All Party Parliamentary Group for Mental Health

Notes of meeting: March 2001

Tuesday 13 March 2001

Speaker: John Hutton MP, Minister of State for Health

Subject: Government White Paper: ‘Reforming the Mental Health Act’

Members Present: Dr Lynne Jones MP (in the Chair), Kelvin Hopkins MP, Doug Naysmith MP, Baroness Whitaker, Earl of Listowel

Observers: Lisa Bird (Mental Health Foundation), Sue Brown (MIND), Simon Denegri (Sainsbury Centre for Mental Health), Philip Dixon-Phillips (UK Federation of Smaller Mental Health Agencies), Dr Roger Freeman (Royal College of Psychiatrists), Gary Hogman (National Schizophrenia Fellowship), Andrew Kennedy (e-mental health), Simon Lawton Smith (Mental After Care Association), Sue Mason (Janssen-Cilag) Catherine Overton (Oxford University Labour Club), Dr Tonmoy Sharma (Institute of Psychiatry), Marjorie Wallace (SANE) and Christopher Walden (Royal College of Psychiatrists).

Mr Hutton opened by saying how he regretted the lack of interest from Members of Parliament in mental health issues. He specifically mentioned how few Parliamentary Questions he was asked about mental health. He added, however, that although mental health may not be a priority in Parliament it was very much a priority for Government.

Mr Hutton said that mental health services had for many years been under-funded and people with mental health problems had drifted in and out of services. The differing levels of care across the country had compounded the problems. Mr Hutton also said that mental health legislation needed updating in order to reflect modern care and treatment which often did not take place in hospital.

On the issue of medication Mr Hutton said the National Institute of Clinical Excellence would be reporting on the use of atypical anti-psychotic drugs for the treatment of schizophrenia. He added that there had been a substantial recent increase in the use of atypical anti-psychotic drugs and he would happy to provide the figures for the Group.

The NHS Plan proposals had highlighted the problem of the shortage of the right type of staff in primary care and proposals had been made to take some of the pressure of GPs. This included the employment of new psychology graduates, which was one of the most popular courses at university. These students would require an extra year of training to prepare them for their work in the NHS.

Mr Hutton said the ‘lion’s share’ of the new investment had gone into primary care. However, if the Government were re-elected it was their intention to make acute in-patient wards a priority after the General Election.

On the issue of the ‘Reforming the Mental Health Act’ Mr Hutton said he realised there were concerns about compulsory treatment but he said there did have to be a framework for treating patients outside a hospital setting. Patient rights had to be balanced with staff and public safety. He said that the Government hoped to bring forward a new Mental Health Bill ‘early in the new Parliament’.

It was not the intention of Government to increase the number of people who would be subject to compulsory treatment and in fact the proposals were aimed to reduce the total – however Mr Hutton said there was little point in compulsory powers ending when the patient left hospital. He did not believe the ‘revolving door’ of mental health care was not humane

Mr Hutton said he thought the proposed Mental Health Tribunals (MHTs) would be a very important new development. The MHTs would have to agree a care and treatment plan for each patient and protect their rights.

Mr Hutton gave some background information regarding the Department of Health’s new campaign to reduce the stigma and discrimination suffered by those with mental health problems. The new campaign would mainly focus on combating discrimination in three areas: among young people; in the media; and among employers.

The Department was particularly going to engage more closely with employers and a reception was being held at Portcullis House the following week to officially launch the campaign with leading corporate figures. Mr Hutton said the Department of Health were well aware of the problems people with mental illness had staying in employment and so were attempting to ascertain what would be the most effective intervention which could be made in the workplace. He added that it was to be a long-haul campaign but the Government was determined to reduce stigma.

Questions

Lynne Jones MP asked if there could be a representative of the National Users Forum on the Mental Health Taskforce. Mr Hutton said that maybe possible at some point in the future and the membership of the Taskforce was due to be reviewed in 2002.

Kelvin Hopkins MP said that he welcomed much of what the Minister said but said more attention did need to be focused on community care and the areas where it was deemed to have let people down. Some people did need extra support when they were in the community and should not left to fend for themselves or often it was the voluntary sector who would help them. Mr Hutton said that for some of those with a mental illness the best place maybe in the community however the system had also failed some people. He added that acute psychiatric wards were not the place for these people to be and he was hoping to increase the support for people across all areas. He would provide details of how many extra staff were in mental health services.

