issue by Derbyshire Patients' Council; and calls on the Government to raise the amount of benefit that long-stay patients receive to at least £30.00 per week.
Response to the Goverment's statement on the Mental Health White Paper Dec 2001
In response to the Government's statement on the Mental Health White Paper, Reforming the Mental Health Act I wrote to Alan Milburn, Secretary of State at the Department of Health, in my capacity as co-chair of the All Party Group on Mental Health (copy of my letter posted below).
I have also tabled Early Day Motion 128 condemning the stereotypes of people with mental illness portrayed in the film 'Me Myself and Irene'
Letter to Alan Milburn on the Government's Statement of 20 December
Alan Milburn MP
Secretary of State
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS
Date: 21 December 2000
Dear Alan,
Mental Health Statement 20 December
I am writing about your reply to the point I made during the statement. Whilst I am totally in agreement with your response, it did actually not address the point I was making which was about the importance of people with symptoms of mental illness referring themselves for help as quickly as possible. The stigma associated with mental illness and the fear of compulsory treatment contribute to the delays in people seeking help.
The White Paper does make the point that good quality care and treatment is the key to making sure that most people with mental health problems will never need to fall within the scope of mental health legislation. I was hoping that my question would have given you the opportunity to reinforce that point and also acknowledge the danger that the extension of compulsory treatment into community settings might possibly increase the reluctance to self referral.
I am sure that you would agree that the possibility of compulsory treatment in the community should not be allowed to reduce responsiveness to a mentally ill person’s or their carer’s request for care. Many mental health organisations fear that this could be an unintentional effect. There is also a need to acknowledge that compulsory drug therapy could involve the use of drugs with greater side effects, particularly depot injections and this could inhibit future compliance once the period of compulsion is at an end.
I hope these comments are helpful. I am very pleased with the progress that is being made in improving mental health services but I am sure you will agree that we still have a long way to go.
Yours sincerely,
LYNNE JONES MP
Article for Mental Health Today - December 2001
Every family in the land is touched in some way by mental illness and yet the overwhelming public perception is that mentally ill people are dangerous and their problems self-inflicted. The only logical interpretation of this inconsistency is that people bottle up their own experiences, whether as a sufferer or as a relative or carer, because of the stigma that continues to be associated with mental illness. Thus is the low priority given to mental illness perpetuated.
We must break out of this cycle. Any reform in legislation must put at its heart the need to treat people with respect. It is clear, from the increased use of existing compulsory powers, that the cries for help of so many sufferers or those close to them are ignored until a person’s condition deteriorates to the extent that compulsory treatment is required. Those subject to compulsion should be seen as victims of inadequate services rather than treated as convicts. Respect requires that service users should have a say in their treatment. Advance treatment directives should be given statutory status.
We must end the use of ‘confidentiality’ as the excuse for preventing relatives and carers from being involved. Service users should be encouraged to include their close family in discussions about their treatment, which should not just be about doling out medication. Mentally ill people and, indeed, people suffering from ‘personality disorder’ (the difference is usually artificial), have often experienced some trauma in their lives, which needs to be understood. Except in exceptional circumstances, family members are vital to this process and their continued support must be nurtured. Only if a patient specifically wants to maintain confidentiality, should next of kin be excluded. Measures need to be introduced to positively review such exclusion.
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