The Earl of Listowel asked Mr Hutton whether there were plans to include discrimination against people with mental illness on the National Curriculum. Mr Hutton felt that this may be an option and could be raised with the Department for Education and Employment and with the ‘Healthy Schools’ initiative overseen by Yvette Cooper MP. 

Dr Tonmoy Sharma (Institute of Psychiatry) asked the Mr Hutton how the Department of Health’s new anti-stigma campaign (Mind-Out) would work alongside campaigns that were already in progress. Dr Sharma felt that it was important that work was not needlessly replicated. Mr Hutton said that Mind-Out would be working with other organisations and he hoped that this would be successful.

Gary Hogman (National Schizophrenia Fellowship) said that the NSF were involved in the Department’s campaign and had been working with Forster, the public affairs company that were organising the campaign. He echoed Mr Hutton’s remarks about the importance of working together. Mr Hutton said that Forster had been picked to help with the campaign because they were completely new to the issue of mental health and therefore had a fresh outlook and was pleased with progress so far.

Baroness Whitaker asked about a proposal in the White Paper: ‘Reforming the Mental Health Act’ which would give doctors a statutory duty to share information about their patients with other agencies, including criminal justice agencies. There was a fear that patients would not tell their doctors in those circumstances.  Mr Hutton answered this point by saying that inquiries into homicides committed by those with a mental illness have shown time and time again that the major problem had been a lack of communication between relevant agencies. The proposal in the White Paper would only affect those who had been compulsorily detained for care and treatment. Mr Hutton added that there was a need to overcome the concerns from medical professionals about the sharing of information and he hoped to be able to assure clinicians and patients.

Prof. Nick Bosanquet (Inner Cities Mental Health Group) asked for clarification on the role of Primary Care Trusts (PCT) and whether the Government were planning special measures to help those with a mental health problem find suitable housing. Mr Hutton said that at least one PCT would be running mental health services from 1 April 2001 and that was in his constituency. He did not rule out PCTs running mental health services in many other areas, particularly largely rural areas, but in the foreseeable future they would remain where they were. Mr Hutton said that the Department of Health was working with the Department for the Environment, Transport and the Regions on new guidance for housing and housing benefit and it was expected to be published later in 2001.

Mr Hutton spoke about the particular problems of dual diagnosis. This was one of the most complicated and difficult areas in mental health and to combat it new money and extra support for drug teams and drug and alcohol teams had been announced in the recent Budget. The exact details were yet to be finalised.

Margaret Edwards (SANE) stressed the need for many new acute psychiatric beds. Mr Hutton said that announcements had been made about this issue and that a significant amount of extra capital money had been spent in this area.

Dr Roger Freeman (Royal College of Psychiatrists) said he was pleased to hear that the obligation to pass on information about patients would apply only to those being compulsorily treated. However in relation to the proposals in the White Paper on ‘dangerous severe personality disorder’ he remained concerned that they would divert much needed funds from areas of greatest need. Mr Hutton said this would not be the case. The Government were attempting to develop a greater knowledge of severe personality disorder but there would be parallel investment in health and prison services. He was very clear that the detention of those with DSPD who had not been convicted of a crime would be health-based. £125 million had been put aside for care and treatment of those with personality disorder.

Sue Brown (MIND) raised her concern that the Mental Health Tribunals would not give a high enough priority to the patients’ best interests. Mr Hutton agreed that there was a need for any future mental health bill to be clearer about what best interests would mean in practice. He stressed however that the Government did not want to see an increase in the numbers subject to compulsory treatment. Those present did not dispute this but there were concerns that an increase would result from the proposals if implemented.

Mr Hutton said he realised there were concerns about the capacity test and the definition of mental disorder. He did not think the capacity test would be workable and respondents to the consultation for the Green Paper had been split on whether it should be included in a new mental health bill. The criteria would be widened however to cover those affected by the ‘Bournewood’ judgement (there were estimated to be 45,000 people whom this would cover in the NHS).

Dr Freeman asked about the Adults with Incapacity (Scotland) Act 2000 and whether the English Department of Health had considered introducing similar legislation south of the border. Mr Hutton said that the situations in England and Scotland varied widely. He said the Millan Committee had produced a very interesting report on the reform of the Mental Health (Scotland) Act 1984 and the Department of Health would be keeping a close eye on how that progressed.

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